Radiation Therapy Side Effects, Part 4

by National Cancer Institute

(Page 8 of 9)

Are There Side Effects With Radiation Therapy for Breast Cancer?

The most common side effects with radiation therapy for breast cancer are fatigue and skin changes. However there may be other side effects as well. If you notice that your shoulder feels stiff, ask your doctor or nurse about exercises to keep your arm moving freely. Other side effects include breast or nipple soreness, swelling from fluid buildup in the treated area, and skin reddening or tanning. Except for tanning which may take up to 6 months to fade, these side effects will most likely disappear in 4 to 6 weeks.

If you are being treated for breast cancer and you are having radiation therapy after a lumpectomy or mastectomy, it's a good idea to go without your bra whenever possible or, if this makes you more uncomfortable, wear a soft cotton bra without underwires. This will help reduce skin irritation in the treatment area.

Radiation therapy after a lumpectomy may cause additional changes in the treated breast after therapy is complete. These long-term side effects may continue for a year or longer after treatment. The skin redness will fade, leaving your skin slightly darker, just as when a sunburn fades to a sun tan. The pores in the skin of your breast may be enlarged and more noticeable. Some women report increased sensitivity of the skin on the breast; others have decreased feeling. The skin and the fatty tissue of the breast may feel thicker and firmer than it was before your radiation treatment. Sometimes the size of your breast changes--it may become larger because of fluid buildup or smaller because of the development of scar tissue. Many women have little or no change in size.

Your radiation therapy plan may include temporary implants of radioactive material in the area around your lumpectomy. A week or two after external treatment is completed, these implants are inserted during a short hospitalization. The implants may cause breast tenderness or a feeling of tightness. After they are removed, you are likely to notice some of the same effects that occur with external treatment. If so, let your doctor or nurse know about any problems that persist.

Most changes resulting from radiation therapy for breast cancer are seen within 10 to 12 months after completing therapy. Occasionally small red areas called telangiectasias appear. These are areas of dilated blood vessels and the color may fade with time. If you see new changes in breast size, shape, appearance, or texture after this time, report them to your doctor at once.

What Side Effects Occur With Radiation Therapy to the Stomach and Abdomen?

If you are having radiation treatment to the stomach or some portion of the abdomen, you may have an upset stomach, nausea, or diarrhea. Your doctor can prescribe medicines to relieve these problems. Do not take any medications for these symptoms unless you first check with your doctor or nurse.

Managing Nausea

It's not unusual to feel queasy for a few hours right after radiation treatment to the stomach or abdomen. Some patients find that they have less nausea if they have their treatment with an empty stomach. Others report that eating a light meal 1 to 2 hours before treatment lessens queasiness. You may find that nausea is less of a problem if you wait 1 to 2 hours after your treatment before you eat. If this problem persists, ask your doctor to prescribe a medicine (an antiemetic to prevent nausea. If antiemetics are prescribed, take them within the hour before treatment or when your doctor or nurse suggests, even if you sometimes feel that they are not needed.

If your stomach feels upset just before every treatment, the queasiness or nausea may be caused by anxiety and concerns about cancer treatment. Try having a bland snack such as toast or crackers and apple juice before your appointment. It may also help to try to unwind before your treatment. Reading a book, writing a letter, or working a crossword puzzle may help you relax.

Here are some other tips to help an unsettled stomach:

• Stick to any special diet that your doctor, nurse, or dietitian gives you.
• Eat small meals.
• Eat often and try to eat and drink slowly.
• Avoid foods that are fried or are high in fat.
• Drink cool liquids between meals.
• Eat foods that have only a mild aroma and can be served cool or at room temperature.

For severe nausea and vomiting, try a clear liquid diet (broth and clear juices) or bland foods that are easy to digest, such as dry toast and gelatin.

What to Do About Diarrhea

Diarrhea may begin in the third or fourth week of radiation therapy to the abdomen or pelvis. You may be able to prevent diarrhea by eating a low fiber diet when you start therapy: avoid foods such as raw fruits and vegetables, beans, cabbage, and whole grain breads and cereals. Your doctor or nurse may suggest other changes to your diet, prescribe antidiarrhea medicine, or give you special instructions to help with the problem. Tell the doctor or nurse if these changes fail to control your diarrhea. The following changes in your diet may help:

• Try a clear liquid diet (water, weak tea, apple juice, clear broth, plain gelatin) as soon as diarrhea starts or when you feel that it's going to start.

• Ask your doctor or nurse to advise you about liquids that won't make your diarrhea worse. Weak tea and clear broth are frequent suggestions.

• Avoid foods that are high in fiber or can cause cramps or a gassy feeling such as raw fruits and vegetables, coffee and other beverages that contain caffeine, beans, cabbage, whole grain breads and cereals, sweets, and spicy foods.

• Eat frequent small meals.

• If milk and milk products irritate your digestive system, avoid them or use lactose-free dairy products.

• Continue a diet that is low in fat and fiber and lactose-free for 2 weeks after you have finished your radiation therapy. Gradually re-introduce other foods. You may want to start with small amounts of low-fiber foods such as rice, bananas, applesauce, mashed potatoes, low-fat cottage cheese, and dry toast.

• Be sure your diet includes foods that are high in potassium (bananas, potatoes, apricots), an important mineral that you may lose through diarrhea.

Diet planning is very important for patients who are having radiation treatment of the stomach and abdomen. Try to pack the highest possible food value into every meal and snack so that you will be eating enough calories and vital nutrients. Remember that nausea, vomiting, and diarrhea are likely to disappear once your treatment is over.

What Side Effects Occur With Radiation Therapy to the Pelvis?

If you are having radiation therapy to any part of the pelvis (the area between your hips), you might have some of the digestive problems already described. You also may have bladder irritation which can cause discomfort or frequent urination. Drinking a lot of fluid can help relieve some of this discomfort. Avoid caffeine and carbonated beverages. Your doctor also can prescribe some medicine to help relieve these problems.

The effects of radiation therapy on sexual and reproductive functions depend on which organs are in the radiation treatment area. Some of the more common side effects do not last long after treatment is finished. Others may be long-term or permanent. Before your treatment begins, ask your doctor about possible side effects and how long they might last.

Depending on the radiation dose, women having radiation therapy in the pelvic area may stop menstruating and have other symptoms of menopause such as vaginal itching, burning, and dryness. You should report these symptoms to your doctor or nurse, who can suggest treatment.

Effects on Fertility

Scientists are still studying how radiation treatment affects fertility. If you are a woman in your childbearing years, it's important to discuss birth control and fertility issues with your doctor. You should not become pregnant during radiation therapy because radiation treatment during pregnancy may injure the fetus, especially in the first three months. If you are pregnant before your therapy begins, be sure to tell your doctor so that the fetus can be protected from radiation, if possible.

Radiation therapy to the area that includes the testes can reduce both the number of sperm and their effectiveness. This does not mean that conception cannot occur, however. Ask your doctor or nurse about effective measures to prevent pregnancy while you are having radiation. If you have any concerns about fertility, be sure to discuss them with your doctor. For example, if you want to have children, you may be concerned about reduced fertility after your cancer treatment is completed. Your doctor can help you get information about the option of banking your sperm before treatment.

Sexual Relations

With most types of radiation therapy, neither men nor women are likely to notice any change in their ability to enjoy sex. Both sexes, however, may notice a decrease in their level of desire. This is more likely to be due to the stress of having cancer than to the effects of radiation therapy. Once the treatment ends, sexual desire is likely to return to previous levels.

During radiation treatment to the pelvis, some women are advised not to have intercourse. Others may find that intercourse is uncomfortable or painful. Within a few weeks after treatment ends, these symptoms usually disappear. If shrinking of vaginal tissues occurs as a side effect of radiation therapy, your doctor or nurse can explain how to use a dilator, a device that gently stretches the tissues of the vagina.

If you have questions or concerns about sexual activity during and after cancer treatment, discuss them with your nurse or doctor. Ask them to recommend booklets that may be helpful.

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