Living with Cancer: Preventing and Managing Side Effects

Your health care team members are the only ones who can properly advise you about your treatment, side effects, at-home care and any other medical concerns you may have. Talk to them about any side effects you may experience, including skin changes, fatigue, diarrhea, or difficulty eating. If you are given any safety guidelines or restrictions, be sure you understand them and know who to contact in case you have more questions.

High doses of radiation damage or destroy cancer cells in the radiation field by damaging the DNA cells. DNA stores genetic information on cell growth, division, and function. Radiation can also damage the DNA of normal cells. This may cause different side effects, depending on the area of the body that is being treated. Many patients have no side effects at all, but some patients have side effects related to the treatment area. Although unpleasant, most side effects are not serious and can be controlled.

IMRT Radiation therapy treatments can cause early and late side effects. Early side effects occur close to the time of treatment. They usually are gone within a few weeks of finishing therapy, although they may be permanent. Late side effects may take months or years to develop and usually are permanent.

The most common side effects are:

• Fatigue (feeling tired)
• Urinary Problems
• Skin Changes
• Gastrointestinal Symptoms

Most side effects go away in time. In the meantime, there are ways to reduce the discomfort they cause. If you have a reaction that is severe, the doctor may order a break in your treatments, change the schedule, or change the type of treatment you are receiving. Tell your doctor, nurse, or radiation therapist about any side effects you notice so they can help you manage them.

Your radiation treatments may cause you to feel tired. Some people may call it weary, weak, malaise, or exhausted. Whatever the word, being tired is common for people receiving radiation therapy. It does not mean that your cancer is increasing or spreading, but may be a result of your body using a lot of energy to fight the cancer and rebuild healthy cells. It’s the body’s defense that helps preserve energy for those purposes. Fatigue usually begins several weeks into therapy and will gradually disappear after you complete therapy. Take rest periods when you feel tired, but continue as much of your usual activity as you can. Continuing your usual activity will help stimulate energy and improve your overall sense of well being. You may notice that you feel less tired on the days when you do not have treatments, like on the weekend. Eat a well balanced diet, including foods high in iron. Also, maintain a fluid intake of at least two quarts a day. Dehydration causes you to feel tired. If you feel extremely fatigued, are short of breath or if dizziness occurs, consult the health care team.

Radiation therapy can affect your skin. Toward the end of your treatment, the skin may become reddened, darkened in color (tanned), blistered and may peel. It is important to monitor your skin and consult the health care team for advice concerning the care of your skin. Below you will find some tips to assist you:

• If your skin is marked with a color dye, do not wash the marks off or ‘refresh’ the marks yourself. They are necessary for accurate daily alignment of the treatment beam.
• At the beginning of your treatments, the therapist may ‘tattoo’ the treatment area. Tattoos are small permanent dots that define the treatment area and allow for accurate daily set ups.
• Keep your skin dry and exposed to the air whenever possible. Use of cornstarch, gently patted on with a powder puff, will keep the skin dry.
• Wear loose fitting clothing that does not rub or irritate the treatment area.
• Avoid extreme hot and cold temperatures to treated areas. This includes heating pads, hot water bottles, ice bags, heat producing ointments and lotions. An electric blanket may be used on low temperature settings.
• Clean the treated area with mild soap and warm water. Do no massage or rub the treated area vigorously.
• Avoid placing any powder, ointments, lotions creams or oils on the treated skin area, unless ordered by your physician.
• Protect your skin from excessive sun exposure.

As your treatment progresses, the doctor will advise you regarding skin care and if necessary, will prescribe medications. Once therapy is complete, skin reactions usually subside in two to four weeks. The skin may be dry, scaly and slightly darker than normal after treatment. Continuing the use of ointment or lotion will aid the return of normal skin texture.

It is important to keep your protein and calorie intake high. Doctors have found that patients who eat well can better handle their cancers and side effects. Unless you are on a special diet for another medical condition such as diabetes, you can continue your normal eating habits throughout treatment. During your weekly visits, your radiation oncologist will ask you if you are having any problems with bowel movements. The reason for this question is that some patients experience rectal irritation during treatment. If that happens, your radiation oncologist may suggest a change in diet that will help with bowel movements and will lessen the rectal irritation. If you feel tired, or have loose stool/diarrhea during your treatment, you should discuss this with your radiation oncologist or nurse. While these are common side effects associated with radiation therapy, they should not be ignored. By discussing these side effects with the doctor or nurse, they can recommend changes to your diet and if necessary in the case of diarrhea, medication can be prescribed.

Diarrhea associated with radiation is temporary and will go away shortly after treatment is complete. You can control diarrhea by:

• Drinking at least 8 glasses of fluid daily.
• Avoid foods known to cause loose stools, gas, or cramps such as raw fruits and vegetables, coffee, beans, cabbage, whole grain, breads and cereals, sweets and spicy foods.
• Increase intake of protein, carbohydrates, fiber, and calories. Be sure your diet includes foods that are high in potassium (bananas, potatoes, apricots), and important mineral you may lose through diarrhea.
• Report loose or watery stools of 3 or more per day.
• Do not take a laxative unless specifically directed by your physician.

Bladder
Bladder irritation results when normal as well as cancer cells are included in the radiation treatment field. The cells that that line the bladder divide rapidly as do cancer cells. Radiation damages cells that divide at a fast rate. This may lead to bladder irritation and infection. If this happens, you may find that you have to urinate frequently and urgently, during the day and at night. You may have the urge to urinate but have difficulty starting your stream. You may feel pain or burning when you urinate and notice pus or small amounts of blood in your urine.

Bladder irritation is temporary. Injured cells will be replaced by new cells and the bladder will usually heal within 2 to 3 weeks after your treatment has ended. Your Radiation Oncologist may order blood or urine tests if you develop signs or symptoms of a bladder infection. It is important to drink plenty of fluid. This dilutes your urine and decreases the risk of infection. It will also help remove pus or blood from the bladder and promote healing if an infection has already developed. If you have any symptoms of bladder irritation, talk to your doctor or nurse.

Sexual Relations
With IMRT treatments, men are not likely to suffer any change in their ability to enjoy sex. However, you may notice a decrease in your level of desire. Radiation may affect a man’s ability to have an erection (if hormone suppression is also given as part of the course of treatment).