You need to take special care of yourself to protect your health during the treatment. Your doctor or nurse will give you advice for caring for yourself that is specific to your treatment and the side effects that might result, but here are some suggestions:

• Be sure to get plenty of rest. You may feel more tired than normal. Be sure that you get good restful sleep at night. Fatigue may last for several weeks after your treatment ends.

• Eat a balanced, nutritious diet. Depending on the area of the body that will receive radiation (for example, the abdomen or pelvic area), your doctor or nurse may suggest changes in your diet.

• Take care of the skin in the treatment area. If you receive external radiation therapy, the skin in the area of treatment may become more sensitive or begin to look sunburned. For this reason, ask your doctor or nurse before using any soaps, lotions, deodorants, medicines, perfumes, cosmetics, talcum powder, or other substances on the treated area. Some of these products may irritate sensitive skin.

• Avoid wearing tight clothes. This includes girdles, pantyhose, or close-fitting collars over the treatment area. Instead, wear loose, soft cotton clothing, and avoid starching your clothes.

• Do not rub, scrub, or use adhesive tape on treated skin. If a dressing is needed, use paper tape or other tape for sensitive skin. Try to put the tape outside the treatment area, and avoid putting the tape in the same place each time.

• Do not apply heat or cold (heating pad or ice pack, etc.) to the treatment area. First talk with your doctor. Even hot water may hurt your skin, so use only lukewarm water for bathing the treated area.

• Do not use a pre-shave or after-shave lotion or hair-removal products. Use an electric shaver if you must shave the area, but only after checking with your doctor or nurse.

• Protect the treated area from the sun. Your skin may be extra sensitive to sunlight. If possible, cover treated skin with dark-colored clothing before going outside. Ask your doctor if you should use a lotion that contains a sunscreen. If so, use a sunscreen product with a sun protection factor (SPF) of at least 15. Reapply the sunscreen often, even after your skin has healed. Continue to provide extra protection to your skin from sunlight for at least 1 year after radiation therapy.

• Tell your doctor about medicines you are taking before treatment. If you take any medicines, even things like aspirin, vitamins, or herbs, let your doctor know first.

Your doctor and nurse are the best people to talk to you about your treatment, side effects, home care, and any other medical concerns you may have. Tell them about any side effects you are having, including skin changes, fatigue, diarrhea, or trouble eating. Be sure that you understand any home care instructions and know who to contact in case you have more questions.

Side effects vary from patient to patient and will depend on the radiation dose and the part of your body treated. Some patients have no side effects at all, while others have quite a few. There is no way to predict who might or might not have side effects. Your general health can sometimes affect how your body reacts to radiation treatment and whether you have side effects.

Radiation therapy can cause early and late side effects. Early side effects are those that happen during or shortly after treatment. They usually are gone within a few weeks after treatment. Late side effects are those that take months or years to develop. They are often permanent.

The most common early side effects are:

• fatigue (feeling tired)
• skin changes
• loss of appetite

Other early side effects usually are related to the area being treated, such as hair loss following radiation treatment to the head.

Most side effects go away in time. In the meantime, there are ways to reduce the discomfort they may cause. If you have a reaction that is severe, the doctor may stop your treatments for a while, change the schedule, or change the type of treatment you are receiving. Tell your doctor, nurse, or radiation therapist about any side effects you notice so they can help you manage them. The information here can serve as a guide to handling some side effects, but it cannot replace talking with your doctor or nurse about your situation.

Dealing With Fatigue

Fatigue is the feeling of being tired physically, mentally, and emotionally. It means having less energy to do the things you normally do or want to do. Cancer-related fatigue is a different kind of tiredness that can happen with cancer or cancer treatment. It can last a long time and can interfere with your usual activities. This is different from the fatigue of everyday life, which is usually temporary and relieved by rest. Cancer-related fatigue is more severe and more distressing. Rest does not always relieve it. This kind of fatigue bothers some people even more than pain, nausea/vomiting, or depression. Cancer-related fatigue can:

• vary in its unpleasantness, how severe it is, and how long it lasts 
• be overwhelming and hinder your ability to feel well 
• make even being with your friends and family difficult 
• decrease your ability to continue normal activities, including going to work 
• make it hard to follow your cancer treatment plan

Only you know if you have fatigue and how severe it is. No lab tests or x-rays can diagnose or describe your level of fatigue. The best measure of fatigue comes from your own report to your doctor or nurse. You can describe your level of fatigue as none, mild, moderate, or severe, or you can use a scale of 0 to 10, where a 0 means no fatigue, and a 10 is the worst fatigue you could imagine.

During cancer treatment, you may find that you become tired more easily because your body is using more energy to handle the demands of cancer and treatment. Stress related to your illness, daily trips for treatment, and the effects of radiation on normal cells may also contribute to fatigue.

Most people begin to feel tired after a few weeks of radiation therapy. Fatigue usually gets worse as your treatment goes on.

The cause of cancer-related fatigue is not always clearly understood. But if the cause of fatigue is known, treatment will be directed at the cause. For example, if anemia (low red blood cell counts) is thought to be causing fatigue, the anemia will be treated. In some patients, treatment may include correcting fluid and mineral imbalances in the blood. The use of physical activity, treatment of sleep problems, and correction of nutrition problems all seem to improve fatigue. Physical activity in particular can have a major effect. Education and counseling are part of the treatment and help people learn how to conserve energy, reduce stress, and use distraction to focus on things other than the fatigue.

By understanding fatigue, you can cope with it better and reduce your distress. Often, a family member can help you talk to your health care team about your fatigue and how it affects you. The best approach is to learn about fatigue before you have it.

Fatigue will go away gradually after your treatment is finished. Until then, there are some things that you can do to help you deal with it:

• Make a list of your regular activities in order of how important they are to you. Try to do the important ones first or when you have the most energy. 
• Have a structured daily routine. 
• Ask for help and give tasks to others when you can. 
• Place things that you use often within easy reach to save your energy. 
• Use methods to reduce stress, such as deep breathing, visual imagery, meditation, prayer, talking with others, reading, listening to music, painting, or any other activity that gives you pleasure. 
• Keep a journal. 
• Balance rest and activities. Avoid too much bed rest, which can lead to feeling weak. Schedule activities so that you have time for plenty of rest. Most people find shorter rest periods to be better than one long one. 
• Talk to your doctor about how to keep any pain, nausea, or depression under control. 
• Discuss physical activity with your doctor before you start any exercise program. 
• Unless you are given other instructions, eat a balanced diet that includes protein (meat, milk, eggs, and beans), and drink plenty of water each day.

Let your doctor or nurse know about your fatigue and talk with them if:

• Your fatigue does not get better, keeps coming back, or becomes severe. 
• You are more tired than usual during or after an activity. 
• You are feeling tired and it is not related to an activity. 
• Your fatigue is not relieved by rest or sleep. 
• You become confused or cannot concentrate. 
• You are unable to get out of bed for more than 24 hours. 
• Your fatigue disrupts your social life or daily routine.

What Can I Do About Skin Problems?

Your skin in the treatment area may look red, irritated, sunburned, or tanned. After a few weeks, your skin may become dry or reddened from the therapy. It is important to let your doctor or nurse know about any skin changes. He or she can suggest measures to relieve your discomfort and possibly lessen further irritation.

Most skin reactions should go away a few weeks after treatment is finished. In some cases, though, the treated skin will remain darker than it was before. You need to be gentle with your skin. Suggestions include:

• Use only lukewarm water and mild soap. Just let water run over the treated area. Do not rub.

• Do not wear tight clothing over the treatment area.

• Try not to rub, scrub, or scratch any sensitive spots.

• Avoid putting anything that is hot or cold, such as heating pads or ice packs, on your treated skin, unless advised by your doctor.

• Ask your doctor or nurse before using any powders, creams, perfumes, deodorants, body oils, ointments, lotions, or home remedies in the treatment area while you are being treated and for several weeks afterward. Many skin products can leave a coating on the skin that may cause irritation, and may even change the dose of radiation into the body.

• Avoid exposing the area to the sun during treatment and for at least 1 year after your treatment is completed.

• If you expect to be in the sun for more than a few minutes, wear protective clothing (such as a hat with a broad brim and shirt with long sleeves) and use a sunscreen. Ask your doctor or nurse about using sunscreen lotions.

Radiation therapy can cause hair loss (alopecia) but only in the area being treated. For example, if you receive treatment to your hip, you will not lose hair from your head. However, radiation to your head may cause you to lose some or all of the hair on your scalp.

Most patients find that their hair grows back after the treatments are finished, but accepting hair loss can be hard. When it does grow back, it may be thinner or a different texture than it was before treatment. Ask your doctor or nurse if you have more questions about hair loss.

Your scalp may be tender after the hair loss, and you may want to cover your head while you are in treatment. You should wear a hat or scarf to protect your head when you are in the sun. If you prefer a hairpiece or wig, be sure the lining does not irritate your scalp. Your local American Cancer Society office may be able to help you get wigs or hats. You may want to check to see if head coverings are a tax-deductible expense or covered by your health insurance.

Will My Blood Counts Be Affected?

Radiation therapy can cause low white blood cell counts or low levels of platelets, but this is rare. These blood cells help your body fight infection and prevent bleeding. If your blood tests show this side effect, treatment might be delayed for about a week to allow your blood counts to return to normal. This side effect is more likely to happen if you are also receiving chemotherapy.


Will I Have Eating Problems?

Coping with short-term diet problems may be easier than you expect. There are a number of guides and recipe booklets for patients who need help with eating problems.

If you have trouble swallowing, tell your doctor or nurse. If you have pain when you chew and swallow, certain medicines may be helpful. Your doctor may also suggest a liquid diet. Many liquid nutrition drinks are available and come in a variety of flavors. They are available at grocery and drugstores without a prescription or you can make them yourself. They can be combined with other foods or added to milkshakes.

The list below suggests ways to help you with your appetite when you don't feel like eating and how to make the most of it when you do feel like eating.

• Eat when you are hungry, even if it is not mealtime.

• Eat 5-6 small meals during the day rather than 2 or 3 large ones.

• Vary your diet and try new recipes. If you enjoy company while eating, try to eat with family or friends, or turn on the radio or television.

• When you feel up to it, make some simple meals in batches and freeze them to use later. Anytime you cook, prepare extra food so you can eat again without cooking.

• Keep healthful snacks close by for nibbling when you get the urge.

• If other people offer to cook for you, let them. Do not be shy about telling them what you would like to eat.

• If you live alone, you might want to arrange for programs like Meals on Wheels to bring food to you. Ask your doctor, nurse, or local American Cancer Society office about Meals on Wheels.

• If you drink alcohol, ask your doctor if you should avoid alcohol during your treatment. Also, ask if it will interact with any medicines you are taking.

If you are able to eat only small amounts of food, you can increase the calories per serving by trying the following:

• Add butter or olive oil.
• Mix canned cream soups with milk or half-and-half rather than water.
• Drink milkshakes or prepared liquid supplements between meals.
• Add cream sauce or melted cheese to your favorite vegetables.

Some people find they can handle large amounts of liquids even when they do not feel like eating solid foods. If this is the case for you, try to get the most from each glassful by making drinks enriched with powdered milk, yogurt, honey, or prepared liquid nutrition drinks.


How Will I Feel Emotionally?

Many patients feel tired due to the radiation therapy, which can affect emotions. You also might feel depressed, afraid, angry, frustrated, alone, or helpless.

Attending a support group of other people with cancer may be helpful. Ask your doctor or call the American Cancer Society for more information about ways to meet with others who share your problems and concerns.


Are There Long-term Side Effects I Should Be Concerned About?

During and right after radiation therapy, it may be hard to think in terms of years down the road. But depending on the type of treatment and the location of the cancer, there may be long-term effects. (Some of these are described in more detail in the next section.) Even though long-term problems are less common than short-term effects, they should still be taken into account when making decisions about radiation therapy.

For example, radiation to the chest area may affect the lungs or heart. In some people this may cause scarring, which can affect a person’s capacity for physical activity. Radiation to the abdomen or pelvis can lead to bladder, bowel, or sexual problems in some people. Radiation in certain areas can also lead to fluid buildup and swelling in an arm or leg, a condition known as lymphedema.

One thing many people are concerned about is a possible increased risk of getting a second cancer some time in the future. The increase in risk is small but real.

The link between radiation and cancer was noted many years ago in studies of atomic bomb survivors, workers exposed to radiation on their jobs, and patients treated with radiation therapy. For example, young women who received whole body radiation for treatment of Hodgkin disease were found to be at increased risk for breast cancer and other cancers later in life. (This treatment is no longer common.) Some cases of leukemia are related to radiation exposure and usually develop within a few years of exposure. This risk peaks at 5 to 9 years after the radiation exposure and then slowly declines. The development of other types of cancer after radiation exposure has been shown to take much longer. Most do not happen until at least 10 years after radiation exposure, and some are diagnosed 15 or more years later.

Radiation therapy techniques have steadily improved over the last few decades. Treatments now target the cancers more precisely, and more is known about choosing the best radiation doses. These advances are expected to reduce the number of second cancers that result from radiation therapy. The risk of second cancers is generally low and must be weighed against the benefits gained with radiation treatments.

Talk to your doctor before starting radiation therapy to make sure you are aware of the possible long-term effects of radiation therapy. This can help you make an informed treatment decision and help you know what symptoms you may need to watch out for after treatment.

Managing Side Effects of Treatment to Specific Parts of the Body

What Side Effects May Happen With Radiation Therapy to the Head and Neck?

Some people who get 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 get 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.

Dental Care

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 one other time 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.

Stereotactic radiosurgery is often used when cancer has only spread to a few sites in the brain. Side effects vary depending on where the radiation is aimed. Talk with your radiation oncologist about what to watch for and when to call for help.

Sometimes the whole brain is treated with radiation when cancer has spread into many sites. Whole brain radiation can cause some of the following side effects:

• headaches 
• swelling of the brain 
• hair loss 
• nausea 
• vomiting 
• fatigue 
• hearing loss 
• skin and scalp changes 
• trouble with memory and speech 
• seizures

Medicines are usually given to prevent brain swelling, but it is important to let your doctor know about headaches and other symptoms. Delayed effects (usually a year or two later) of whole brain radiation can be caused by death of brain tissue, and include serious problems such as memory loss, stroke-like symptoms, and poor brain function.

What Side Effects May Occur With Radiation Therapy to the Breast and Chest?

Radiation treatment to the chest may cause problems when swallowing, 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 underwire so that 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 build-up in the treated area. These side effects most likely will go away a month or 2 after you finish radiation therapy. If fluid build-up continues to be a problem (a condition called lymphedema), ask your doctor what steps you can take.

Skin may turn red or tan. This will most likely fade 1 or 2 months after you finish radiation.

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 build-up 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 notice breast tenderness or tightness. After the implants are removed, you are likely to have 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 fully inflate and take in air. If a large area of the lungs is treated with radiation, these changes can cause shortness

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

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 help relieve these problems. Check with your doctor or nurse about any home remedies you are thinking about taking during your treatment.

Managing Nausea

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 notice nausea 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.

How to Handle Diarrhea

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 you take in enough potassium (bananas, potatoes, apricots, peaches), 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.

What Side Effects May Occur With Radiation Therapy to the Pelvis?

If you get 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.

Other than studies that looked at survivors of atomic bomb blasts, there is little information about radiation's effect on the offspring of men who were conceived during and after being irradiated. Because of the uncertain risk, doctors often advise men to avoid conceiving a child during and for some weeks after cancer treatment, especially if there is radiation to or near the genital area.

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 or 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. You can also get more information from the American Cancer Society's booklet, Sexuality and Cancer: For the Woman Who Has Cancer and Her Partner.

Radiation may affect the nerves that control a man's ability to have an erection. If a man is having 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 many months or years. Talk with your doctor about treatment options if this is a concern for you. You can also get more information from the American Cancer Society's booklet, Sexuality and Cancer: For the Man Who Has Cancer and His Partner.

Will Side Effects Limit My Activity?

They might. However, what you can do will depend on how you feel. Some patients are able to go to work or enjoy leisure activities while they have radiation therapy. Others find they need more rest than usual and cannot do as much. Your doctor may suggest you limit activities that might irritate the area being treated.

Revised: 10/02/2007