After you complete radiation, your treatment team will establish a follow-up care plan to check your progress. Because radiation does not immediately kill cancer cells, follow-up is especially important to monitor the tumor and determine the effectiveness of treatment. You may also need to watch for any long-term or late effects of treatment.
If you are receiving radiation therapy after you’ve finished primary surgical treatment and/or chemotherapy, the goal is to kill any microscopic cancer cells that may remain. Monitoring progress during treatment may not be an option because there will be no physical evidence of how remaining cancer cells are responding to treatment. Because of this, it is important that you complete your entire radiation schedule.
Post-treatment side effects
Long-term effects are those that last beyond the end of treatment for weeks or even months. Late effects are side effects that develop after treatment has ended, months or even years later. Make sure you talk to your doctor about the possible long-term and late effects of radiation treatment as well as any side effects that could be permanent. Consider the possibility of these effects when making a decision about whether radiation treatment is right for you.
Possible long-term and late effects include damage to other organs, and a risk of a second cancer developing. In nearly all cases, these risks are small.
Damage to other organs
Some patients who require radiation to lymph node regions have a risk of developing arm swelling after treatment. Radiation can also cause damage to nearby structures; for example, radiation to the chest may affect the heart. Damage to the heart can lead to hardening of the arteries, which may increase your risk of having a heart attack later in life; or damage to the heart valves.
The most common radiation side effects associated with breast cancer treatments involve the skin within the treatment field and the soft tissues of the breast or chest wall.
External-beam radiation therapy can cause inflammation of the lungs from six weeks to six months after treatment ends; this inflammation is called radiation pneumonitis. Whether radiation pneumonitis develops will depend on the radiation area, your history of radiation treatment and any treatments you are receiving at the same time as radiation. You may or may not experience any symptoms, which can include cough, fever, shortness of breath or pink-tinged sputum (saliva and mucus from the respiratory tract). Steroids are typically used to reduce the inflammation.
Radiation to the pelvis can cause bowel alteration, such as diarrhea, gas and cramping. These bowel changes may be managed by following a low fiber diet during the radiation treatment course and by taking over the counter medications, such as loperamide (Imodium) or simethicone (Alka-Seltzer Anti-Gas, Gas-X, Mylanta Gas, Maalox Anti-Gas). Pelvic radiation may also cause hemorrhoidal irritation, which may cause pain with bowel movements and blood streaked stools. A sitz bath and steroid rectal cream may be very helpful. Most patients recover from these within 1 to 3 months after treatment ends, although a small proportion of patients do experience lasting bowel alteration over several years.
Less commonly, radiation to the pelvis may cause bladder inflammation, which leads to pain or burning during urination, trouble passing urine, an urge to urinate frequently, and/or blood in the urine or incontinence (inability to control the flow of urine). Most bladder issues are resolved over time but in some cases, damage to the lining of the bladder can be permanent. This damage can cause radiation cystitis, resulting in pain and bleeding during urination.
Radiation to the head and neck can cause long-term swallowing and dental issues. Good dental hygiene and regular dental exams are important for patients who receive radiation to the mouth area. Patients who receive radiation to the neck may also need to have periodic blood tests because radiation can affect levels of thyroid hormone. In some cases oral thyroid medication may be needed.
Risk of second cancers
Although rare, radiation damage to healthy tissues may increase your risk of a second cancer developing many years later. Tissues closest to the radiation site are at the greatest risk for the development of cancer. For example, patients who receive radiation to the chest may be at an increased risk of breast cancer. This increased risk, however, appears to be limited to women treated at a young age. There does not appear to be an increased risk in women who are age 40 or older at the time of chest radiation. Cancers that result from past radiation exposure usually don’t develop until 10 or even 15 years after treatment ends. Talk to your doctor about your concerns when deciding if radiation is right for you.
Myth vs Fact
MYTH: Radiation therapy is painful.
FACT: Radiation therapy does not typically cause pain. Receiving external-beam radiation therapy is like getting an X-ray and will likely be painless. If you are receiving internal radiation, the process of implantation may cause discomfort, but the radiation itself should not be painful. Ask your treatment team about other side effects you may experience and how you can prevent or manage them.
MYTH: Radiation causes hair loss.
FACT: You may lose body hair at the site of treatment but radiation will not cause you to lose the hair on your head, as chemotherapy sometimes does. The only time you may lose hair from your head is if you receive radiation to the brain or head and neck.
MYTH: Radiation increases my risk of recurrence.
FACT: Treating a specific cancer with radiation will not increase your risk of that same cancer recurring (developing again). For example, radiation to the breast to treat breast cancer will not increase your risk of breast cancer in the other breast. There is a very rare risk, however, of a second type of cancer developing several years later. Talk to your doctor about any concerns you have before deciding whether radiation is right for you.
MYTH: Radiation will cause me to be radioactive.
FACT: External-beam radiation therapy, the most common type of radiation treatment, will not cause you to be radioactive. Only certain kinds of radiation therapy will cause you to emit small amounts of radiation following treatment. Talk to your doctor about what precautions to take when receiving internal or systemic radiation.