American Cancer Society (ACS) Possible Side Effects with Radiation Therapy to the:
Breast and Chest Area
Head and Neck Area
Stomach and Abdomen Area
Breast and Chest Area
Radiation treatment to the chest may cause problems when swallowing, development of a cough, or shortness of breath. Be sure to tell your doctor or nurse if you notice any of these side effects.
If you receive radiation therapy after a lumpectomy or mastectomy for breast cancer, try to go without wearing a bra whenever you can. If this is not possible, wear a soft cotton bra without underwires so your skin is not irritated. If your shoulders feel stiff, ask your doctor or nurse about exercises to keep your arms moving freely.
Other side effects may include breast soreness and swelling from fluid buildup in the treated area. These side effects, as well as skin reddening or tanning, most likely will go away a month or two after you finish radiation therapy. If fluid buildup continues to be a problem (a condition called lymphedema), ask your doctor what steps you can take.
Radiation therapy after a lumpectomy may also cause other changes in the breast after therapy. Your skin may be slightly darker, and pores may be enlarged and more noticeable. The skin may be more or less sensitive and feel thicker and firmer than it was before your treatment. Sometimes the size of your breast changes -- it may become larger because of fluid buildup or smaller because of the development of fibrous tissue. Many women have little or no change in breast size. These side effects may continue for a year or longer after treatment.
If your radiation therapy includes implants, you might experience breast tenderness or tightness. After the implants are removed, you are likely to notice some of the same effects that occur with external radiation treatment. If so, follow the advice given above and let your doctor know about any problems that persist.
After 12 months, you should not have any new changes. If you do see changes in breast size, shape, appearance, or texture after this time, report them to your doctor right away.
When radiation treatments include the chest area, the lungs can be affected. One early change is a decrease in the levels of surfactant, the substance that helps keep the air passages open. This keeps the lungs from fully expanding, which may cause shortness of breath or cough. These symptoms are sometimes treated with steroids.
A possible late effect of radiation to the lungs is fibrosis (stiffening or scarring). When this happens, the lungs can no longer inflate and take in air. If a large area of the lungs is treated with radiation, these changes can cause shortness of breath and less tolerance for physical activity.
Head and Neck Area
Some people who receive radiation to the head and neck experience redness and irritation in the mouth, a dry mouth, trouble swallowing, changes in taste, or nausea. Other possible side effects include a loss of taste, earaches and swelling. You may lose your hair, your skin texture might change and your jaw may feel stiff.
If you receive radiation therapy to the head or neck, you need to take good care of your teeth, gums, mouth and throat.
Here are a few tips that may help you manage mouth problems:
- Avoid spices and coarse foods such as raw vegetables, dry crackers and nuts.
- Do not eat or drink very hot or very cold foods.
- Do not smoke, chew tobacco, or drink alcohol because tobacco and alcohol can further irritate mouth sores.
- Stay away from sugary snacks.
- Ask your doctor or nurse to recommend a good mouthwash. The alcohol content in some mouthwashes has a drying effect on mouth tissues.
- Rinse your mouth with warm salt water every 1 to 2 hours as needed.
- Sip cool drinks often throughout the day.
- Eat or chew sugar-free candy or gum to help keep your mouth moist.
- Moisten food with gravies and sauces to make eating easier.
- Ask your doctor or nurse about medicines to help treat mouth sores and control pain while eating.
If these measures are not enough, ask your dentist about artificial saliva. Mouth dryness may continue to be a problem even after treatment is over.
Radiation treatment of your head and neck can increase your chances of getting cavities. Mouth care designed to prevent problems will be an important part of your treatment. Before starting radiation therapy, arrange for a complete checkup with your dentist. Ask your dentist to talk with your radiation oncologist before your treatments begin. If you have problem teeth, your dentist may suggest having them removed before starting treatment. Radiation (and dry mouth) may damage them to the point where they will need to be removed later, when it may be harder to do so.
If you wear dentures, they may no longer fit well because of swollen gums. If your dentures cause gum sores, you may need to stop wearing them until your radiation therapy is over because these sores can become infected.
Your dentist probably will want to see you during your radiation therapy to talk to you about caring for your mouth and teeth and help you deal with any soreness. Most likely, you will be told to do the following:
- Clean your teeth and gums with a very soft brush after meals and at least once more each day.
- Use a fluoride toothpaste that contains no abrasives.
- Use unwaxed dental tape to gently floss between teeth once a day.
- If your dentist recommends it, use a special solution or tablet (disclosing solution) after brushing to show plaque that you have missed.
- Rinse your mouth well with cool water or a baking soda solution after you brush. (Use 1 teaspoon of baking soda in 1 quart of water.)
- Apply fluoride regularly as prescribed by your dentist.
If you receive radiation therapy to any part of the pelvis, you might have one or more of the digestive problems already described. You also may have some irritation of your bladder, which can be uncomfortable and cause you to urinate often.
Effects on female fertility: DO NOT TRY to become pregnant during radiation therapy because radiation can harm the fetus. Women should discuss with their doctor their birth control options and how radiation may affect their fertility. If you are pregnant, let your doctor know before beginning treatment.
Depending on the radiation dose, women having radiation therapy in the pelvic area may stop having their menstrual periods and have other symptoms of menopause. Treatment also can result in vaginal itching, burning and dryness. Report these symptoms to your doctor so you can learn about options for relieving these side effects.
Effects on male fertility: For men, radiation therapy to an area that includes the testes can reduce both the number of sperm and their ability to function. This does not mean though that pregnancy cannot occur. If you want to father a child and are concerned about reduced fertility, talk to your doctor before starting treatment. One option may be to bank your sperm ahead of time.
Sexual relations: With some types of radiation therapy involving the pelvis, men and women may notice some change in their ability to enjoy sex or a decrease in their level of desire.
During treatment to the pelvis, some women are advised not to have intercourse because they may find it painful. You most likely will be able to resume having sex within a few weeks after your treatment ends, but check with your doctor first. Some types of treatment may have more long-term effects, such as scarring that could affect the ability of the vagina to stretch during intercourse. Again, your doctor may be able to offer suggestions if this occurs.
Radiation may affect the nerves that control a man's ability to have an erection. If a man is receiving seed implant radiation therapy, he should check with his doctor about safety precautions, such as using condoms. If erection problems do occur, it is usually gradual over the course of several months or years. Talk with your doctor about treatment options if this is a concern for you.
Stomach and Abdomen Area
If you are having radiation treatment to the stomach or some part of the abdomen, you may have vomiting, nausea, or diarrhea. Your doctor can prescribe medicines to relieve these problems. Check with your doctor or nurse about any home remedies you are thinking about taking during your treatment.
Some patients report feeling queasy for a few hours right after radiation therapy. If you have this problem, do not eat for several hours before your treatment. You may be able to handle the treatment better on an empty stomach. After treatment, you may want to wait 1 to 2 hours before eating. If the problem persists, ask your doctor about medicines to prevent and treat nausea. Be sure to take the medicine as prescribed.
If you have an upset stomach before your treatment, eat a bland snack such as toast or crackers and try to relax as much as possible. Here are some tips to help an upset stomach:
Stick to any special diet your doctor or dietitian gives you.
Eat small meals.
Eat often and try to eat and drink slowly.
Avoid foods that are fried or 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 a severe upset stomach, try a clear liquid diet (broth and juices) or bland foods that are easy to digest, such as dry toast and gelatin.
Learn relaxation techniques and use these when feeling nauseated.
Diarrhea most often begins a few weeks after starting radiation therapy. Your doctor may prescribe medicine or give you special instructions to help with the problem. He or she may also recommend changes in your diet, such as:
Try a clear liquid diet (water, weak tea, apple juice, peach nectar, clear broth, popsicles, plain gelatin) as soon as diarrhea starts or when you feel it is going to start.
Avoid foods that are high in fiber or can cause gas or cramps, such as raw fruits and vegetables, coffee, beans, cabbage, whole grain breads and cereals, sweets and spicy foods.
Eat frequent small meals.
Avoid milk and milk products if they irritate your bowels.
When the diarrhea starts to improve, try eating small amounts of low-fiber foods such as rice, bananas, applesauce, yogurt, 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 you may lose through diarrhea.
Diet planning is an important part of radiation treatment of the stomach and abdomen. Keep in mind these problems will be reduced greatly when treatment is over. In the meantime, try to pack the highest possible food value into even small meals so you get enough calories, vitamins and minerals.