General side effects of external radiotherapy Radiotherapy affects people in different ways, so its difficult to predict exactl y how

youll react to your treatment. Before you start, the staff will discuss the side effects of the particular treatment youre having with you. On this page Tiredness Feeling sick Eating and drinking Skin care Hair loss Changes in your blood The effects of smoking Possible long-term side effects On this page,we discuss the general side effects of radiotherapy that you may exp erience, whichever part of the body youre having radiotherapy to.Being aware of si de effects in advance can help you cope with any that may develop. You may find it helpful to read this information alongside information about the specific typ e of cancer you have. External radiotherapy tends to cause more general side effects than internal the rapy. Its important to remember that most people will have only a few of the side effects mentioned here, and for many people they will be mild. There have been huge improvements in radiotherapy treatment, and severe side effects are very ra re. Most side effects of radiotherapy will continue for about 10-15 days after treat ment has finished and then gradually begin to get better. For some people howeve r, they may continue for a few weeks. Tiredness Back to top You may feel very tired during your radiotherapy treatment. Tiredness (fatigue) can often be made worse by having to travel to hospital each day, or by other tr eatment such as surgery or chemotherapy. Listen to your body and, if necessary, allow yourself extra time to rest, perhaps by taking a nap. It may help if you s pread chores out over the week, sit down to do them wherever possible and accept any offers of help. Tiredness can be a problem for several months after your tr eatment has finished. Feeling sick Back to top Some people find that their treatment makes them feel sick (nauseous), and somet imes they may actually be sick (vomit). This is most common when the treatment a rea is near the stomach. Your clinical oncologist can prescribe very effective a nti-sickness (anti-emetic) drugs if this happens, and they may prescribe them an yway as a precaution. Tell your clinical oncologist if you have any nausea or vomiting, and remember t hat it usually stops once treatment is over. Eating and drinking Back to top As always during treatment of any kind, its important to have ahealthy diet and dr ink plenty of fluids. At times you may not feel like eating or you might find th at your eating habits change. It can be easier to have small snacks throughout t he day rather than large meals. You may lose a bit of weight during radiotherapy , especially if you have radiotherapy to the head or neck area. Its important to tryto maintain your weight throughout treatment, as the radiotherapy will have be en planned on your bodys shape. Tell the radiotherapy staff if youre having any pr oblems with eating, as they can arrange for you to talk to the hospital dietitia n. Skin care Back to top Some people develop a skin reaction while having external radiotherapy. If this happens, it may begin after about 10 days. How your skin reacts will vary depending on the amount of radiotherapy you have. People with pale skin may find that the skin in the treatment area becomes red and sore or itchy. People with darker skin may also find their skin feels itchy and becomes darker with a blue or black tinge. Sometimes the skin will get very sore and it may break and leak fluid, although this doesnt happen very often. If

your skin gets very sore, your treatment may have to be delayed for a short time to allow the area to recover, although this is rare. The extent of the reaction depends on the area being treated and the individuals skin. Some people have no skin problems at all. Your radiographers will be looki ng for these reactions, but you should also let them know as soon as you notice any soreness or change in skin colour. Staff in the radiotherapy department will be able to give you advice on how to l ook after your skin in the treated area. This will vary according to the part of the body thats being treated and the dose of radiotherapy. You may be advised to use only tepid water and unperfumed soap s 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 or using a hairdryer blowing cold air, bu t you shouldnt rub the area, as this may make it sore. Perfumed soaps, talcum powder, deodorants and perfumes may also make your skin s ore and shouldnt be used at all. The staff at the hospital may suggest that you g ently apply plain moisturisers, such as E45 cream or aqueous cream, to the area. After your treatment, plain soap and plain moisturisers are often recommended. A loe vera cream can sometimes help the skin to heal. Its important not to use any creams or dressings unless they have been prescribed or recommended by your clinical oncologist or radiographer. Its very important that any marks put on your skin to show the treatment area are not removed until the treatment has finished. If the marks do fade or disappear , dont try to replace them yourself- tell the radiotherapy staff straight away. 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 wetshaving. These restrictions apply only to the treatment area- the rest of your skin can be treated normally. Your skin may peel after the redness has faded, but it will g radually heal. Changes to the skin usually settle down 2-4 weeks after treatment has finished, but the area may stay slightly darker than the surrounding skin. Avoiding the sun The skin in the treated area is very sensitive and needs protecting from the sun or cold winds. If youre 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, its very important to cover the treated area if you go out in strong sunshine. Wear clothes made of cotton o r natural fibres, which have a closer weave and offer good protection against th e sun. Even after this time, the area of treated skin will be more delicate than normal, so take extra care. Use a suncream with a high sun protection factor (SPF) of at least 30 and cover the area with a hat or close-weave clothing. Its important to remember that you c an burn 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 mon th of finishing treatment. If you are swimming outdoors however, dont stay in the water too long and remember to use a waterproof suncream. Clothing Loose-fitting clothes, preferably made of natural fibres rather than man-made ma terials, are more comfortable and less irritating to the skin. Avoid tight colla rs and ties if youre having radiotherapy to your neck. Shoulder straps and bra straps can cause irritation if they rub against treated skin. If your breast area is being treated, you may be more comfortable not wear ing a bra or wearing a vest instead. Hair loss Back to top Having radiotherapy causes hair loss within the treatment area. Hair loss can al so 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. Hair usually begins to fall out after 2-3 weeks. Hair should grow back after tre atment finishes. This may take several months, although it depends on the dose o f radiotherapy you have.

Your radiographer can tell you if any hair loss is likely to be permanent. Ourhair losssection gives tips on covering it up and coping with the emotional eff ects. Changes in your blood Back to top Radiotherapy to some parts of the body may affect the bone marrow. This is the s pongy material inside some of our bones and is where the different types of bloo d cells are made. If the doctors think this might happen to you, you will have r egular blood tests during your treatment to check the number of cells in your bl ood (your blood count). If your blood count is low, you may feel tired and run d own. If your blood count becomes very low (which is unlikely), you may need to h ave a short rest from treatment so that your blood cell levels can return to nor mal. You may also need to have ablood transfusion. Its very important to let your doctors know if you feel very unwell, if your temp erature goes above 38C (100.4F), or if you start feeling cold and shaky. The effects of smoking Back to top 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 s ide effects. It will also improve your general health and reduce your risk of de veloping other cancers. Stopping smoking or even cutting down at such a stressful time can be very diffi cult, but do your best. If you want help or advice you can talk to your speciali st, GP or a specialist nurse, who will be able to suggest ways of stopping. Orga nisations such as QUIT also offer advice and valuable support. Possible long-term side effects Back to top All cancer treatments can result in long-term side effects. Modern ways of givin g radiotherapy are designed to limit the chance of permanent side effects as muc h as possible, and very few people develop long-term problems. If youre concerned about the risk of developing particular side effects from radiotherapy, its best to speak to your clinical oncologist before your treatment starts. Possible long-term side effects Here we discuss some of the long-term side effects that can occur, but they will depend on thepart of the body that was treated, so you wont necessarily experienc e all of them. Long-term side effects can take months and sometimes years to develop: Hair loss can be permanent or new hair growth may be a different colour or textu re to what it was before. The skin can feel different or may be darker than before. Infertility can occur if the ovaries or testicles are within the treatment area. Swelling in a limb or on the body (lymphoedema) can develop when lymph nodes are damaged during treatment. Red spidery marks (telangectasia) may appear on the skin because small blood vesse ls are damaged, but this is very rare. Shortness of breath can happen, as radiotherapy can make the lungs less stretchy . Narrowing of the vagina can occur. Difficulty swallowing can occur due to a narrowing of the gullet (oesophagus) or reduced amounts of saliva. Passing a lot of urine can sometimes happen if the bladder becomes less stretchy after radiotherapy. Our sections about the long-term side effects of pelvic radiotherapy for men and women have more information about some of these side effects. Second cancers Radiotherapy can cause cancer, and a small number of people will develop a secon d cancer because of the treatment theyve had. However, the chance of a second can cer developing is so small that the risks of having radiotherapy are far outweig hed by the benefits.