Effects of Radiotherapy on Cancer

The Importance of Radiation Therapy for Cancer

Radiation therapy for cancer is one of the most common cancer treatments, employed in over half of cancer cases. It can be utilized to treat nearly all types of cancer and is particularly effective at destroying the genetic material of rapidly dividing cells, a characteristic that distinguishes cancer cells from many normal cells in the body. Cancer cells also exhibit a reduced ability to repair damage to their genetic material compared to normal cells, which in turn increases the efficacy of radiation therapy in combating cancer.

Safety of Radiation Therapy

Radiation therapy has been successfully utilized for over 100 years, and the techniques, efficacy, and safety of radiation treatment have improved significantly over recent years. Healthcare providers carefully prepare the appropriate equipment and dose tailored to the individual patient before commencing treatment.

Indications for Radiation Therapy Use

Radiation therapy can be an essential treatment for cancer or can serve as an adjunct therapy alongside other treatment modalities, such as chemotherapy, to enhance therapeutic response and inhibit cancer cell metastasis. Below are some scenarios where radiation therapy is particularly indicated:

Main Treatment: In certain cases of cancer, such as specific types of prostate cancer and laryngeal cancer, radiation therapy may be the sole treatment.
Adjuvant Treatment: Radiation therapy may be employed as an adjunct in conjunction with other treatments, such as surgical and chemotherapy interventions for breast cancer. It can also be used pre-surgery to shrink tumors or post-surgery to suppress the growth of any remaining cancer cells.
Palliative Care: This type of radiation therapy focuses solely on relieving cancer symptoms in advanced disease stages, such as reducing lung tumors to alleviate breathing difficulties.

Side Effects of Radiation Therapy for Cancer

Some patients may experience few or no side effects from radiation therapy, while others may experience varying degrees of side effects. Most side effects can be treated or prevented, often subsiding after the completion of treatment. Predicting the potential side effects is challenging, as they are influenced by various factors, including the treatment area, type of radiation therapy used, and the patient’s overall health. Radiation therapy typically affects a specific area of the body, which helps to minimize associated side effects. For instance, hair loss generally only occurs if radiation is applied to the head.

Timing of Radiation Therapy Side Effects

Side effects from radiation therapy can be categorized as early or late effects. Early side effects manifest during or shortly after treatment, lasting several weeks and may include fatigue, skin disturbances, and, most commonly, hair loss and nausea. Late effects may arise years later, impacting organs such as the heart and lungs.

Common General Side Effects of Radiation Therapy

Fatigue

Fatigue is a prevalent side effect associated with cancer and radiation therapy, causing patients to feel physically, emotionally, and mentally drained. This feeling typically emerges weeks into treatment, stemming from the destruction of some healthy cells during the process, as well as stress related to frequent visits to treatment centers. It’s important to note that treatment-related fatigue differs from typical daily fatigue. While it usually resolves some time after treatment concludes, the following strategies may help mitigate fatigue:

Maintain overall health, follow a balanced diet, adhere to the treatment plan, and ensure adequate rest.
Conserve energy for essential activities.
Consult healthcare providers for advice on preserving energy and managing stress, and avoid dwelling on feelings of fatigue.
Balance rest and activity, as excessive rest can lead to increased fatigue, while ensuring breaks between activities is essential.
Seek support from family and friends, and don’t hesitate to request time off work if fatigue affects job performance.

Skin Disorders

Patients undergoing radiation therapy may experience skin issues depending on the treatment area, typically occurring one to two weeks after starting treatment. Symptoms can include itching, dryness, sores, and skin peeling, which usually resolve a few weeks after treatment ends. It is crucial to consult a physician upon the appearance of these symptoms, as they may adjust the treatment plan or provide guidance on alleviating the discomfort. Here are some recommended strategies:

Moisturize the skin daily.
Avoid swimming in chlorinated water.
Refrain from scrubbing dry skin; pat it instead.
Wash affected areas daily with non-scented soap and water.
Steer clear of perfumes, scented soaps, and powders on affected areas.
Avoid shaving the treated area with razors whenever possible; consider using an electric razor instead.
Apply sunscreen before going outdoors to protect against sun exposure.
Wear loose-fitting, breathable clothing made from natural fibers and avoid tight garments.

Lymphedema

Lymphedema, or lymphatic swelling, is a common side effect that can occur with radiation therapy. It involves swelling caused by fluid accumulation under the skin due to the removal or damage of lymph nodes, which play a crucial role in fluid regulation and waste removal. Consequently, health issues affecting the lymph nodes can lead to blockages and gradual fluid buildup, often occurring in the arms and legs. Treatment aims to alleviate pain and swelling and may include:

Engaging in light exercise to assist with fluid drainage in the affected limb.
Wrapping the affected limb to facilitate fluid movement towards the torso.
Manual lymphatic drainage, a specialized massage technique that promotes fluid drainage from the affected area; however, it should be avoided if any skin infections or blood clot issues are present.
Pneumatic compression therapy, which uses inflatable garments to apply pressure to the affected area and promote fluid movement.
Wearing compression garments, such as stockings or sleeves, that apply pressure to help with fluid circulation.
In severe cases, surgical intervention may be necessary to remove excess tissue and reduce swelling, and modern surgical techniques may involve lymph node transplantation or redirecting lymphatic flow to veins.

Side Effects by Treatment Area

The side effects associated with radiation therapy can vary depending on the targeted area. Below are specific effects by treatment area:

Head and Neck

Radiation therapy targeting the head and neck can irritate the mucous membranes lining the mouth, throat, and upper esophagus. Other potential side effects include:

Oral ulcers.
Dry mouth.
Skin disorders.
Hair loss.
Altered taste sensation.
Loss of appetite.
Difficulties swallowing.
Jaw stiffness, known as trismus.
Nausea and vomiting.
Dental issues such as cavities.
Dry eyes and vision disturbances.
Ear pain and hearing loss in affected ears.
Nerve damage, which can cause vision and hearing issues, as well as weakness in the face, tongue, neck, and shoulders if major nerves are affected.
Osteoradionecrosis.
Voice changes such as hoarseness.
Hormonal imbalances due to potential impact on hormone-secreting glands such as the pituitary and thyroid glands.

Some strategies to mitigate these side effects include:

Avoiding mouthwashes containing alcohol and consulting a physician about suitable alternatives.
Gargling with a salt and baking soda solution every couple of hours to alleviate oral radiation effects, mixing one teaspoon of salt with half a teaspoon of baking soda.
Informing the physician if wearing dentures prior to treatment.
Avoiding sharp-edged foods like chips.
Opting for soft, moist foods.
Eating when hunger strikes, even outside of regular meal times.
Using sugar-free candies and gum to alleviate dry mouth.
Utilizing electric razors and avoiding alcohol-based shaving creams.
Inquiring about liquid nutritional supplements.
Carrying a water bottle for regular hydration.

Chest

Potential side effects associated with radiation therapy in the chest region include:

Coughing.
Shortness of breath.
Skin disorders.
Hair loss.
Fatigue.
Throat disturbances such as swallowing difficulties.

To ease these side effects, patients may consider the following:

Avoiding irritants like smoke.
Ensuring adequate intake of water and fluids to help thin mucus.
Using a home humidifier to combat mucus buildup, cleaning the device daily with water and vinegar solution.
Keeping arms supported on a table while seated for comfort.
Inhaling through the nose and exhaling slowly through pursed lips during episodes of shortness of breath.
Elevating head and chest while resting, potentially with specially designed pillows.

Pelvis

Radiation therapy to the pelvic area may lead to the following side effects:

Rectal bleeding.
Diarrhea.
Bladder irritation.
Urinary incontinence.

Additional side effects may differ between men and women:

Men: Some men may experience sexual dysfunction, including erectile dysfunction and reduced semen quantity and quality following radiation to the testes or prostate. Consultation with a physician regarding the impact of treatment on fertility is important.
Women: Women may also experience fertility issues, thus consulting a physician about potential impacts on fertility is crucial, particularly if the ovaries are affected. Menstrual disturbances such as menopause may occur, accompanied by symptoms like vaginal itching, burning, and dryness.

To alleviate these side effects, patients can follow the recommendations below:

Avoiding uncooked vegetables, fruits, and whole grains.
Dividing meals into smaller, more frequent servings.
Steering clear of alcohol and caffeine.
Drinking ample fluids daily, targeting about two liters.
Using contraception to avoid pregnancy during treatment.
Consulting a physician about medications to relieve symptoms like painful urination or reduce frequent bowel movements.

Brain

Radiation therapy for the brain can produce a variety of side effects, with brain swelling being a common issue. Steroids are often administered to reduce swelling in such cases. Additionally, many may experience hair loss on the scalp about two weeks after starting treatment, with hair regrowth typically occurring around three months after treatment cessation. To address the psychological impact of hair loss, discussions with healthcare providers and the option of wearing wigs during treatment may be beneficial. Other potential side effects from brain radiation therapy can include:

Fatigue.
Nausea and vomiting.
Headaches.
Vision disturbances.
Skin disorders.

Breasts

Women receiving radiation therapy to the breast may encounter side effects such as skin changes beginning two weeks into treatment, typically resolving several weeks after treatment concludes. These changes can include skin redness and, in rare cases, peeling blisters. There may also be a slight alteration in skin pigmentation post-treatment. Other symptoms may consist of breast tenderness, swelling, changes in breast size or texture, fatigue, and hair loss. Suggested strategies for managing these side effects include:

Consulting a physician regarding the use of deodorants.
Avoiding underwire bras, or exclusively wearing sports or surgical bras.
Refraining from intense exercise that causes excessive sweating to prevent skin irritation.

Abdomen

The side effects associated with radiation therapy in the abdominal region vary based on the treatment site. Upper gastrointestinal radiation may lead to irritation of the stomach and esophagus, while treatment to the lower gastrointestinal tract may irritate the small and large intestines. Potential abdominal side effects include:

Diarrhea.
Stomach ulcers.
Indigestion.
Loss of appetite.
Hair loss.
Abdominal bloating and gas.
Skin disorders.
Nausea and vomiting.
Kidney disturbances.
Radiation enteritis.

Most side effects subside following the conclusion of radiation therapy, and potential dietary adjustments along with medical guidance can assist in symptom management. Suggested strategies include:

Dividing meals into six smaller portions throughout the day.
Consuming light snacks like crackers or toast and sipping fluids such as apple juice before treatment if experiencing nausea.
Avoiding food intake immediately before and several hours after treatment if nausea persists.
Avoiding fatty, spicy, and fried foods.
Steering clear of hot foods and drinks.
Refraining from strong-smelling foods.

Long-Term Side Effects

While most side effects associated with radiation therapy typically resolve after treatment, some may persist for extended periods or appear long after treatment concludes. It is essential to note that the benefits of treatment often outweigh the risks of these side effects, which can include:

Development of secondary cancers due to radiation exposure.
Osteoporosis.
Changes in skin color.
Emotional and psychological changes.
Pulmonary or cardiac complications following chest radiation.
Fertility issues resulting from pelvic radiation.

When to Consult a Doctor Regarding Radiation Therapy Side Effects

Some side effects of radiation therapy warrant prompt medical attention. Symptoms to report include:

A fever surpassing 38 degrees Celsius, or experiencing chills.
Severe skin issues, including pain and purulence.
Bowel disturbances characterized by watery stools six times or more within a single day.
Noticing blood in the stool.
Inability to eat or drink for 12 consecutive hours.
Unexplained weight loss of approximately two kilograms.
Nausea and vomiting.
Difficulty breathing.
Vomiting three times within an hour for an extended period.
Inability to take medication due to stomach upset.