Why Does Radiation Therapy Cause Side Effects
High doses of radiation therapy are used to destroy cancer cells. Side effects come from damage to healthy cells and tissues near the treatment area. There have been major research advances in radiation therapy in recent years that have made it more precise. This has reduced this treatment’s side effects, compared to radiation therapy techniques used in the past.
Some people experience few side effects from radiation therapy. Or even none. Other people experience more severe side effects.
Reactions to the radiation therapy often start during the second or third week of treatment. Or, they may last for several weeks after the final treatment. Some side effects may be long term. Talk with your treatment team about what to expect.
Skin Problems Are A Common Side Effect
Skin problems are a common side effect of external radiation therapy. The types of skin problems that occur as a result of radiation therapy include:
- General irritation
- Skin may appear tan
These side effects occur in the area being exposed to radiation. People may also lose hair in the area being treated.
Leukemia And Myelodysplastic Syndrome
Past radiation exposure is one risk factor for most kinds of leukemia, including acute myelogenous leukemia , chronic myelogenous leukemia , and acute lymphoblastic leukemia . Myelodysplastic syndrome , a bone marrow cancer that can turn into acute leukemia, has also been linked to past radiation exposure. The risk of these diseases after radiation treatment for cancer depends on a number of factors, such as:
- How much of the bone marrow was exposed to radiation
- The amount of radiation that reached the bone marrow
- The radiation dose rate
Most often, these cancers develop within several years of a person’s radiation treatment. Then the chance of developing a new cancer slowly declines over the following years.
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Different Types Of Nausea And Vomiting Are Caused By Chemotherapy Radiation Therapy And Other Conditions
Nausea and vomiting can occur before, during, or after treatment.
The types of nausea and vomiting include:
- Acute: Nausea and vomiting that happen within 24 hours after treatment starts.
- Delayed: Nausea and vomiting that happen more than 24 hours after chemotherapy. This is also called late nausea and vomiting.
- Anticipatory: Nausea and vomiting that happen before a chemotherapy treatment begins. If a patient has had nausea and vomiting after an earlier chemotherapy session, he or she may have anticipatory nausea and vomiting before the next treatment. This usually begins after the third or fourth treatment. The smells, sights, and sounds of the treatment room may remind the patient of previous times and may trigger nausea and vomiting before the chemotherapy session has even begun.
- Breakthrough: Nausea and vomiting that happen within 5 days after getting antinausea treatment. Different drugs or doses are needed to prevent more nausea and vomiting.
- Refractory: Nausea and vomiting that does not respond to drugs.
- Chronic: Nausea and vomiting that lasts for a period of time after treatment ends.
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Dark Lines On The Fingernails Or Toenails
The appearance of a dark area under a fingernail or toenail that appears without an obvious injury should always be investigated. Melanoma of the nail bed often presents when a pigmented streak of the nail involves the cuticle . These cancers are most common on the thumb and big toe but may occur on any nail.
While subungual melanomas are uncommon in whites, accounting for only around 1% of melanomas, they are the most common form of melanoma found in dark-skinned individuals.
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Talking With Your Health Care Team About Skin And Nail Changes
Prepare for your visit by making a list of questions to ask. Consider adding these questions to your list:
- What skin-and nail related side effects are common for the type of treatment Im receiving?
- Are there steps I can take to prevent any of these problems?
- What problems should I call you about? Are there any problems that need urgent medical care?
- When might these problems start? How long might they last?
- What brands of soap and lotion would you advise me to use on my skin? On my nails?
- Are there skin and nail products I should avoid?
- Should I see a dermatologist so I can learn more about how to prevent or manage skin problems?
How Fertility Might Be Affected
For women: Talk to your cancer care team about how radiation might affect your fertility . Its best to do this before starting treatment so you are aware of possible risks to your fertility.
Depending on the radiation dose, women getting radiation therapy in the pelvic area sometimes stop having menstrual periods and have other symptoms of menopause. Report these symptoms to your cancer care and ask them how to relieve these side effects.Sometimes menstrual periods will return when radiation therapy is over, but sometimes they do not.
See Fertility and Women With Cancer to learn more.
For men: Radiation therapy to an area that includes the testicles can reduce both the number of sperm and their ability to function. If you want to father a child in the future and are concerned about reduced fertility, talk to your cancer care team before starting treatment. One option may be to bank your sperm ahead of time.
See Fertility and Men With Cancer to learn more.
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Cancer Treatment Side Effect: Skin Changes
Did you know that cancer treatments can cause changes to your skin? Sometimes these changes are simply cosmetic, but other times they may require attention from your care team.
To better understand skin changes that happen during cancer treatment and how best to address these side effects, we spoke with Anisha Patel, M.D. Heres what she had to say.
What types of cancer treatments cause skin changes?
All cancer treatments have side effects, but patients are sometimes surprised by the skin changes they see when receiving chemotherapy and immunotherapy. Since these therapies are used to treat a variety of cancers and were constantly expanding and improving their use through clinical trials skin changes are common.
What are common skin changes during cancer treatment?
The most common things we see are rashes and dry skin, which may be accompanied by itchiness or burning of the skin.
Chemotherapy and immunotherapy can also change the color, or pigment, of the skin, but its less common. You may not even notice. Depending on the therapy, you may see lightening or darkening of skin, hair and nails.
A less common side effect that we see with newer treatments is the development of new growths, such as moles, warts and raised areas of the skin.
Its important to know that the type of skin side effect you may experience depends on your medical history and the type of treatment youre receiving, so talk with your doctor about what you should expect.
Types Of Skin Reactions
Radiation-induced skin reactions may progress from erythema , to desquamation , and sometimes to ulceration. During the first week or two of radiation treatment, you may notice a faint redness and your skin may become itchy or tender. After three to four weeks, your skin may become dry and peel, or you may notice moist areas. Later effects of radiation may include darkening or thinning of the skin.
The following are some possible side effects that may occur on radiated skin:
- Rash, redness, sunburn-like appearance
- Dry mouth or mouth sores
- Dryness, peeling
- Increased sensitivity to sunlight
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Intensity Modulated Radiation Therapy
Intensity modulated radiation therapy is a highly targeted form of treatment that helps doctors avoid surrounding healthy tissue. Its used to treat cancerous lymph nodes in people who arent candidates for surgery or in areas where lymph nodes were removed after surgery.
The radiation is delivered from different directions and is broken into many small, computer-controlled beams of different adjustable strengths. Together, these minibeams are sculpted in three dimensions to conform to the size, shape, and location of the area of tissue being targeted.
Is Internal Radiation Therapy Used To Treat Skin Cancer
Internal radiation therapy is when a radioactive material is placed on or in the body.1 This type of radiation therapy is one of the main treatments for melanoma of the eye. A radioactive plaque is placed near the tumor. The word for this is brachytherapy. The plaque stays in place for several days. Then your doctor removes it.3
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Radioprotective Drugs For Reducing Side Effects
One way to reduce side effects is by using radioprotective drugs, but these are only used for certain types of radiation given to certain parts of the body. These drugs are given before radiation treatment to protect certain normal tissues in the treatment area. The one most commonly used today is amifostine. This drug may be used in people with head and neck cancer to reduce the mouth problems caused by radiation therapy.
Not all doctors agree on how these drugs should be used in radiation therapy. These drugs have their own side effects, too, so be sure you understand what to look for.
Are There Options To Prevent Or Treat These Side Effects
Yes. Your health care team can help you prevent or relieve many side effects. Preventing and treating side effects is an important part of your overall cancer treatment. This is called palliative care or supportive care. Before treatment begins, ask what side effects are likely from the specific type of treatment you are receiving and when they may happen. And during and after treatment, let your health care team know how you are feeling on a regular basis.
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Risk Of Developing Second Cancers After Radiation Therapy
Radiation therapy was recognized as a possible cause of cancer many years ago. In fact, much of what we know about the health effects of radiation has come from studying survivors of atomic bomb blasts in Japan. We also have learned from workers in certain jobs that included radiation exposure, and patients treated with radiation therapy for cancer and other diseases.
What Are Common Side Effects Of Radiation Therapy
Radiation therapy is called a local treatment. This means that it only affects the area of the body that is targeted. For example, radiation therapy to the scalp may cause hair loss. But people who have radiation therapy to other parts of their body do not usually lose the hair on their head.
Common physical side effects of radiation therapy include:
Skin changes. Some people who receive radiation therapy experience dryness, itching, blistering, or peeling. These side effects depend on which part of the body received radiation therapy and other factors. Skin changes from radiation therapy usually go away a few weeks after treatment ends. If skin damage becomes a serious problem, your doctor may change your treatment plan. Lotion may help with skin changes, but be sure to check with your nurse or other health care team about which cream they recommend and when to apply it. It is also best to protect affected skin from the sun. Learn more about skin-related side effects.
Fatigue. Fatigue is a term used to describe feeling tired or exhausted almost all the time. Many patients experience fatigue. Your level of fatigue often depends on your treatment plan. For example, radiation therapy combined with chemotherapy may result in more fatigue. Learn how to cope with fatigue.
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Cancer Types And Ionizing Radiation
Ionizing radiation can cause cancer in whichever part of the body is exposed to it, but some cancer types seem more common than others. They include leukemia and cancers of the bone marrow, as well as thyroid cancer. Other cancers associated with exposure include lung cancer, skin cancer, breast cancer and stomach cancer. For instance, some studies have shown that women with Hodgkin’s lymphoma who are treated with chest radiation are at higher risk of developing breast cancer when they are older.
You can read more about secondary cancers caused by cancer treatment at the American Cancer Society.
How You Have It
You have radiotherapy treatment in the hospital radiotherapy department. The number of treatments you have depends on the type of skin cancer you have, where it is and how big it is.
You usually have radiotherapy once a day, from Monday to Friday, over a number of weeks. You have a rest at the weekend. The length of treatment varies from one to about 6 weeks.
Older and frail people may have their radiotherapy treatment less often. So they don’t need to attend the radiotherapy department daily. Some treatment plans might be once a week or 2 to 3 times a week.
Some people might have a single treatment of radiotherapy.
Your doctor will tell you what treatment plan is best for you.
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Squamous Cell Carcinoma And Bowen Disease
Squamous cell carcinoma of the skin is the second most common type of skin cancer.
Squamous cell carcinoma develops from flat, scale-like skin cells called keratinocytes, which lie on top of the basal cell layer of the epidermis. Most squamous cell carcinomas occur on sun-exposed areas, largely the forehead, temple, ears, neck, and back of the hands. Burns or other heat-related injured sites are more likely to develop squamous cell carcinoma. People who have spent considerable time sunbathing may develop them on their lower legs. Squamous cell carcinomas occur more often than basal cell cancers in African Americans and Asians, and are more common in men than women.
Although squamous cell skin carcinomas usually can be removed completely with no risk of the cancer spreading, they are more likely than basal cell cancers to be invasive and spread elsewhere in the body.
Types of squamous cell carcinoma:
- Squamous cell carcinoma in situ is the earliest form of this type of cancer. The cancer is confined to the epidermis and has not invaded the deeper dermis. Cancer areas can appear as reddish patches that are scaly and crusted. They can look like warts.
- Invasive squamous cell carcinoma is more likely to spread. The skin cancer lesions can grow rapidly or slowly . Eventually they break into an open wound that will not heal.
Getting prompt treatment is important, because squamous cell cancers are more likely than basal cell cancers to spread to local lymph nodes.
When Is Radiation Therapy Used For Cscc And Metastatic Cscc
Surgery is usually the preferred way to treat CSCC. But radiation therapy is a treatment choice for CSCCs that are superficial or cant be cut out. Some elderly patients who arent well enough to have surgery may consider radiation treatment for their skin lesions.
Sometimes radiation is used after surgery if theres a high risk that the cancer will spread. In this case, the therapy lowers the chances that the cancer will come back.
Doctors might also recommend radiation for metastatic CSCC if your tumor is large, has grown deep, or is hard to remove. It can also be used to treat skin cancers that have spread to lymph nodes or other organs.
If your cancer is very advanced, radiation therapy can help lessen your pain and make you more comfortable.
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Dermatologists Treat Skin Problems Caused By Cancer Treatment
As the skin, hair, and nail specialist, dermatologists are often called upon to treat reactions caused by cancer treatment. They are familiar with the many reactions that can occur during and years after cancer therapy.
If you develop a skin problem after cancer treatment, you dont have to live with the discomfort.
ImageImage used with permission of Journal of the American Academy of Dermatology: J Am Acad Dermatol. 2006 54:28-46.
ReferencesAmerican Academy of Dermatology. Skin conditions could hinder treatment in cancer patients, negatively impact quality of life. News release issued February 4, 2011. Last accessed August 24, 2018.
Greenwald E, Gorcey L, et al. Poster 2706: Importance of skin cancer screening after radiation therapy. J Am Acad Dermatol. 2016 74 suppl 1:AB199. Commercial support: None identified.
Hymes SR, Strom EA, et al. Radiation dermatitis: Clinical presentation, pathophysiology, and treatment. J Am Acad Dermatol. 2006 54:28-46.
Veness M and Richards S. Radiotherapy. In: Bolognia JL, et al. Dermatology. . Mosby Elsevier, Spain, 2008:2127-37.
Skin Care During Radiotherapy
Advice about skin care varies from one hospital to another. It is best to follow the instructions of your radiographers and doctor. The advice applies only to the treatment or exit site area. You can treat the rest of your skin normally.
Don’t use talcum powder because this can contain tiny metal particles that can make the soreness worse after radiotherapy.
Your radiographers or nurses might put on special dressings after your treatment if the cancer is affecting your skin. Don’t use sticky tape or dressings in the treatment area.
Other skin care tips when washing and shaving in the treatment area include:
- Don’t rub the area too hard because this makes it sore.
- Don’t use perfume on the area as this can irritate the skin.
- Continue to use normal deodorant , but stop using it if the skin is broken.
- Wash your skin gently with soap and water and gently pat dry.
- Avoid shaving and don’t use heat and cooling pads/ice, or wax and creams for hair removal in the treatment area.
- Men can use an electric trimmer instead of shaving.
- Don’t use dressings on the treatment area unless your specialist or radiographer has told you to.
- Wash your hair gently with your usual shampoo but don’t dry it with a hairdryer.
- Use your usual moisturiser unless this irritates your skin
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