Radiotherapy : Side effects

Radiotherapy can cause side effects, although many of these can be treated or prevented and most will pass once treatment stops.

It's difficult to predict what side effects you'll get.

It varies from person to person and depends on things such as the part of your body being treated and the type of radiotherapy you have. Ask your care team about the side effects you might get.

Some of the main side effects are listed below, but it's unlikely you'll have all of these.

Sore skin

In some people, radiotherapy can make the skin sore and red (similar to sunburn), darker than normal or dry and itchy.

This tends to start a week or two after treatment begins.

Tell your care team if you notice any soreness or changes to your skin. They may suggest:

  • washing your skin every day with mild, unperfumed soap
  • patting your skin dry instead of rubbing it
  • moisturising your skin every day
  • not using perfume, perfumed soaps or talcum powder on the area
  • not shaving the area if possible – if you need to shave, use an electric razor instead of wet shaving
  • wearing loose-fitting clothes made of natural fibres, and avoid tight collars, ties or shoulder straps
  • using a high-factor sunscreen (SPF 15 or above) to protect your skin from the sun
  • not swimming in chlorinated water

Skin problems usually settle within 2 to 4 weeks of treatment finishing, but sometimes your skin may stay slightly darker (like it's tanned) than it was before.

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Many people having radiotherapy feel tired a lot of the time or tire very easily doing everyday activities.

This usually starts during treatment and can continue for several weeks or months after treatment finishes.

It can help to:

  • get plenty of rest
  • avoid doing tasks or activities that you don't feel up to
  • do light exercise, such as going for short walks, if you're able to – this can boost your energy levels, but be careful not to push yourself too hard
  • ask your friends and family for help with everyday tasks

If you're working, you may want to ask your employer for time off or to let you work part-time until your treatment has finished.

Read more tips to help fight fatigue.

Contact your care team if you suddenly feel very tired and out of breath. This can be a sign of a lack of red blood cells (anaemia), which may need to be treated.

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Hair loss

Hair loss is a common side effect of radiotherapy. But unlike chemotherapy, it only causes hair loss in the area being treated.

Ask your care team to show you exactly where your hair is likely to fall out.

Your hair will usually start to fall out 2 to 3 weeks after treatment starts.

It should start to grow back a few weeks after treatment finishes, although sometimes it may be a slightly different texture or colour than it was before.

Occasionally, hair loss can be permanent if you have a high dose of radiotherapy. Ask your doctor if this is a risk before starting treatment.

Coping with hair loss

Hair loss can be upsetting. Talk to your care team if you find losing your hair difficult to cope with.

They understand how distressing it can be and can support you and discuss your options with you.

You may decide you want to wear a wig if you lose the hair on your head. Synthetic wigs are available free of charge on the NHS for some people, but you'll usually have to pay for a wig made from real hair.

Other options include headwear such as headscarves.

Read advice about cancer and hair loss.

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Feeling sick

Some people feel sick during, or for a short time after, radiotherapy treatment sessions.

This is more likely to happen if the treatment area is near your stomach, or if your brain is being treated.

Tell your care team if you feel sick during or after treatment. They can prescribe anti-sickness medication to help.

You should stop feeling sick soon after your treatment finishes.

Macmillan has more information about managing sickness and vomiting.

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Problems eating and drinking

Radiotherapy can sometimes cause:

  • a sore mouth
  • loss of appetite and weight loss
  • discomfort when swallowing

Sore mouth

Radiotherapy to the head or neck can make the lining of the mouth sore and irritated. This is known as mucositis.

Symptoms tend to develop within a couple of weeks of treatment starting and can include:

  • the inside of your mouth feeling sore – as if you've burnt it by eating very hot food
  • mouth ulcers, which can become infected
  • discomfort when eating, drinking and/or talking
  • dry mouth
  • reduced sense of taste
  • bad breath

Tell your care team if you have any of these problems. They may recommend painkillers or special mouthwashes that can help. Avoiding spicy, salty or sharp foods can also help.

Mucositis usually clears up a few weeks after treatment finishes, although sometimes a dry mouth can be a long-term problem.

Loss of appetite

Feeling sick and tired during radiotherapy can make you lose your appetite, which could lead to weight loss.

But it's important to try to eat healthily and maintain your weight during treatment, so tell your care team if you don't feel you're eating enough.

They may give you tips such as eating frequent small meals instead of 3 large ones or refer you to a dietitian.

Discomfort when swallowing

Radiotherapy to the chest can irritate the gullet (oesophagus), which can temporarily make swallowing uncomfortable.

Tell your care team if this affects you, as you may need to make some changes to your diet (such as eating soft or liquid foods).

You may also be prescribed medication to reduce the discomfort and in a few cases you may need a temporary feeding tube.

Read more about treatments for swallowing problems.

Swallowing problems will usually improve after treatment stops.

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Diarrhoea is a common side effect of radiotherapy to the tummy or pelvic area.

It usually starts a few days after treatment begins and may get a bit worse as treatment continues.

Tell your care team if you get diarrhoea. Medication is available to help relieve it.

Diarrhoea should disappear within a few weeks of treatment finishing. Tell your doctor if your symptoms haven't improved after a few weeks, or if you notice blood in your poo.

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Stiff joints and muscles

Radiotherapy can sometimes makes the joints and muscles in the area being treated stiff, swollen and uncomfortable.

Exercising and stretching regularly can help to prevent stiffness.

Tell your care team if it's a problem. They may refer you to a physiotherapist, who can recommend exercises for you to try.

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Sex and fertility issues

Radiotherapy can have an effect on your sex life and fertility, especially if your lower tummy, pelvic area or groin is treated.

Ask your care team if there's a chance it could affect you.

Sex and fertility issues for women

In women, there's a risk that radiotherapy could cause:

  • loss of interest in sex – this tends to gradually improve after treatment stops
  • stiffening and narrowing of the vagina – your care team may suggest using vaginal dilators (devices you insert into your vagina) to prevent this; having sex regularly may also help
  • vaginal dryness – lubricants, vaginal moisturisers and medicated creams can help with this
  • the menopause – this can cause symptoms such as hot flushes and night sweats, but treatment with hormone replacement therapy (HRT) can help
  • infertility – if there's a risk this could happen, it may be possible to store some of your eggs before treatment

Cancer Research UK has more information about women's sex life and fertility after radiotherapy.

Sex and fertility issues for men

In men, there's a risk that radiotherapy could cause:

  • loss of interest in sex – this tends to gradually improve after treatment stops
  • difficulty getting an erection (erectile dysfunction) – this tends to improve with time and there are several erectile dysfunction treatments available
  • pain when ejaculating – this should pass a few weeks after the treatment ends
  • infertility – if there's a risk this could happen, it may be possible to store a sample of your sperm before treatment

Cancer Research UK has more information about men's sex life and fertility after radiotherapy.

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Emotional issues

Having radiotherapy can be a frustrating, stressful and traumatic experience. It's natural to feel anxious and to wonder if your treatment will be successful.

Stress and anxiety can also increase your risk of getting depression.

Speak to your care team if you're struggling to cope emotionally. They can offer support and discuss possible treatment strategies.

Joining a cancer support group may also help. Talking to other people in a similar situation can often reduce feelings of isolation and stress.

The charity Macmillan Cancer Support has a directory of support groups. You can also call the Macmillan Support Line free on 0808 808 00 00 (Monday to Friday 9am to 8pm).

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Radiotherapy can damage your body's lymphatic system, a network of channels and glands that form part of your immune system (the body's defence against illness).

One of the jobs of the lymphatic system is to stop fluid building up in your body. If it becomes damaged, you may experience pain and swelling. This is known as lymphoedema.

It's most common in the arms or legs, but it can affect other areas, depending on the part of your body that was treated.

It may be possible to reduce your risk of lymphoedema by looking after your skin and doing regular exercises. Ask your care team if you're at risk and what you can do to help avoid it.

If you do get it, treatment for lymphoedema can often help keep the symptoms under control.

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Getting another type of cancer

Radiotherapy can slightly increase your risk of developing another type of cancer in the years after treatment.

But the chance of this happening is small and the benefits of treatment generally outweigh the risk.

Talk to your care team if you're concerned about the risk of developing another type of cancer in the future.

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