Radiationttherapy and You PDF
Radiationttherapy and You PDF
Radiationttherapy and You PDF
U.S. DEPARTMENT
OF HEALTH AND
HUMAN SERVICES
National Institutes
of Health
For More Information
This booklet is only one of many free booklets for people with cancer.
Here are some others you may find useful:
■ Biological Therapy
*For information about your specific type of cancer, see the PDQ®
database. PDQ® is NCI’s complete cancer database. You can find it at
www.cancer.gov.
Product or brand names that appear in this book are for example only. The U.S.
Government does not endorse any specific product or brand. If products or brands are
not mentioned, it does not mean or imply that they are not satisfactory.
1-800-4-CANCER (1-800-422-6237)
About This Book
Rather than
Radiation Therapy and You is written for you—someone who is about read this book
to get or is now getting radiation therapy for cancer. People who are
close to you may also find this book helpful. from beginning
This book is a guide that you can refer to throughout radiation therapy.
to end—
It has facts about radiation therapy and side effects and describes how look at only
you can care for yourself during and after treatment.
those sections
■ Side Effects and Ways To Manage Them. A chart that shows problems that may
happen as a result of treatment and ways you can help manage them.
■ Questions To Ask. Questions for you to think about and discuss with your doctor,
nurse, and others involved in your treatment and care.
■ Lists of Foods and Liquids. Foods and drinks you can have during radiation therapy.
■ Words To Know. A dictionary that clearly explains medical terms used in this book.
These terms are in bold print the first time they appear.
■ Ways To Learn More. Places to go for more information—in print, online (Internet),
and by telephone.
Talk with your doctor and nurse about the information in this book. They may suggest that
you read certain sections or follow some of the tips. Since radiation therapy affects people
in different ways, they may also tell you that some of the information in this book is not
right for you.
www.cancer.gov
Table of Contents
Rather than
Questions and Answers About Radiation Therapy...................... 1 read this book
External Beam Radiation Therapy .................................................... 9 from beginning
to end—
Internal Radiation Therapy .............................................................. 15
look at only
Your Feelings During Radiation Therapy ...................................... 19 those sections
Radiation Therapy Side Effects ........................................................ 21 you need now.
Radiation Therapy Side Effects At-A-Glance.........................................23 Later, you
Radiation Therapy Side Effects and Ways to Manage Them ...............24 can always
Diarrhea ..............................................................................................24 read more.
Fatigue .................................................................................................26
Hair Loss .............................................................................................28
Mouth Changes ..................................................................................30
Nausea and Vomiting ........................................................................34
Sexual and Fertility Changes ............................................................36
Skin Changes ......................................................................................40
Throat Changes ..................................................................................43
Urinary and Bladder Changes .........................................................45
Late Radiation Therapy Side Effects .......................................................47
www.cancer.gov
Questions and Answers About Radiation Therapy
Who gets Many people with cancer need radiation therapy. In fact, more
radiation therapy? than half (about 60 percent) of people with cancer get radiation
therapy. Sometimes, radiation therapy is the only kind of
cancer treatment people need.
What does Given in high doses, radiation kills or slows the growth of
radiation therapy cancer cells. Radiation therapy is used to:
do to cancer cells?
■ Treat cancer. Radiation can be used to cure, stop, or slow
the growth of cancer.
www.cancer.gov 1
How long does Radiation therapy does not kill cancer cells right away. It takes
radiation therapy days or weeks of treatment before cancer cells start to die. Then,
take to work? cancer cells keep dying for weeks or months after radiation
therapy ends.
What does Radiation not only kills or slows the growth of cancer cells, it
radiation therapy do can also affect nearby healthy cells. The healthy cells almost
to healthy cells? always recover after treatment is over. But sometimes people
may have side effects that do not get better or are severe.
Doctors try to protect healthy cells during treatment by:
Does radiation No, radiation therapy does not hurt while it is being given. But
therapy hurt? the side effects that people may get from radiation therapy can
cause pain or discomfort. This book has a lot of information
about ways that you, your doctor, and your nurse can help
manage side effects.
2 1-800-4-CANCER (1-800-422-6237)
Is radiation therapy Yes, radiation therapy is often used with other cancer
used with other types treatments. Here are some examples:
of cancer treatment?
■ Radiation therapy and surgery. Radiation may be
given before, during, or after surgery. Doctors may use
radiation to shrink the size of the cancer before surgery, or
they may use radiation after surgery to kill any cancer cells
that remain. Sometimes, radiation therapy is given during
surgery so that it goes straight to the cancer without passing
through the skin. This is called intraoperative radiation.
Who is on my Many people help with your radiation treatment and care. This
radiation therapy group of health care providers is often called the “radiation
team? therapy team.” They work together to provide care that is just
right for you. Your radiation therapy team can include:
www.cancer.gov 3
■ Radiation nurse. This person provides nursing care during
You are radiation therapy, working with all the members of your
the most radiation therapy team. He or she will talk with you about
your radiation treatment and help you manage side effects.
important part
of the radiation ■ Radiation therapist. This person works with you during
each radiation therapy session. He or she positions you for
therapy team. treatment and runs the machines to make sure you get the
dose of radiation prescribed by your radiation oncologist.
4 1-800-4-CANCER (1-800-422-6237)
Is radiation therapy Yes, radiation therapy costs a lot of money. It uses complex
expensive? machines and involves the services of many health care
providers. The exact cost of your radiation therapy depends on
the cost of health care where you live, what kind of radiation
therapy you get, and how many treatments you need.
Should I follow Your body uses a lot of energy to heal during radiation therapy.
a special diet It is important that you eat enough calories and protein to keep
while I am getting your weight the same during this time. Ask your doctor or
radiation therapy? nurse if you need a special diet while you are getting radiation
therapy. You might also find it helpful to speak with a dietitian.
To learn more about foods and drinks that are high in calories
or protein, see the chart on page 54. You may also want to
read Eating Hints, a book from the National Cancer Institute.
You can order a free copy online at http://www.cancer.gov/
publications or 1-800-4-CANCER.
www.cancer.gov 5
Can I go to work Some people are able to work full-time during radiation
during radiation therapy. Others can only work part-time or not at all. How
therapy? much you are able to work depends on how you feel. Ask your
doctor or nurse what you may expect based on the treatment
you are getting.
You are likely to feel well enough to work when you start
radiation therapy. As time goes on, do not be surprised if
you are more tired, have less energy, or feel weak. Once you
have finished your treatment, it may take a few weeks or many
months for you to feel better.
What happens Once you have finished radiation therapy, you will need
when radiation follow-up care for the rest of your life. Follow-up care refers to
therapy is over? checkups with your radiation oncologist or nurse practitioner
after your course of radiation therapy is over. During these
checkups, your doctor or nurse will see how well the radiation
therapy worked, check for other signs of cancer, look for late
side effects, and talk with you about your treatment and care.
Your doctor or nurse will:
6 1-800-4-CANCER (1-800-422-6237)
After radiation You have gone through a lot with cancer and radiation therapy.
therapy is over, Now you may be even more aware of your body and how you
what symptoms feel each day. Pay attention to changes in your body and let
should I look for? your doctor or nurse know if you have:
www.cancer.gov 7
External Beam Radiation Therapy
What is external beam External beam radiation therapy comes from a machine that
radiation therapy? aims radiation at your cancer. The machine is large and may be
noisy. It does not touch you, but rotates around you, sending
radiation to your body from many directions.
External beam radiation therapy comes from a machine that aims radiation
at your cancer.
How often will I Most people get external beam radiation therapy once a day,
get external beam 5 days a week, Monday through Friday. Treatment lasts for
radiation therapy? 2 to 10 weeks, depending on the type of cancer you have and
the goal of your treatment. The time between your first and last
radiation therapy sessions is called a course of treatment.
www.cancer.gov 9
Where do I go for Most of the time, you will get external beam radiation therapy
external beam as an outpatient. This means that you will have treatment at a
radiation therapy? clinic or radiation therapy center and will not have to stay in
the hospital.
What happens You will have a 1- to 2-hour meeting with your doctor or nurse
before my first before you begin radiation therapy. At this time, you will have a
external beam physical exam, talk about your medical history, and maybe have
radiation treatment? imaging tests. Your doctor or nurse will discuss external beam
radiation therapy, its benefits and side effects, and ways you
can care for yourself during and after treatment. You can then
choose whether to have external beam radiation therapy.
10 1-800-4-CANCER (1-800-422-6237)
■ You may need a body mold. This is a plastic or plaster form
that helps keep you from moving during treatment. It also
helps make sure that you are in the exact same position each
day of treatment.
If the body mold or mask makes you feel anxious, see page 13
for ways to relax during treatment.
What should I Wear clothes that are comfortable and made of soft fabric,
wear when I get such as cotton. Choose clothes that are easy to take off, since
external beam you may need to change into a hospital gown or show the area
radiation therapy? that is being treated. Do not wear clothes that are tight, such
as close-fitting collars or waistbands, near your treatment
area. Also, do not wear jewelry, BAND-AIDS®, powder, lotion,
or deodorant in or near your treatment area, and do not use
deodorant soap before your treatment.
www.cancer.gov 11
What happens during ■ You may be asked to change into a hospital gown or robe.
treatment sessions?
■ You will go to a treatment room where you will receive
radiation.
■ You will need to stay very still so the radiation goes to the
exact same place each time. You can breathe as you always
do and do not have to hold your breath.
The radiation therapist will leave the room just before your
treatment begins. He or she will go to a nearby room to
control the radiation machine and watch you on a TV screen
or through a window. You are not alone, even though it may
feel that way. The radiation therapist can see you on the screen
or through the window. He or she can hear and talk with you
through a speaker in your treatment room. Make sure to tell
the therapist if you feel sick or are uncomfortable. He or she
can stop the radiation machine at any time. You cannot feel,
hear, see, or smell radiation.
12 1-800-4-CANCER (1-800-422-6237)
Will external beam No, external beam radiation therapy does not make people
radiation therapy radioactive. You may safely be around other people, even
make me radioactive? babies and young children.
How can I relax ■ Bring something to read or do while in the waiting room.
during my treatment
sessions? ■ Ask if you can listen to music or books on tape.
www.cancer.gov 13
Internal Radiation Therapy
What happens You will have a 1- to 2-hour meeting with your doctor or nurse
before my first internal before you begin internal radiation therapy. At this time, you
radiation treatment? will have a physical exam, talk about your medical history, and
maybe have imaging tests. Your doctor will discuss the type
of internal radiation therapy that is best for you, its benefits
and side effects, and ways you can care for yourself during and
after treatment. You can then choose whether to have internal
radiation therapy.
www.cancer.gov 15
What happens when You will most likely be in the hospital when your catheter or
the catheter or applicator is put in place. Here is what to expect:
applicator is ■ You will either be put to sleep or the area where the catheter
put in place? or applicator goes will be numbed. This will help prevent
pain when it is put in.
■ If you are awake, you may be asked to lie very still while
the catheter or applicator is put in place. If you feel any
discomfort, tell your doctor or nurse so he or she can give
you medicine to help manage the pain.
What happens Once your treatment plan is complete, radiation will be placed
after the catheter or inside the catheter or applicator. The radiation source may be
applicator is placed kept in place for a few minutes, many days, or the rest of your
in my body? life. How long the radiation is in place depends on which type of
brachytherapy you get, your type of cancer, where the cancer is in
your body, your health, and other cancer treatments you have had.
16 1-800-4-CANCER (1-800-422-6237)
■ Permanent implants. After the radiation source is put in
place, the catheter is removed. The implants always stay in
your body, while the radiation gets weaker each day. You
may need to limit your time around other people when
the radiation is first put in place. Be extra careful not to
spend time with children or pregnant women. As time goes
by, almost all the radiation will go away, even though the
implant stays in your body.
What happens ■ Your body will give off radiation once the radiation source is
while the radiation in place. With brachytherapy, your body fluids (urine, sweat,
is in place? and saliva) will not give off radiation. With liquid radiation,
your body fluids will give off radiation for a while.
www.cancer.gov 17
You may also need to follow safety measures once you leave
the hospital, such as not spending much time with other
people. Your doctor or nurse will talk with you about the safety
measures you should follow when you go home.
What happens when ■ You will get medicine for pain before the catheter or
the catheter is taken applicator is removed.
out after treatment
with LDR or HDR ■ The area where the catheter or applicator was might be
implants? tender for a few months.
18 1-800-4-CANCER (1-800-422-6237)
Your Feelings During Radiation Therapy
■ Anxious
■ Depressed
■ Helpless
■ Alone
How can I cope There are many things you can do to cope with your feelings
with my feelings during treatment. Here are some things that have worked for
during radiation other people:
therapy?
■ Relax and meditate. You might try thinking of yourself in
a favorite place, breathing slowly while paying attention to
each breath, or listening to soothing music. These kinds of
activities can help you feel calmer and less stressed.
www.cancer.gov 19
chance to talk about your feelings and listen to other people
talk about theirs. You can learn how others cope with
cancer, radiation therapy, and side effects. Your doctor,
nurse, or social worker can tell you about support groups
near where you live. Some support groups also meet over
the Internet, which can be helpful if you cannot travel or
find a meeting in your area.
Ways to To learn more about ways to cope with your feelings, read
Learn More Taking Time: Support for People with Cancer, a book from
the National Cancer Institute. You can get a free copy at
http://www.cancer.gov/publications or 1-800-4-CANCER
(1-800-422-6237).
CancerCare, Inc.
Offers free support, information, financial assistance, and
practical help to people with cancer and their loved ones.
Toll-free: 1-800-813-HOPE (1-800-813-4673)
E-mail: [email protected]
Online: http://www.cancercare.org
20 1-800-4-CANCER (1-800-422-6237)
Radiation Therapy Side Effects
Common Many people who get radiation therapy have skin changes and
Side Effects some fatigue. Other side effects depend on the part of your
body being treated.
Skin changes may include dryness, itching, peeling, or
blistering. These changes occur because radiation therapy
damages healthy skin cells in the treatment area. You will need
to take special care of your skin during radiation therapy. To
learn more, see page 40.
Fatigue is often described as feeling worn out or exhausted.
There are many ways to manage fatigue. To learn more, see
page 26.
Depending on the part of your body being treated, you may
also have:
www.cancer.gov 21
Late side effects may first occur 6 or more months after
radiation therapy is over. They vary by the part of your body
that was treated and the dose of radiation you received.
Late side effects may include infertility, joint problems,
lymphedema, mouth problems, and secondary cancer.
Everyone is different, so talk to your doctor or nurse about
whether you might have late side effects and what signs to look
for. See page 47 for more information on late side effects.
Radiation Therapy Radiation therapy side effects depend on the part of your body
Side Effects being treated. You can use the chart on page 23 to see which
At-A-Glance side effects might affect you. Find the part of your body being
treated in the column on the left, then read across the row to
see the side effects. A checkmark means that you may get this
side effect. Ask your doctor or nurse about your chances of
getting each side effect.
To learn more about each side effect, see the page listed in the
top row of the table on page 23.
22 1-800-4-CANCER (1-800-422-6237)
Radiation Therapy Side Effects At-A-Glance
■ Find the part of your body being treated in the column on the left.
Diarrhea Fatigue Hair Loss Mouth Nausea Sexual Skin Throat Urinary Other
(on the Changes and and Changes Changes and Side
part of Vomiting Fertility Bladder Effects
the body Changes Changes
being
treated)
Brain 4 4 4 4 Headache
Blurry vision
Breast 4 4 4 Tenderness
Swelling
Chest Cough
4 4 4 4
Shortness
of breath
Pelvic
Area
4 4 4 4 4 4 4
Rectum 4 4 4 4 4 4
Stomach
and 4 4 4 4 4 4
Abdomen
www.cancer.gov 23
Radiation Therapy Side Effects and Ways to Manage Them
Diarrhea
What it is
Diarrhea is frequent bowel movements which may be soft,
formed, loose, or watery. Diarrhea can occur at any time
during radiation therapy.
Why it occurs
Radiation therapy to the pelvis, stomach, and abdomen
can cause diarrhea. People get diarrhea because radiation
harms the healthy cells in the large and small bowels.
These areas are very sensitive to the amount of radiation Radiation to the shaded area may
needed to treat cancer. cause diarrhea.
Ways to manage
When you have diarrhea:
■ Drink 8 to 12 cups of clear liquid per day. See page 53 for ideas of drinks and foods
that are clear liquids.
If you drink liquids that are high in sugar (such as fruit juice, sweet iced tea, Kool-Aid®,
or Hi-C®) ask your nurse or dietitian if you should mix them with water.
■ Eat many small meals and snacks. For instance, eat 5 or 6 small meals and snacks
rather than 3 large meals.
■ Eat foods that are easy on the stomach (which means foods that are low in fiber,
fat, and lactose). See page 55 for other ideas of foods that are easy on the stomach. If
your diarrhea is severe, your doctor or nurse may suggest the BRAT diet, which stands
for bananas, rice, applesauce, and toast.
24 1-800-4-CANCER (1-800-422-6237)
■ Take care of your rectal area. Instead of toilet paper, use
a baby wipe or squirt of water from a spray bottle to clean
yourself after bowel movements. Also, ask your nurse about
taking sitz baths, which is a warm-water bath taken in a sitting
position that covers only the hips and buttocks. Be sure to tell
your doctor or nurse if your rectal area gets sore.
■ Talk to your doctor or nurse. Tell them if you are having diarrhea. He or she will
suggest ways to manage it. He or she may also suggest taking medicine, such as
Imodium®.
To learn more about dealing with diarrhea during cancer treatment, see Eating Hints: Before,
During, and After Cancer Treatment, a book from the National Cancer Institute. You can get
a free copy at http://www.cancer.gov/publications or 1-800-4-CANCER (1-800-422-6237).
www.cancer.gov 25
Radiation Therapy Side Effects and Ways to Manage Them
Fatigue
What it is
Fatigue from radiation therapy can range from a mild to Fatigue is a common
an extreme feeling of being tired. Many people describe
fatigue as feeling weak, weary, worn out, heavy, or slow. side effect, and there
is a good chance that
Why it occurs you will feel some
level of fatigue from
Fatigue can happen for many reasons. These include:
radiation therapy.
■ Anemia
■ Anxiety
■ Depression
■ Infection
■ Lack of activity
■ Medicines
Fatigue can also come from the effort of going to radiation therapy each day or from stress.
Most of the time, you will not know why you feel fatigue.
Ways to manage
■ Try to sleep at least 8 hours each night. This may be more sleep
than you needed before radiation therapy. One way to sleep better
at night is to be active during the day. For example, you could go
for walks, do yoga, or ride a bike. Another way to sleep better at
night is to relax before going to bed. You might read a book, work
on a jigsaw puzzle, listen to music, or do other calming hobbies.
26 1-800-4-CANCER (1-800-422-6237)
■ Plan time to rest. You may need to nap during the day. Many people say that it helps
to rest for just 10 to 15 minutes. If you do nap, try to sleep for less than 1 hour at a time.
■ Try not to do too much. With fatigue, you may not have enough energy to do all the
things you want to do. Stay active, but choose the activities that are most important to
you. For example, you might go to work but not do housework, or watch your children’s
sports events but not go out to dinner.
■ Exercise. Most people feel better when they get some exercise each day. Go for a
15- to 30-minute walk or do stretches or yoga. Talk with your doctor or nurse about
how much exercise you can do while having radiation therapy.
■ Plan a work schedule that is right for you. Fatigue may affect
the amount of energy you have for your job. You may feel well
enough to work your full schedule, or you may need to work
less—maybe just a few hours a day or a few days each week. You
may want to talk with your boss about ways to work from home
so you do not have to commute. And you may want to think
about going on medical leave while you have radiation therapy.
■ Plan a radiation therapy schedule that makes sense for you. You may want to
schedule your radiation therapy around your work or family schedule. For example,
you might want to have radiation therapy in the morning so you can go to work in the
afternoon.
■ Let others help you at home. Check with your insurance company to see whether it
covers home care services. You can also ask family members and friends to help when
you feel fatigue. Home care staff, family members, and friends can assist with household
chores, running errands, or driving you to and from radiation therapy visits. They
might also help by cooking meals for you to eat now or freeze for later.
■ Learn from others who have cancer. People who have cancer can help each other by
sharing ways to manage fatigue. One way to meet other people with cancer is by joining
a support group—either in person or online. Talk with your doctor or nurse to learn
more about support groups.
■ Talk with your doctor or nurse. If you have trouble dealing with fatigue, your doctor
may prescribe medicine (called psychostimulants) that can help decrease fatigue, give
you a sense of well-being, and increase your appetite. Your doctor may also suggest
treatments if you have anemia, depression, or are not able to sleep at night.
www.cancer.gov 27
Radiation Therapy Side Effects and Ways to Manage Them
Hair Loss
What it is You will lose hair only
Hair loss (also called alopecia) is when some or all
on the part of your
of your hair falls out.
body being treated.
Why it occurs
Radiation therapy can cause hair loss because it damages cells that grow quickly, such as
those in your hair roots.
Hair loss from radiation therapy only happens on the part of your body being treated. This
is not the same as hair loss from chemotherapy, which happens all over your body. For
instance, you may lose some or all of the hair on your head when you get radiation to your
brain. But if you get radiation to your hip, you may lose pubic hair (between your legs) but
not the hair on your head.
Once your hair starts to grow back, it may not look or feel the way it did before. Your hair
may be thinner, or curly instead of straight. Or it may be darker or lighter in color than it
was before.
28 1-800-4-CANCER (1-800-422-6237)
■ If you plan to buy a wig, do so while you still have
hair. The best time to select your wig is before radiation
therapy begins or soon after it starts. This way, the wig
will match the color and style of your own hair. Some
people take their wig to their hair stylist. You will want
to have your wig fitted once you have lost your hair.
Make sure to choose a wig that feels comfortable and
does not hurt your scalp.
■ Check with your health insurance company to see whether it will pay for your
wig. If it does not, you can deduct the cost of your wig as a medical expense on your
income taxes. Some groups also sponsor free wig banks. Ask your doctor, nurse, or
social worker if he or she can refer you to a free wig bank in your area.
■ Be gentle when you wash your hair. Use a mild shampoo, such as a baby shampoo.
Dry your hair by patting (not rubbing) it with a soft towel.
■ Do not use curling irons, electric hair dryers, curlers, hair bands, clips, or hair
sprays. These can hurt your scalp or cause early hair loss.
■ Do not use products that are harsh on your hair. These include hair colors, perms,
gels, mousse, oil, grease, or pomade.
■ Stay warm. Your hair helps keep you warm, so you may feel
colder once you lose it. You can stay warmer by wearing a hat, turban, scarf, or wig.
www.cancer.gov 29
Radiation Therapy Side Effects and Ways to Manage Them
Mouth Changes
What they are
Radiation therapy to the head or neck can cause problems such as:
■ Loss of taste
■ Tooth decay
■ Jaw stiffness and bone changes Radiation to the shaded area may
cause mouth changes.
■ Thick, rope-like saliva
30 1-800-4-CANCER (1-800-422-6237)
Ways to manage
■ If you are getting radiation therapy to your head or neck, visit a dentist at least 2
weeks before treatment starts. At this time, your dentist will examine your teeth and
mouth and do any needed dental work to make sure your mouth is as healthy as possible
before radiation therapy. If you cannot get to the dentist before treatment starts, ask
your doctor if you should schedule a visit soon after treatment begins.
■ Check your mouth every day. This way, you can see or feel
problems as soon as they start. Problems can include mouth
sores, white patches, or infection.
www.cancer.gov 31
■ Be careful what you eat when your mouth is sore.
• Choose foods that are easy to chew and swallow.
• Take small bites, chew slowly, and sip liquids with your meals.
• Eat moist, soft foods such as cooked cereals, mashed potatoes, and scrambled eggs.
• Wet and soften food with gravy, sauce, broth, yogurt, or other liquids.
• Eat foods that are warm or at room temperature.
■ Stay away from things that can hurt, scrape, or burn your mouth, such as:
• Sharp, crunchy foods such as potato or corn chips
• Hot foods
• Spicy foods such as hot sauce, curry dishes, salsa, and chili
• Fruits and juices that are high in acid such as tomatoes, oranges, lemons,
and grapefruits
• Toothpicks or other
sharp objects Do not use tobacco or drink alcohol
• All tobacco products, while you are getting radiation
including cigarettes, pipes, therapy to your head or neck.
cigars, and chewing tobacco
• Drinks that contain alcohol
■ Stay away from foods and drinks that are high in sugar. Foods and drinks that
have a lot sugar (such as regular soda, gum, and candy) can cause tooth decay.
32 1-800-4-CANCER (1-800-422-6237)
■ Medicine. Ask your doctor or nurse about medicines that can protect your saliva
glands and the moist tissues that line your mouth.
■ Call your doctor or nurse when your mouth hurts. There are medicines and other
products, such as mouth gels, that can help control mouth pain.
■ You will need to take extra good care of your mouth for the rest of your life. Ask
your dentist how often you will need dental check-ups and how best to take care of your
teeth and mouth after radiation therapy is over.
Phone: 301-402-7364
Online: http://www.nidcr.nih.gov
Smokefree.gov
Provides resources, including information on quit lines, a step-by-step cessation guide, and
publications, to help you or someone you care about quit smoking.
www.cancer.gov 33
Radiation Therapy Side Effects and Ways to Manage Them
Ways to manage
■ Prevent nausea. The best way to keep from vomiting is to prevent nausea. One way
to do this is by having bland, easy-to-digest foods and drinks that do not upset your
stomach. These include toast, gelatin, and apple juice. To learn more, see the list of
foods and drinks that are easy on the stomach on page 55.
34 1-800-4-CANCER (1-800-422-6237)
■ Plan when to eat and drink. Some people feel better when they eat before radiation
therapy; others do not. Learn the best time for you to eat and drink. For example, you
might want a snack of crackers and apple juice 1 to 2 hours before radiation therapy.
Or, you might feel better if you have treatment on an empty stomach, which means not
eating 2 to 3 hours before treatment.
To learn more about dealing with nausea and vomiting during cancer treatment, see
Eating Hints: Before, During, and After Cancer Treatment, a book from the National
Cancer Institute. You can get a free copy at http://www.cancer.gov/publications or
1-800-4-CANCER (1-800-422-6237).
www.cancer.gov 35
Radiation Therapy Side Effects and Ways to Manage Them
36 1-800-4-CANCER (1-800-422-6237)
Why they occur
Sexual and fertility changes can happen when people get radiation therapy to the pelvic
area. For women, this includes radiation to the vagina, uterus, or ovaries. For men, this
includes radiation to the testicles or prostate. Many sexual side effects are caused by scar
tissue from radiation therapy. Other problems, such as fatigue, pain, anxiety, or depression,
can affect your interest in having sex.
Ways to manage
For both men and women, it is important to be open and
honest with your spouse or partner about your feelings,
concerns, and how you prefer to be intimate while you are
getting radiation therapy.
For women, here are some issues to discuss with your doctor or nurse:
■ Fertility. Before radiation therapy starts, let your doctor or nurse know if you think
you might want to get pregnant after your treatment ends. He or she can talk with you
about ways to preserve your fertility, such as preserving your eggs to use in the future.
■ Sexual problems. You may or may not have sexual problems. Your doctor or nurse
can tell you about side effects you can expect and suggest ways for coping with them.
■ Birth control. It is very important that you do not get pregnant while having radiation
therapy. Radiation therapy can hurt the fetus at all stages of pregnancy. If you have not
yet gone through menopause, talk with your doctor or nurse about birth control and
ways to keep from getting pregnant.
■ Pregnancy. Make sure to tell your doctor or nurse if you are already pregnant.
www.cancer.gov 37
■ Stretching your vagina. Vaginal stenosis is a common problem for women who have
radiation therapy to the pelvis. This can make it painful to have sex. You can help by
stretching your vagina using a dilator (a device that gently stretches the tissues of the
vagina). Ask your doctor or nurse where to find a dilator and how to use it.
■ Lubrication. Use a special lotion for your vagina (such as Replens®) once a day to keep
it moist. When you have sex, use a water- or mineral oil-based lubricant (such as K-Y
Jelly® or Astroglide®).
■ Sex. Ask your doctor or nurse whether it is okay for you to have sex during radiation
therapy. Most women can have sex, but it is a good idea to ask and be sure. If sex is
painful due to vaginal dryness, you can use a water- or mineral oil-based lubricant.
For men, here are some issues to discuss with your doctor or nurse:
■ Fertility. Before you start radiation therapy, let your doctor or nurse know if you think
you might want to father children in the future. He or she may talk with you about ways
to preserve your fertility before treatment starts, such as banking your sperm. Your
sperm will need to be collected before you begin radiation therapy.
■ Impotence. Your doctor or nurse can let you know whether you are likely to become
impotent and how long it might last. Your doctor can prescribe medicine or other
treatments that may help.
■ Sex. Ask if it is okay for you to have sex during radiation therapy. Most men can have
sex, but it is a good idea to ask and be sure.
38 1-800-4-CANCER (1-800-422-6237)
Ways to learn more
American Cancer Society
Offers a variety of services to patients and their families. It also supports research, provides
printed materials, and conducts educational programs.
fertileHope
Dedicated to helping people with cancer faced with infertility.
www.cancer.gov 39
Radiation Therapy Side Effects and Ways to Manage Them
Skin Changes
What they are
Radiation therapy can cause skin changes in your treatment area. Here are some common
skin changes:
■ Redness. Your skin in the treatment area may look as if you have a mild to severe
sunburn or tan. This can occur on any part of your body where you are getting
radiation.
■ Pruritus. The skin in your treatment area may itch so much that you always feel
like scratching. This causes problems because scratching too much can lead to skin
breakdown and infection.
■ Dry and peeling skin. This is when the skin in your treatment area gets very dry—
much drier than normal. In fact, your skin may be so dry that it peels like it does after
a sunburn.
■ Moist reaction. Radiation kills skin cells in your treatment area, causing your skin to
peel off faster than it can grow back. When this happens, you can get sores or ulcers.
The skin in your treatment area can also become wet, sore, or infected. This is more
common where you have skin folds, such as your buttocks, behind your ears, under your
breasts. It may also occur where your skin is very thin, such as your neck.
■ Swollen skin. The skin in your treatment area may be swollen and puffy.
40 1-800-4-CANCER (1-800-422-6237)
Ways to manage
■ Skin care. Take extra good care of
your skin during radiation therapy. Take extra good care of your
Be gentle and do not rub, scrub, skin during radiation therapy.
or scratch in the treatment area.
Be gentle and do not rub, scrub,
Also, use creams that your doctor
prescribes. or scratch.
■ Be gentle when you shower or take a bath. You can take a lukewarm shower every
day. If you prefer to take a lukewarm bath, do so only every other day and soak for less
than 30 minutes. Whether you
take a shower or bath, make sure to
use a mild soap that does not have Be careful not to wash off the
fragrance or deodorant in it. Dry ink markings you need for
yourself with a soft towel by patting,
radiation therapy.
not rubbing, your skin. Be careful
not to wash off the ink markings
that you need for radiation therapy.
■ Use only those lotions and skin products that your doctor or nurse suggests. If
you are using a prescribed cream for a skin problem or acne, you must tell your doctor
or nurse before you begin radiation treatment. Check with your doctor or nurse before
using any of the following skin products:
• Bubble bath • Hair removers • Perfume
• Cornstarch • Makeup • Powder
• Cream • Oil • Soap
• Deodorant • Ointment • Sunscreen
■ Cool, humid places. Your skin may feel much better when you are in cool, humid
places. You can make rooms more humid by putting a bowl of water on the radiator
or using a humidifier. If you use a humidifier, be sure to follow the directions about
cleaning it to prevent bacteria.
■ Soft fabrics. Wear clothes and use bed sheets that are soft, such as those made
from cotton.
■ Do not wear clothes that are tight and do not breathe, such as girdles
and pantyhose.
www.cancer.gov 41
■ Protect your skin from the sun every day. The sun can burn
you even on cloudy days or when you are outside for just a few
minutes. Do not go to the beach or sun bathe. Wear a broad-
brimmed hat, long-sleeved shirt, and long pants when you are
outside. Talk with your doctor or nurse about sunscreen lotions.
He or she may suggest that you use a sunscreen with an SPF of 30 or
higher. You will need to protect your skin from the sun even after radiation therapy is
over, since you will have an increased risk of skin cancer for the rest of your life.
■ Do not use tanning beds. Tanning beds expose you to the same harmful effects as
the sun.
■ Adhesive tape. Do not put bandages, BAND-AIDS®, or other types of sticky tape on
your skin in the treatment area. Talk with your doctor or nurse about ways to bandage
without tape.
■ Shaving. Ask your doctor or nurse if you can shave the treated area. If you can shave,
use an electric razor and do not use pre-shave lotion.
■ Rectal area. If you have radiation therapy to the rectal area, you
are likely to have skin problems. These problems are often worse
after a bowel movement. Clean yourself with a baby wipe or
squirt of water from a spray bottle. Also ask your nurse about sitz
baths (a warm-water bath taken in a sitting position that covers
only the hips and buttocks.)
42 1-800-4-CANCER (1-800-422-6237)
Radiation Therapy Side Effects and Ways to Manage Them
Throat Changes
What they are
Radiation therapy to the neck or chest can cause the lining of your
throat to become inflamed and sore. This is called esophagitis.
You may feel as if you have a lump in your throat or burning in
your chest or throat. You may also have trouble swallowing.
Radiation to the shaded area
may cause throat changes.
Why they occur
Radiation therapy to the neck or chest can cause throat changes because it not only kills cancer
cells, but can also damage the healthy cells that line your throat. Your risk for throat changes
depends on how much radiation you are getting, whether you are also having chemotherapy,
and whether you use tobacco and alcohol while you are getting radiation therapy.
Ways to manage
■ Be careful what you eat when your throat is sore.
• Choose foods that are easy to swallow.
• Cut, blend, or shred foods to make them easier to eat.
• Eat moist, soft foods such as cooked cereals, mashed potatoes, and scrambled eggs.
• Wet and soften food with gravy, sauce, broth, yogurt, or other liquids.
• Drink cool drinks.
• Sip drinks through a straw.
• Eat foods that are cool or at room temperature.
■ Eat small meals and snacks. It may be easier to eat a small amount of food at one time.
Instead of eating 3 large meals each day, you may want to eat 5 or 6 small meals and snacks.
■ Choose foods and drinks that are high in calories and protein. When it hurts to
swallow, you may eat less and lose weight. It is important to keep your weight the same
during radiation therapy. Having foods and drinks that are high in calories and protein
can help you. See the chart of foods and drinks that are high in calories and protein on
page 54 for ideas.
www.cancer.gov 43
■ Sit upright and bend your head slightly forward when you are eating or
drinking. Remain sitting or standing upright for at least 30 minutes after eating.
■ Don’t have things that can burn or scrape your throat, such as:
• Hot foods and drinks
• Spicy foods
• Foods and juices that are high in acid, such as tomatoes and oranges
• Sharp, crunchy foods such as potato or corn chips
• All tobacco products, such as cigarettes, pipes, cigars, and chewing tobacco
• Drinks that contain alcohol
■ Talk with a dietitian. He or she can help make sure you eat enough to maintain your
weight. This may include choosing foods that are high in calories and protein and foods
that are easy to swallow.
Smokefree.gov
Provides resources, including information on quit lines, a step-by-step cessation guide, and
publications, to help you or someone you care about quit smoking.
44 1-800-4-CANCER (1-800-422-6237)
Radiation Therapy Side Effects and Ways to Manage Them
■ Incontinence, when you cannot control the flow of urine from your bladder, especially
when coughing or sneezing
www.cancer.gov 45
Ways to manage
■ Drink a lot of fluids. This means 6 to 8 cups of fluids
each day. Drink enough fluids so that your urine is clear
to light yellow in color.
■ Avoid coffee, black tea, alcohol, spices, and all tobacco products.
■ Talk with your doctor or nurse if you think you have urinary or bladder
problems. He or she may ask for a urine sample to make
sure that you do not have an infection.
■ Medicine. Your doctor may prescribe antibiotics if your problems are caused by an
infection. Other medicines can help you urinate, reduce burning or pain, and ease
bladder spasms.
46 1-800-4-CANCER (1-800-422-6237)
Late Radiation Therapy Side Effects and Ways to Manage Them
Your doctor or nurse will talk with you about late side effects and discuss ways to help
prevent them, symptoms to look for, and how to treat them if they occur.
Some late side effects are brain problems, infertility, joint problems, lymphedema, mouth
problems, and secondary cancers.
Brain Changes
What they are
Radiation therapy to the brain can cause problems months or years after treatment
ends. Side effects can include memory loss, problems doing math, movement problems,
incontinence, trouble thinking, or personality changes. Sometimes, dead tumor cells can
form a mass in the brain, which is called radiation necrosis.
Ways to manage
You will need to have check-ups with your doctor or nurse for the rest of your life. If you have
symptoms, you will have tests to see whether they are due to the cancer or late side effects.
■ Will talk with you about ways to manage late side effects
■ May refer you to a physical, occupational, or speech therapist who can help with
problems caused by late side effects
www.cancer.gov 47
Late Radiation Therapy Side Effects and Ways to Manage Them
Infertility
What it is
For men, infertility means not being able to get a woman pregnant. For women, it means
not being able to get pregnant.
■ Surrogacy. Another woman carries and gives birth to your child. She can also donate
her egg, which is fertilized by your partner’s sperm.
■ Adoption. Taking on legal responsibility for someone else’s child and raising the child
as your own.
Joint Changes
What they are
Radiation therapy can cause scar tissue and weakness in the part of the body that was
treated. This can lead to loss of motion in your joints, such as your jaw, shoulders, or hips.
Joint problems can show up months or years after radiation therapy is over.
Ways to manage
Notice early signs of joint problems. These signs include:
Talk with your doctor or nurse. He or she may refer you to a physical therapist who will
assess your joint problems. The therapist can give you exercises to decrease pain, increase
strength, and improve movement.
48 1-800-4-CANCER (1-800-422-6237)
Late Radiation Therapy Side Effects and Ways to Manage Them
Lymphedema
What it is
Swelling in an arm or a leg caused by a build up of lymph fluid. Lymphedema can happen if
your lymph nodes were removed during surgery or damaged by radiation therapy.
Tell your doctor or nurse if you notice swelling in the arm or leg on the side where you
had radiation.
Ways to manage
■ Meet with your doctor or nurse. Ask about your risk of
lymphedema and ways to prevent it. Your doctor or nurse
may suggest exercises, medicines, or compression garments
(special wraps to put on your legs or arms). You might also
want to ask for a referral to a physical therapist.
■ Be active. Exercise can help prevent and treat lymphedema.
Ask your doctor, nurse, or physical therapist which exercises are
safe for you to do.
■ Notice early signs of lymphedema. Let your doctor or nurse know if you have:
• Pain or a sense of heaviness in your arm or leg
• A feeling of tightness in your arm or leg
• Trouble putting on your shoes or rings
• Weakness in your arm or leg
• Redness, swelling, or other signs of infection
www.cancer.gov 49
Late Radiation Therapy Side Effects and Ways to Manage Them
Mouth Changes
What they are
Radiation therapy to your head and neck can cause late side effects in your mouth.
Problems may include dry mouth, cavities, or bone loss in the jaw.
Ways to manage
■ Visit your dentist. You may be asked to have
your teeth checked every 1 to 2 months for at
least 6 months after radiation treatment ends.
During this time, your dentist will look for
changes in your mouth, teeth, and jaw.
Secondary Cancer
What it is
Radiation therapy can cause a new cancer many years after you have finished treatment.
This does not happen very often.
Ways to manage
You will need to have check-ups with your radiation oncologist or nurse practitioner for the
rest of your life to check for cancer—the one you were treated for and any new cancer that
may occur.
See Resources for Learning More on pages 59 and 60 for ways to learn more about late
side effects.
50 1-800-4-CANCER (1-800-422-6237)
Questions To Ask Your Doctor or Nurse
Here are some questions you might want to ask your doctor or nurse. You may want to
write down their answers so you can review them again later.
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
What kind of late side effects should I expect after radiation therapy is over?
________________________________________________________________________
________________________________________________________________________
www.cancer.gov 51
What can I do to manage these side effects?
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
52 1-800-4-CANCER (1-800-422-6237)
Lists of Foods and Liquids
Clear Liquids
This list may help if you have diarrhea. See page 24 for more information.
Soups Bouillon
Clear, fat-free broth
Consommé
Strained vegetable broth
www.cancer.gov 53
Foods and Drinks That Are High in Calories or Protein
This list may help if you need ideas for keeping your weight the same. See pages 5 and 43 for
more information.
54 1-800-4-CANCER (1-800-422-6237)
Foods and Drinks That Are Easy on the Stomach
This list may help if you have diarrhea or nausea and vomiting. See pages 24 and 34 for
more information.
www.cancer.gov 55
Words To Know
56 1-800-4-CANCER (1-800-422-6237)
Imaging tests: Tests that produce pictures of areas inside the body.
Implant: Radioactive material put in your body through a sealed thin wire, catheter, or tube.
Impotence (IM-po-tense): Not able to have an erection of the penis adequate for sexual
intercourse. Also called erectile dysfunction.
IMRT (intensity-modulated radiation therapy): A technique that uses a computer to
deliver precise radiation doses to a cancer tumor or specific areas within the tumor.
Incontinence (in-KAHN-tih-nens): A problem in which you cannot control the flow of
urine from your bladder.
Infertility: Not being able to produce children.
Inflammation: Redness, swelling, pain, and/or a feeling of heat in an area of the body.
Internal radiation therapy (ray-dee-AY-shun): Treatment in which a radioactive substance
is put inside your body.
Intraoperative radiation (ray-dee-AY-shun): Radiation treatment aimed directly at cancer
during surgery.
Late side effects: Side effects that first occur 6 or more months after radiation therapy
is finished.
Local treatment: Radiation is aimed at only the part of your body with cancer.
Lymphedema: A problem in which excess fluid collects in tissue and causes swelling. It
may occur in the arm or leg after lymph vessels or lymph nodes in the underarm or groin
are removed by surgery or treated with radiation.
Medical leave: Taking time off work for a while due to a medical problem.
MRI (magnetic resonance imaging): A procedure in which radio waves and a powerful
magnet linked to a computer are used to create detailed pictures of areas inside the body.
Nausea: When you have an upset stomach or queasy feeling and feel like you are going to
throw up.
Pelvis: The area between your legs. Also called the groin.
Permanent implants: Radioactive pellets or seeds that always stay in your body.
PET (Positron emission tomography) scan: A procedure in which a small amount of
radioactive glucose (sugar) is injected into a vein, and a scanner is used to make detailed,
computerized pictures of areas inside the body where the glucose is used. Because cancer
cells often use more glucose than normal cells, the pictures can be used to find cancer cells
in the body.
Pruritus: Severe itching.
Psychostimulants: Medicines that can help decrease fatigue, give a sense of well-being, and
increase appetite.
www.cancer.gov 57
Radiation necrosis: A problem in which dead tumor cells form a mass in the brain.
Radiation oncologist (ray-dee-AY-shun on-KO-lo-jist): A doctor who specializes in using
radiation to treat cancer.
Radiation therapy (ray-dee-AY-shun): High doses of radiation used to treat cancer and
other diseases.
Radiotherapy (RAY-dee-o-THER-a-pee): Another word for radiation therapy.
Simulation (sim-you-LAY-shun): A process used to plan radiation therapy so that the
target area is precisely located and marked.
Sitz bath: A warm-water bath taken in a sitting position that covers only the hips and
buttocks.
Skin breakdown: A side effect from radiation therapy in which the skin in the treatment
area peels off faster than it can grow back.
Support groups: Meetings for people who share the same problems, such as cancer.
Treatment field: One or more places on your body where the radiation will be aimed. Also
called treatment port.
Treatment port: One or more places on your body where the radiation will be aimed. Also
called treatment field.
Urinate (YOOR-in-nate): Emptying your bladder of urine.
Vaginal stenosis (ste-NO-sis): A problem in which the vagina narrows and gets smaller.
Vomiting: When you get sick and throw up your food.
Xerostomia: Dry mouth.
58 1-800-4-CANCER (1-800-422-6237)
Resources for Learning More
CancerCare, Inc.
Offers free support, information, financial assistance, and practical help to people with
cancer and their loved ones.
Toll-free: 1-800-813-HOPE (1-800-813-4673)
Online: http://www.cancercare.org
E-mail: [email protected]
fertileHOPE
Dedicated to helping people with cancer faced with infertility.
Toll-free: 1-888-994-HOPE (1-888-994-4673)
Online: http://www.fertilehope.org
www.cancer.gov 59
National Brain Tumor Foundation
Dedicated to providing information and support for brain tumor patients, their family
members, and health care professionals, while supporting innovative research into better
treatment options and a cure for brain tumors.
Toll-free: 1-800-934-2873
Online: http://www.braintumor.org
60 1-800-4-CANCER (1-800-422-6237)
NIH Publication No. 12-7157
Revised May 2007
Printed May 2012