Managing side effects of radiation therapy

Fatigue is feeling very tired and lacking energy for day-to-day activities. It is the most common side effect of radiation therapy to any area of the body. During treatment, your body uses a lot of energy dealing with the effects of radiation on normal cells. Fatigue can also be caused by travelling to daily treatment sessions and other appointments.

Fatigue usually builds up slowly during treatment, particularly towards the end, and may last for some weeks or months after treatment finishes. Many people find that they cannot do as much as they normally would, but others are able to continue their usual activities.

Depending on the part of the body treated, the number of treatments and the radiation dose, EBRT may make skin in the treatment area dry, itchy and flaky. Your skin may change in colour (look red, sunburnt or tanned) and may feel painful if it peels. Skin changes often start 10–14 days after the first treatment. They often get worse during treatment, before improving in the weeks after treatment.

You may need dressings and creams to help the area heal, avoid infection and make you more comfortable. Pain medicine can help if the skin is very sore. Your treatment team will check your skin regularly. Let them know about skin changes, such as cracks or blisters, moist areas, rashes, infections, swelling or peeling.

If you have hair in the area being treated, you may lose some or all of it during or just after radiation therapy. The hair will usually grow back a few months after treatment has finished, but it may be thinner or have a different texture. Hair loss may be permanent with higher doses of radiation therapy.

Hair will only fall out in the treatment area. Talk with your doctor before treatment starts about what hair loss to expect.

At first, I couldn’t think about eating without thinking about throwing up. Drinking ginger beer helped control the nausea

Simon

Radiation therapy is often used to treat cancers in the mouth, throat, neck or upper chest region. Depending on the area treated, radiation therapy may affect your mouth and teeth. This can make eating and swallowing difficult, and change your sense of taste.

If you have radiation to the pelvic area, the radiation therapists may advise you to drink fluids before each treatment. This will expand your bladder and push the bowel away from the radiation.

Even with precautions, radiation therapy can irritate the lining of the bowel or stomach and affect the way the bowel works. These changes are usually temporary, but for some people they are permanent and can have a major impact on quality of life. It is important to talk to your treatment team if you are finding bowel issues difficult to manage.

Radiation therapy to the abdomen or pelvic area can irritate the bladder or, more often, the urethra (the tube that carries urine from the bladder to the outside of the body).

When lymph fluid builds up in the tissues under the skin, it can cause swelling (oedema). This is known as lymphoedema. It can happen if lymph nodes have been removed during surgery or damaged by the cancer, infection, injury or radiation therapy. Lymphoedema usually occurs in an arm or leg, but can also affect other parts of the body. The main signs of lymphoedema include swelling, aching or a feeling of tightness, which may come and go.

People who have had surgery followed by radiation therapy are more at risk. Lymphoedema or swelling is sometimes just a temporary effect of radiation therapy, but it can be ongoing. It can also be a late effect, appearing months or even years after treatment.

You may notice a lack of interest in sex or a loss of desire (libido), or you may feel too tired or unwell to want to be intimate. You may feel less sexually attractive because of changes to your body. All of these feelings are quite common. Although it is usually safe to have sexual intercourse after radiation, it may be uncomfortable, depending on where the radiation therapy is given. Talk to your doctor about ways to manage any side effects that change your sex life.

A woman’s eggs (ova) and a man’s sperm can be affected by very small amounts of radiation when having radiation therapy to any part of the body. Depending on the type of radiation therapy you have, your doctor may talk to you about using a barrier method of contraception (such as a condom or female condom). If pregnancy is possible, your doctor will advise you to avoid pregnancy by using contraception during radiation therapy and for at least 6 months after you have finished treatment. Talk to your doctor as soon as possible if pregnancy occurs.

The risk of infertility (difficulty getting pregnant or conceiving a child) will depend on the area treated, the dose of radiation and the number of treatment sessions. If you are treated with both radiation therapy and chemotherapy (chemoradiation), the risk of permanent infertility is higher.

Radiation therapy to the pelvic area, abdomen and sexual organs can affect your fertility, and this can be temporary or permanent. Radiation therapy to the brain can damage the pituitary gland, which controls the hormones the body needs to produce eggs or sperm.

If infertility is a potential side effect, your radiation oncologist will discuss it with you before treatment starts. Let them know if you think you may want to have children in the future. Ask what can be done to reduce the chance of problems and whether you should see a fertility specialist beforehand.

Sometimes, however, it is not possible to properly treat the cancer and maintain fertility. Many people feel a sense of loss when they learn they may no longer be able to have children. If you have a partner, talk to them about your feelings. Talking to a counsellor may also help.

For more information, see also Sex, intimacy and cancer and Fertility and cancer.

• Radiation therapy to the vulva or vagina may cause inflammation, making intercourse painful. This usually improves in the weeks after treatment ends. Your treatment team will recommend creams and pain relief to use until the skin heals.
• Talk to your doctor about using vaginal moisturisers, which may help with discomfort. In some cases, oestrogen creams are prescribed.
• The vagina may become shorter and narrower (vaginal stenosis), making intercourse difficult or painful. Having regular intercourse or using vaginal dilators after treatment ends can help keep the vagina open. Wait until any soreness or inflammation has settled before you start using a dilator or having sex. This is usually 2–6 weeks after your last session of radiation therapy. Using a dilator can be challenging. Your doctor, nurse or a physiotherapist can provide instructions.
• If sexual penetration is painful or difficult, explore other ways to orgasm or climax.

• Radiation therapy to the pelvic area or abdomen usually stops the ovaries producing female hormones, which leads to menopause.
• Your periods will stop and you may have menopausal symptoms. These may include hot flushes, dry skin, vaginal dryness, mood swings, trouble sleeping (insomnia) and tiredness.
• If vaginal dryness is a problem, take more time before and during sex to become aroused. Using lubrication may also make intercourse more comfortable.
• Discuss changes to your libido with your partner so they understand how you’re feeling.
• Ask your GP to arrange a bone density test to check for osteoporosis or osteopenia, which can develop after menopause.
• Talk to your doctor about ways to manage the symptoms of menopause. If you need support resuming sexual activity, ask your doctor for a referral to a sex therapist or psychologist.

• Radiation therapy to the pelvic area or near the testicles may temporarily affect how much sperm you make. You may notice that you feel the sensation of orgasm but ejaculate little or no semen. This is known as dry orgasm. It may be temporary or permanent.
• Depending on the dose and the area of the pelvis treated, you may have trouble getting and keeping an erection firm enough for intercourse. This is called erectile dysfunction or impotence. Sometimes impotence may be permanent.
• In some cases, you may experience pain when ejaculating. The pain usually eases over a few months but may be permanent.
• Talk to your treatment team if erection problems are ongoing and causing you distress. They can suggest ways to keep your penis erect, such as prescription medicines, penile implants or vacuum erection devices.

• Sometimes, changes to sperm production and ability to have erections are permanent. This may cause infertility. If you want to have a child, you may choose to store sperm before treatment starts. Your partner can use this sperm to conceive through artificial insemination or in‑vitro fertilisation in the future.
• If radiation therapy causes menopause, you will no longer be able to become pregnant. If you wish to have children in the future, talk to your radiation oncologist before treatment starts about ways to preserve your fertility, such as storing eggs or embryos or freezing ovarian tissue.
• If your ovaries don’t need to be treated, one or both of the ovaries may be surgically moved higher in the abdomen and away from the field of radiation. This is called ovarian transposition or relocation (oophoropexy). It may lower the amount of radiation your ovaries receive and it may help them keep working properly.