Radiation Therapy is one of the most common treatment options for almost every type of cancer. Special X-rays are beamed from an external machine on to the site of cancer, which is why it is also called External Beam Radiation Therapy (EBRT). The other type being brachytherapy where the radiation source is implanted in the body. The beams help destroy cancerous cells by modifying their cellular structure. The intention of Radiation Therapy is to destroy cancerous cells only and spare healthy cells in the vicinity.
In the past such efforts were not very successful, so healthy tissues around the cancerous growth would also be affected. This is precisely why there are side-effects to Radiation Therapy. But, in recent years, the technology has become more sophisticated, so the beams are more focused now, however there is still collateral damage to nearby tissues. Radiation Therapy may be used for reasons other than cancer treatment, but for the purpose of this article, we will focus on side-effects from radiation for cancer treatment.
General/Common side-effects
Irrespective of the site, or type of cancer, there are some common side-effects. Most of them are early-stage, or short-term side-effects. This means, the side-effects appear immediately upon start of treatment but disappear in 2-3 months once the therapy is stopped. These include:
- Fatigue: Fatigue is the most common and prominent side-effect. This is not the same as day-to-day fatigue that one feels after exertion. This is more severe. The patient feels exhausted all through the day and it does not go away even after resting or sleeping. The doctors will constantly check with the patient about the level of fatigue, which he/she must rate on a 1 to 10 scale. The combination of fatigue and recurring visits for therapy also makes some patients depressed. So friends and family members should watch out for these signs and engage with the patient closely.
- Skin changes: When the treatment begins, the skin reacts by becoming red, swollen, sometimes tanned or sunburned in appearance, and develop blisters. In a few weeks, the skin starts becoming dry, flaky, itchy and start peeling off. The condition is called Radiation Dermatitis. Once the treatment is stopped, the skin returns to normal condition. However, in some people, the skin at the site may be permanently darker than the surrounding area. Radiation recall is another condition in which the skin appears severely blistered and this generally happens when Radiation is followed by Chemotherapy.
- Low blood-counts: Radiation causes a drop in the count of RBCs, WBCs and platelets. The doctors are aware of this and will be monitoring this through blood tests. Since WBCs are vital to immunity and fighting disease, once its count drops below a certain number, the doctors will stop the therapy temporarily to give time for the count to improve, and then resume treatment.
- Poor Appetite: While loss of appetite is a definite side-effect of radiation for cancers in the head, neck, chest and abdomen, it can occur for other cancers too. This is because the body is expending a lot of energy to heal itself from the effects of therapy and the cancer itself. The person feels tired and loses interest in eating. Further, the food may also taste different now, so he/she starts avoiding food. However, it’s very important to eat a healthy and nutritious meal during therapy.
- Late side-effects: While all the above are short-term side-effects that appear almost immediately and disappear in a couple of months, there can also be long-term or late side-effects. Some of them are organ damage, and secondary cancers, that is cancers in surrounding organs or tissues. Whether one will develop late side-effects or not depends on factors such as site or type of cancer, extent of cancer and hence radiation given, other cancer treatments given in the past, family history of cancer, and if one is a smoker or not.
Site-specific side-effects
As per the cancer, specific organs or parts of the body will be targeted for radiation, thereby causing localized side-effects. The extent of each side-effect and whether all side-effects listed below will occur or not, varies from person to person. Also, please note, some of the above-mentioned common side-effects will also be present.
Brain Cancer
- Hair loss
- Headache
- Memory or concentration problems
- Blurry vision
- Nausea and vomiting
- Slurred speech
- Hearing loss
- Seizures
Cancers in the head, neck and shoulders
- Hair loss
- Mouth problems – lack of saliva, or thick saliva
- Trouble swallowing
- Throat pain
- Hoarse voice
- Cough
- Less active thyroid gland
- Taste changes
- Dry mouth
- Tooth decay
- Earache
- Stiffness in the jaw
- Mouth ulcers and gum sores
Breast Cancer
- Hair loss
- Swelling (edema)
- Tenderness
- Breast or nipple soreness
- Heart complications
- Rib fracture
- Fluid build-up in the breasts (lymphedema)
- Brachial plexopathy: Weakness, numbness, pain or tingling in the shoulder and hand
Cancers in the chest region
- Hair loss
- Shortness of breath
- Trouble swallowing
- Throat pain
- Hoarse voice
- Cough
- Breast or nipple soreness
- Stiff shoulder
- Fever
- Radiation pneumonitis: Chest feels heavy or full
- Radiation Fibrosis: permanent scars in the lung
- Heart complications such as hardening of the arteries (which can lead to heart attack), damage to valves and irregular heartbeat
- Rib fracture
- Pink-coloured sputum
Stomach cancers, cancers in the abdomen
- Nausea and vomiting
- Hair loss
- Diarrhea
- Urinary and bladder problems (blood in the urine, pain while urinating, frequent urge to urinate, trouble passing urine, urinary retention)
- Bowel cramps
- Belly cramps
Cancers of the genito-urinary system
- Diarrhea
- Nausea and vomiting
- Hair loss
- Urinary and bladder problems (blood in the urine, pain while urinating, frequent urge to urinate, trouble passing urine, urinary retention)
- Painful bladder spasms
- Impotence in men
- Fertility issues in men (low sperm count, low motility of sperms)
- Fertility issues in women (a temporary stop in menstruation)
- Menopausal symptoms in women such as itching, burning and dryness in the vagina
- Pain during sex in women
- Low libido or sex-drive in men and women
- Incontinence or inability to control the bladder
- Fistulas, or gaps that are created between organs, for ex, between bladder and rectum
Cancers of the rectum and colon
Same as above. In addition,
Coping with side-effects
The above information may look ominous, but please note, doctors are well-aware of the same. Cancer Specialists will give you various tips on how to overcome each of the above-mentioned side-effects. These tips may even be formalized in the treatment plan. Further, cancer care is a very sophisticated industry today involving specialists and therapists across disciplines. Also, there are various medical and paramedical agencies today that provide palliative or supportive care for side-effects.
So if you or any of your dear ones are diagnosed with cancer and put on Radiation therapy, do not fret or panic. Consult a reputed hospital. They will help you at every step right from the time the cancer is diagnosed, through the therapies, coping with side-effects, and thereafter the recovery and rehabilitation.
Reviewed by Dr Suresh S Venkita, Group Medical Director, Kauvery Hospitals
Kauvery Hospital is globally known for its multidisciplinary services at all its Centers of Excellence, and for its comprehensive, Avant-Grade technology, especially in diagnostics and remedial care in heart diseases, transplantation, vascular and neurosciences medicine. Located in the heart of Trichy (Tennur, Royal Road and Alexandria Road (Cantonment), Chennai, Hosur, Salem, Tirunelveli and Bengaluru, the hospital also renders adult and pediatric trauma care.
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