Side Effects of Radiation Therapy -
Esophageal Cancer
The following are the most common side effects, both acute and chronic, resulting from radiation. Unforeseen side effects may occur because of the unique and varied tolerance of individual persons. Late effects of treatment may not always be predictable and may be influenced by concurrent and/or subsequent treatment for this and other diseases. These common side effects include, but may not be limited to the following.
Radiation therapy for esophageal cancer, with or without chemotherapy, is typically given for 5 to 7 weeks, once per day, five days per week. The esophagus is a long structure extending from the neck down to the abdomen. Accordingly, potential side effects will vary depending upon which part of the esophagus requires treatment. Symptoms may also relate to surgery or chemotherapy should you receive these.
Fatigue is common. This is not normally debilitating and, in itself, should not affect your daily activities or ability to drive. However, you may wish to go to bed earlier or take an afternoon nap during this period. Fatigue and weakness are worse in patients who lose weight. Accordingly, we strongly encourage you to supplement your diet with high calorie foods or commercially available nutritional supplements (for example Ensure Plus, Sustacal, Boost), if necessary to maintain your weight.
Some patients complain of poor appetite or even nausea and vomiting. Should you experience these, please speak with the nurse or your physician so that you receive appropriate medications. Similarly, difficulty swallowing or sore throat may be alleviated with medications. We may also recommend appropriate lotions to apply should you develop local irritation or itchiness of the skin.
Your blood counts may require monitoring periodically during treatment, especially if you also receive chemotherapy.
The side effects of treatment usually resolve 2-6 weeks after completion of treatment. Long-term effects of radiation may be serious and involve inflammation or scarring within the lung, esophagus, heart, or spinal cord. Fortunately, serious complications are unusual. Lung injury occurs in 3% or less, and spinal cord injury occurs in approximately 1 in 1,000 patients.
You may also notice subtle permanent changes in the treated area including the skin. Inexpensive moisturizing lotion is recommended for local dryness or itchiness. The treated skin may be more sensitive to sun exposure. Accordingly, we advise wearing clothing or sunscreen over the treated area while spending time outdoors. This is a lifelong recommendation.
This statement is not a warranty, but it is simply meant to give information regarding typical radiotherapy side effects and their management. Catastrophic or even fatal radiation complications may occur in rare cases. Great care will be taken to minimize the side effects and reduce the risk of radiation damage to normal tissues.
Side Effects of Radiation Therapy - Gastrointestinal Malignancies
The following are the most common side effects, both acute and chronic, resulting from radiation. Unforeseen side effects may occur because of the unique and varied tolerance of individual persons. Late effects of treatment may not always be predictable and may be influenced by concurrent and/or subsequent treatment for this and other diseases. These common side effects include, but may not be limited to the following.
Radiation for gastrointestinal malignancies includes treatment for cancers arising from the stomach, pancreas, gallbladder, bile ducts, small intestine and large intestine, including the rectum. These treatments are often given in addition to surgery and/or chemotherapy. Specifically, a chemotherapy drug called 5-fluorouracil (5-FU) is often given with radiation to act as a radiation sensitizer against malignant cells. The radiation series typically lasts 5 to 7 weeks, once per day five days per week. Occasionally, we treat according to a "split course" schedule which may add to the total length of time under treatment by introducing treatment breaks at planned intervals.
Many patients experience fatigue which starts during the second or third week and progresses as the treatment progresses. This typically subsides gradually over 2 to 6 weeks following the radiation treatment. This is not normally debilitating and in itself should not effect your daily activities or ability to drive. However, you may wish to go to bed earlier or take a nap during the afternoon. Fatigue and weakness are worse in patients who lose weight. Accordingly, we strongly encourage you to supplement your diet with high calorie foods or commercially available nutritional supplements (for example, Ensure Plus, Sustacal, Boost), if necessary to maintain your weight.
Your blood counts may require monitoring periodically during treatment, especially if you also receive chemotherapy.
If treatment is directed toward the upper abdomen, the major short-term side effects typically include nausea with or without vomiting, loss of appetite, upper abdominal pain reminiscent of ulcers and sometimes, crampy diarrhea. A variety of medicines are available to treat all of these effects and will be employed as needed. The end result of these side effects may be weight loss which your physician and staff to try to minimize through dietary advice and appropriate use of medications. In severe cases, more aggressive dietary support may be needed including measures such as placement of a small flexible tube directly into the gastrointestinal tract, bypassing the irritated segment.
When the pelvic area is treated, such as in patients with rectal cancer, there tends to be less difficulty with nausea and vomiting, but a greater problem with diarrhea and intestinal cramping. These symptoms are typically improved through avoidance of fiber in the diet and appropriate medications such as Imodium. We keep a specific list detailing foods that may or may not satisfy the recommendation for low fiber for your availability upon request.
When pelvic radiation is given, the bladder and urethra may also become irritated such that urination becomes more frequent, especially at night, causing you to arise multiple times, occasionally with mild burning discomfort as well. Again, appropriate medications may be given to decrease this problem.
The skin within the treated area may become red with temporary itching and discomfort. This is particularly problematic in patients treated for pelvic malignancies, such as rectal cancer in which case the reaction in the region of the buttocks and anus is particularly annoying. There are a variety of topical measures used to alleviate this condition.
The longer term risks of radiation to the upper abdomen include injury to stomach or small intestine which may closely resemble peptic ulcer disease. This class of injury generally responds to ulcer medications, although may take the form of a more devastating injury in a very small minority of patients. Very rarely, normal liver or kidneys could be injured by upper abdominal radiotherapy, but we take great care to irradiate no more of these sensitive tissues than absolutely necessary to accomplish the mission.
Another rare delayed complication of radiotherapy is bowel obstruction, which is more commonly seen after radiation therapy to the pelvis in patients treated for cancer of the rectum. Maintaining a full bladder for each treatment will help displace small intestine out of the path of the radiation beam during the treatment of pelvic malignancies, decreasing the chance of a radiation-induced small bowel injury. Fortunately, major complications of radiotherapy are rare with modern techniques.
You may also notice subtle permanent changes in the treated area including the skin. Inexpensive moisturizing lotion or aloe vera gel is recommended for local dryness or itchiness. The treated skin may be more sensitive to sun exposure. Accordingly, we advise wearing clothing or sunscreen over the treated area while spending time outdoors. This is a lifelong recommendation.
This statement is not a warranty, but it is simply meant to give information regarding typical radiotherapy side effects and their management. Catastrophic or even fatal radiation complications may occur in rare cases. Great care will be taken to minimize the side effects and reduce the risk of radiation damage to normal tissues.
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