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While radiotherapy can destroy cancer cells, it can also have an effect on some of the surrounding normal cells. The side effects that may occur are described in the following pages. It’s important to remember that most people will have only a few of them, and for many people they will be mild.
There have been huge improvements in radiotherapy machines and severe side effects are very rare.
As radiotherapy affects people in different ways, it's difficult to predict exactly how you will react to your treatment. Before you start, the staff will discuss with you any likely side effects of the particular treatment you're having. They can also give tips on how to deal with them and how they can be treated. Being aware of side effects in advance can help you to cope with any that may occur.
Most side effects of radiotherapy disappear gradually once the course of treatment is over. For some people however, they may continue for a few weeks.
Some issues pertaining to the general side effects are
Tiredness
You may feel very tired during your radiotherapy. This can often be made worse by having to travel to hospital each day. Listen to your body, and if necessary allow yourself extra time to rest, perhaps by taking a nap. It may help if you spread chores out over the week, sit down to do them wherever possible, and accept any offers of help. Tiredness can be a problem for some months after your treatment has finished.
Eating and drinking
As always during treatment of any kind, it’s important to maintain a healthy diet and drink plenty of fluids. At times you probably won't feel like eating, or you may find that your eating habits change. It may be easier to have small snacks throughout the day rather than large meals. It’s not unusual to lose a little weight during radiotherapy, but if you're having any problems with eating it is important to tell the radiotherapy staff. They can arrange for you to talk to the dietitian at the hospital.
Skin care
Some people develop a skin reaction while having external radiotherapy. If this affects you, it will normally happen after 3–4 weeks. People with pale skin may find that the skin in the treatment area becomes red and sore or itchy. People with darker skin may find that their skin becomes darker and can have a blue or black tinge. The amount of the reaction depends on the area being treated and the individual's skin. Some people have no skin problems at all. Your radiographers will be looking for these reactions, but you should also let them know as soon as you notice any soreness or change in skin colour.
It’s important not to use any creams or dressings unless they have been prescribed or recommended by your specialist or the radiographer.
Occasionally, if your skin gets very sore, your treatment may have to be delayed for a short time to allow the area to recover.
Staff at the radiotherapy department will be able to give you advice on how to look after your skin in the area being treated. This will vary according to the part of the body that is being treated and the dose of radiotherapy.
You may be advised to use only tepid water and unperfumed soaps to wash the area, and not to soak too long in the bath. You can dry your skin by patting it gently with a soft towel, but you shouldn’t rub the area as this may make it sore.
Perfumed soaps, talcum powder, deodorants and perfumes may also make your skin sore and should not be used. The staff at the hospital may suggest that you gently apply plain moisturisers, such as E45 cream or aqueous cream, to the area. After your treatment, plain soap and plain moisturisers are often recommended. Aloe vera cream or arnica cream can sometimes help the skin to heal. Always check with the radiotherapy staff before applying anything to your skin.
It is very important that any marks put on your skin to show the treatment area are not removed. If the marks do fade or disappear, don’t try to replace them yourself but let the radiotherapy staff know.
Men who are having radiotherapy to the head and neck may be advised not to shave the area, or to use an electric razor rather than wet-shaving.
These restrictions apply only to the treatment area, and the rest of your skin can be treated normally. Your skin may peel after the redness has faded, but it will gradually heal. Changes in the skin usually settle down two to four weeks after the treatment has finished, but the area may stay slightly darker than the surrounding skin.
Avoiding the sun
Your skin in the treated area is very sensitive and needs protecting from the sun or cold winds. If you're having radiotherapy to your head or neck, try wearing a hat or a silk or cotton scarf when you go outside.
For at least the first year after your radiotherapy, it’s very important to cover the treated area if you go out in strong sunshine. Wear clothes made of cotton or natural fibres, which have a closer weave and offer more protection against the sun. Even after this time the area of treated skin will be more delicate than normal, so take extra care. Use a sun-cream (of at least factor 15) and cover the area with a hat or close-weave clothing. It’s important to remember that you can burn even through clothing if you are out in hot sun for a long time.
You can swim as soon as any skin reaction has settled down, usually within a month of finishing treatment. If you are swimming outdoors however, don’t stay in the water too long, and remember to use a waterproof sun-cream.
Clothing
Loose-fitting clothes, preferably in natural fibres rather than man-made materials, are more comfortable and less irritating to the skin. Avoid tight collars and ties if you’re having radiotherapy to your neck.
Shoulder straps and bra straps can also cause irritation if they rub against treated skin. If your breast area is being treated, you may be more comfortable not wearing a bra or wearing a cropped top or vest.
Hair loss
With radiotherapy you lose hair within the treatment area, but it can also happen where the radiation beam leaves the body (for example, on the back of the neck), as well as where it enters the body. Ask your clinical oncologist or radiographer to show you exactly where your hair will fall out. The hair usually begins to fall out after two to three weeks. Hair should grow back after treatment is finished, although this depends on the dose of radiotherapy you have. Your radiographer can explain if your hair loss is likely to be permanent.
You may need to find ways of covering up the hair loss and there are several ways of doing this. You can find out more in the section on coping with hair loss.
Changes in your blood
Radiotherapy to some parts of the body may affect the bone marrow, which is where the different types of blood cells are made. If the doctors think this might happen to you, you will have regular blood tests during your treatment to check the number of cells in your blood (your blood count). If your blood count is low, you may feel tired and run down. If your blood count becomes very low (which is unlikely), it may be necessary to have a short rest from treatment so that your blood cell levels can return to normal. You may also need to have a blood transfusion.
It is very important to let your doctors know if you feel very unwell, if your temperature goes above 38ºC (100.4ºF), or if you start feeling cold and shaky.
Smoking
Stopping smoking during and after radiotherapy is very worthwhile. Research has shown that it may make the radiotherapy more effective as well as reducing the side effects. It will also improve your general health and reduce your risk of developing other cancers.
Stopping smoking or even cutting down at such a stressful time can be very difficult, but do your best. If you want help or advice you can talk to your specialist, GP or a specialist nurse, who will be able to suggest ways of stopping. Organisations such as QUIT also offer advice and valuable support.
Long-term side effects
All cancer treatments (including surgery, chemotherapy and radiotherapy) can result in long-term side effects. Modern ways of giving radiotherapy are designed to limit the chance of permanent side effects as much as possible and very few people develop long-term effects nowadays. If you are concerned about the risk of developing particular side effects from radiotherapy, it’s best to speak to your specialist before treatment starts.
Possible long-term side effects
Below are some of the long-term side effects that can occur, but they will depend upon the part of the body that was treated (so you won’t necessarily experience all of them). The long-term side effects can take months and sometimes years to develop.
Second cancers
Radiotherapy can cause cancer and a small number of people will develop a second cancer because of the treatment they have had. However, the chance of a second cancer developing is so small that the risks of having radiotherapy are far out-weighed by the benefits. If you are concerned about your risk of developing a second cancer you should discuss your worries with your specialist.
Side effects of radiotherapy to specific areas of the body
This section gives information about the side effects of external radiotherapy to different areas of the body. As radiotherapy treats only the part of the body affected by the cancer, you only need to read the section that relates to your treatment area. See the cancer type section for more information about how radiotherapy is given for specific cancers.
Radiotherapy to the head and neck
Mouth care
Your mouth may become sore during treatment because the cells that line the mouth are very sensitive to radiation. This can happen after 2–3 weeks of radiotherapy and may be more severe if you are having chemotherapy as well. The treatment may also make you more likely to develop mouth infections such as thrush, and you may find that you are producing sticky mucus.
It's very important to take care of your mouth while you are having treatment; the radiotherapy staff or a dental hygienist will show you how to do this. Regular mouthwashes, lozenges and painkillers will be prescribed for you when necessary.
Eating
As your mouth will be more sensitive than usual, try to avoid hot, spicy or very cold food or drink. Also avoid hard foods such as toast. Use only the mouthwashes prescribed for you by the radiotherapy department, as mouthwashes bought from a shop or chemist are usually alcohol- based and can make the soreness worse.
Taste changes
Your taste buds may be affected by treatment and you may notice changes in the way your food tastes. Some people say food has a metallic taste, while others say that all foods taste the same. As the effects of the treatment fade away your sense of taste will probably return to normal, but it may take over a year for this to happen. The radiotherapy staff can arrange for you to talk to a dietitian for advice on adapting your diet to overcome any taste changes.
Alcohol (particularly spirits) and tobacco can irritate the lining of the mouth and it’s best to avoid them during your treatment and for a few weeks afterwards. Your specialist may advise you to stop altogether if you can.
Dry mouth
The glands that produce saliva may be affected by the treatment, making you produce less saliva or none at all. This can make it uncomfortable to chew or swallow. The dryness in your mouth may last for several months after treatment and for some people it may be permanent. These side effects can be difficult to cope with at first, but there are ways to help. Your specialist can prescribe different treatments to help keep your mouth moist.
Loss of appetite and weight loss
The above side effects in your mouth may cause a loss of appetite and weight loss. Food supplements, such as high-calorie drinks, will be recommended until your mouth feels better. If you are having problems with eating, talk to your radiographers or the nursing staff, who will be able to help. You may be referred to a dietitian for specific advice. Our section on eating well also has some useful tips.
If eating and drinking become too painful, a thin, flexible tube, called a nasogastric (NG) tube, may be passed up your nose and down into your stomach. Liquid foods can be given through the NG tube. Another way of giving liquid foods is by passing a tube (a PEG or RIG tube) through the wall of your abdomen and into the stomach. This can be done while you are under general anaesthetic, usually when you are having surgery for the cancer. Being fed for a time through a feeding tube may be the best way to make sure you keep up your strength during your treatment.
Voice changes
If you are having treatment to your voice box (larynx), you may notice that your voice becomes hoarse or husky and may disappear completely at times. These changes are only temporary and it should go back to normal a few weeks after your treatment is over.
Tooth decay
Radiotherapy to the mouth can make you more likely to get tooth decay and you will need more frequent check-ups at the dentist. Fluoride treatment can often help to protect your teeth against the effects of radiotherapy, and your clinical oncologist may refer you for special dental treatment before your radiotherapy starts.
Gently brushing your teeth with a soft toothbrush and high-fluoride toothpaste as many as five or six times a day will help. It is important to tell your dentist that you have had radiotherapy before having any dental work later on.
Radiotherapy to the chest (thorax)
Difficulty swallowing
About two to three weeks (but sometimes only a few days) after radiotherapy to the chest has started, you might notice that your chest feels tight, which makes it difficult to swallow solid foods.This is a common reaction to treatment. It may help to try a soft, plain diet supplemented by high-calorie drinks such as Build-Up® and Complan®. By trying different foods, you’ll find out which ones are easiest to swallow. Your specialist may prescribe painkillers or liquid medicines (such as Asilone®, Maalox® or Altacite Plus®) to be taken before meals to make eating less uncomfortable. The discomfort will usually get better on its own in about five to eight weeks.
Feeling sick
Some people find that their treatment makes them feel sick (nauseated), and sometimes they may actually be sick (vomit). This is most common when the treatment area is near the stomach. Your specialist can prescribe anti-sickness drugs (anti-emetics) if this happens, and may prescribe them anyway, as a precaution. They are usually very effective.
Tell your specialist if you have any nausea or vomiting, and remember that it usually stops once treatment is over.
Weight loss
If you are having problems with eating or sickness, you may begin to lose weight. This can make you feel tired and weak. At times you may not feel like eating. The dietitian or your specialist will be able to give you advice if eating is a problem, and our section on eating well gives helpful advice on dealing with this.
Breathlessness
After radiotherapy to the chest you may notice that you develop a dry cough and breathlessness. This side effect may not occur until several months after your treatment. Whenever it happens you should report it to your doctor, who may treat it with a course of steroids and possibly antibiotics. It is important to let your doctor know if you notice any changes in your breathing at any time during and after your treatment.
Radiotherapy to the stomach and pelvis
Diarrhoea
This is a fairly common side effect of treatment to this area, and stomach cramps and wind may also occur. As well as being unpleasant, diarrhoea can make you feel weak and tired. Your specialist can prescribe anti-diarrhoea drugs for you. If a large area of the abdomen or pelvis is being treated, you may be advised to drink lots of fluid. You will generally be advised to eat a normal healthy diet. The diarrhoea may continue for some weeks after your treatment. If it doesn't seem to be getting better over time, contact the radiotherapy department or your doctor.
Discomfort around the back passage
Your rectum (back passage) may become irritated by the radiotherapy if the area being treated is in the lower pelvis; such as radiotherapy for womb, prostate, rectal or bladder cancer. If this is likely you may be advised to follow a high-fibre diet to avoid becoming constipated, as constipation can make the irritation of the back passage (proctitis) worse.
If you already have piles, they may become more irritating, and local anaesthetic, steroid creams or suppositories may be prescribed to ease any discomfort. Sometimes, after radiotherapy to the pelvic area, there may be a mucus discharge or some bleeding from the back passage. Let your specialist know if you have any of these problems.
Feeling sick
Some people find that their treatment makes them feel sick (nauseated) and they may actually be sick (vomit). Your specialist can prescribe anti-sickness drugs (anti-emetics) for you. Any feeling of sickness usually stops once your treatment is over.
Loss of appetite and weight loss
These side effects may occur as a result of diarrhoea and nausea. At times you may not feel like eating, and the idea of preparing food may make you feel sick. If you can, ask someone else to prepare your meals for you. You may find it easier to eat little and often – having small, more frequent meals or snacks rather than conventional larger meals at set times.
Food supplements, such as Build-Up® and Complan®, can be used in place of meals to add necessary calories. Your dietitian or specialist can give you advice if eating becomes a problem for you.
Our booklets on eating well may be helpful. Occasionally, if you continue to lose weight, you may need to spend a short time in hospital so that you can be fed in other ways. Liquid food can be given into a vein (intravenously) or by a tube through your nose and into your stomach (a nasogastric or NG tube) until you are able to eat properly again.
Pain while passing urine
Inflammation of the bladder (cystitis) may develop during radiotherapy to the lower abdomen, usually after several treatments have been given. You may notice a burning sensation or discomfort when you pass urine, and feel that you need to pass water more often than usual, including during the night.
Drinking more fluids will help to relieve these symptoms, but try to avoid coffee, tea, alcohol and acidic fruit juices such as orange juice, as these irritate the bladder and will make the symptoms worse. Some people find that cranberry juice or lemon barley water help to reduce the symptoms. If necessary, medicines can be given to treat these symptoms.
See our detailed information about how to cope with the Side effects of pelvic radiotherapy in women and men.
Also see the Effects of pelvic radiotherapy on fertility and sexuality.
Radiotherapy and complementary therapies
Complementary therapies can help to improve your quality of life and wellbeing and can sometimes help to reduce the side effects of radiotherapy. Many people find that complementary therapies or practices can help them to feel stronger and more confident in dealing with radiotherapy. These therapies can be used alongside conventional treatments and medicines. Some complementary therapies, such as meditation or visualisation, can be done by the person with cancer themselves and can help to reduce anxiety. Other therapies, such as gentle massage, can be carried out by relatives or carers and can help them to support the person with cancer.
Physical contact and touch can be among the most powerful forms of support for people who are faced with uncertainty, fear or pain, whether emotional or physical. Touching someone gently can express how much you care about them.
Some hospitals offer complementary therapies alongside conventional care. These may include:
Relaxation
Deep relaxation is a skill which can be learned. It can be used to help:
Relaxation is not simply 'taking it easy', but involves making time to reflect on problems or anxieties and, hopefully, develop a positive mental outlook.
There are several different relaxation techniques which can be self-taught from books or tapes. You can get these from your local library, bookshop and some chemists. Therapists and groups throughout the country also teach particular relaxation methods.
Effects of radiotherapy on sexuality
Radiotherapy can sometimes cause physical changes that may affect your sex life. If you are having problems, it may help to talk these over with your partner and your medical team. Although it can be embarrassing to talk to health professionals about such intimate things, remember that they are used to dealing with these issues and can suggest things that will help you.You can also get advice and support from the British Association of Sexual and Relationship Therapy. You may also wish to phone our cancer support specialists.
On this page
For women
External and internal radiotherapy to the pelvis usually affects the ovaries. Radiotherapy to the ovaries will cause the menopause. This may happen gradually over a few months. The normal signs of the menopause will develop, such as hot flushes, dry skin and dryness in the vagina. This can be very distressing, particularly for younger women who are not prepared for the menopause. Depending on your type of tumour, your doctor may prescribe hormone replacement therapy, which can help to overcome these problems. Occasionally – for example, when treating some types of cancer called lymphomas – the ovaries may be moved out of the treatment area and into the upper part of the abdomen. This is done by an operation before the radiotherapy treatment. Your specialist can tell you more about this.
Radiotherapy to the vaginal area can occasionally make the vagina narrower. The radiotherapy staff will show you how to use vaginal dilators and a lubricant to keep your vagina supple once you have finished treatment.
At first you may find sex uncomfortable, and it may be helpful to use a lubricant such as KY Jelly®, which you can buy at your local chemist. Regular sex may help to prevent narrowing of the vagina, but many women will not feel ready to return to a regular sex life while they have the side effects of radiotherapy. This is very natural; your interest in sex will usually come back as the effects of treatment wear off. In the meantime, using a dilator is an effective way of keeping your vagina healthy.
Our JASCAP booklet on Sexuality and cancer offers useful information.
For men
Men who have radiotherapy may have some problems with sex. It may be that you lose interest in sex or become temporarily unable to have an erection (impotent) because of your anxiety about your illness, or worries about the future, or because the treatment is making you too tired to think about sex. These effects may last for a few weeks after radiotherapy has finished, and can be very distressing.
Radiotherapy to the pelvis to treat bladder, rectal or prostate cancer may cause impotence, which may develop months or years after your radiotherapy is finished. Talking openly to your partner about your problems may help, and you can ask the radiotherapy staff about any problems that you have. There are practical ways to overcome impotence and these are discussed in detail in our section on sexuality and cancer.
Contraception
It is very important for women of childbearing age to use effective contraception throughout their radiotherapy treatment. Radiotherapy could cause a miscarriage or cause a child to be born with abnormalities. If you think that you may be pregnant when you are told that you are to have radiotherapy treatment, it’s extremely important to let your clinical oncologist know. The oncologist will discuss with you whether the treatment can be delayed until the baby is born.
Effects of radiotherapy on fertility
On this page
In women
Most radiotherapy treatment has no effect on your ability to have children, unless the ovaries are included in the radiotherapy treatment area.
Many healthy babies have been born to parents who have had radiotherapy, and the risk of having a baby with health problems is not increased if you have had treatment in the past. Many specialists recommend that women wait for about two years after having radiotherapy before trying to get pregnant, to give the body a chance to get over the effects of the cancer and its treatment.
If radiotherapy treatment is given for cancer of the cervix or ovary and includes the ovaries, temporary or permanent infertility is likely. This can be very difficult to come to terms with.
In men
In men, sperm production can be reduced if the testicles are in the area being treated, and this can lead to temporary or permanent infertility. Fortunately, it is usually possible to avoid giving radiotherapy to the testicles as part of treatment for the cancers that are most common in younger men. Radiotherapy for prostate or bladder cancers is likely to cause permanently low sperm counts.
Information about fertility
Before you have radiotherapy, your specialist should discuss with you the possibility that it may lead to infertility, and will normally ask you to sign a form consenting to treatment. Understandably, this can be a traumatic time, particularly for young people who were planning to have children. If you have a partner, they will be encouraged to join in this meeting, giving both of you a chance to discuss any worries you may have and talk them through.
Sperm banking and egg storage
Sometimes it may be possible for men to store sperm before they have radiotherapy. The sperm are frozen and can be stored for several years until the couple are ready to have children. This is known as sperm banking.
Before treatment starts women may be able to store fertilised eggs (embryos) using sperm from a partner. It can take between 4–6 weeks to collect the eggs and won’t be possible if treatment
needs to start straight away. It is now sometimes possible to store a woman's unfertilised eggs as well, although this is still at a very early, experimental stage and the service is not widely available. See also our Fertility and cancer booklet.
Contraception
Even if your treatment is likely to make you infertile, you may be strongly advised to use a reliable form of birth control. If pregnancy occurs during or shortly after radiotherapy, there is a possibility of damage to the baby.
Feelings about sexuality and infertility
It is not easy to come to terms with the prospect of infertility, or any of the side effects of your treatment. It will take a while for you to sort out your emotions and be able to talk about them. When you're ready, it may help you to talk openly to your partner or a friend about these feelings. If they can understand how you feel it will probably be easier for them to offer help and support. Some people prefer to talk to someone they don't know. Support groups offer you the chance to talk to other people who have been through a similar experience. Another possibility is to talk things over with a counsellor. Your hospital may offer a counselling service. Our information nurses can give you details of how to find counsellors in your local area or see our list of counselling organisations.
Your emotions and radiotherapy
'During my radiotherapy I became very emotional. I would start crying for no reason.'
This is how one woman felt. Another described herself as being 'very weepy', not during the treatment but a couple of weeks afterwards. These emotions are shared by many people who have radiotherapy, or any treatment for cancer. It can be very difficult to try to come to terms not only with the illness itself but also with the treatments and possible side effects.
Many people who have radiotherapy will already have had some cancer treatment; for others this may be the beginning of a long treatment period. Radiotherapy can bring about physical changes which are very distressing, such as the menopause or hair loss.
We all have our own ways of coping with difficulties. Some people have a close network of family and friends who give emotional support. Others would rather seek help from people who are not involved in their illness. Either way it is important to know that support is available if you need it.
You can ask at your treatment hospital if help is available locally.
You will also find useful advice in the following booklets:
The nurses at our cancer support service can give you information on all aspects of cancer and its treatment, and on the practical and emotional problems of living with the illness. Some people find it helpful to talk through their feelings with a trained counsellor.
NOTE: JASCAP has booklets on each of the above subjects.
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