RADIOTHERAPY LATE-EFFECTS

Radiotherapy late-effects can occur many months or even years after completing radiotherapy for cancer . They may happen once, persist long-term, or come and go. While some side-effects may not be curable, it might be possible to manage them.

Everyone is different, and you may experience a late-effect that is not listed here. It is not possible to predict if or when you will experience them.

The frequency or likelihood of experiencing late-effects is approximate and can be explained in the following way: 

Definite (100%): This is a side-effect that will affect everyone who has radiotherapy.

Expected (50 - 100%): It is anticipated that more than half of patients who have radiotherapy are expected to experience these side-effects.

Common (10 - 50%): It is anticipated that up to half of patients who have radiotherapy will experience these side-effects.

Less common (Less than 10%): It is anticipated that fewer than one in ten patients who have radiotherapy will experience these side-effects.

Rare (Less than 1%): It is anticipated that less than 1 out of 100 patients who have radiotherapy will experience these side-effects.

The Royal College of Radiologists National Radiotherapy Consent Forms are used to help people understand the types of side-effects and how common they are:

Expected (50-100%) 

Breastfeeding: After breast radiotherapy (and/ or surgery), you may not produce milk in that breast, but the other breast will not be affected.

Common (10-50%) 

Skin colour change in the treatment area: Lighter or darker for any skin tone.

Subtle changes to breast appearance: Change to breast size, shape, and texture. 

Breast/ chest wall/ axilla discomfort: Aching and shooting pains.

Worsened cosmetic outcome after reconstruction surgery: Which may require the implant to be replaced.

Less common (less than 10%) 

Marked change to breast appearance: Change to breast size, shape, and texture. Breast/chest wall swelling. 

Shoulder stiffness. 

Swelling (lymphoedema) of the arm fluid collecting in the arm which may cause swelling, pain, and/ or movement difficulties.

Rare (less than 1%) 

Skin changes (telangiectasia) in the treatment area: Small visible blood vessels which look like spidery marks.

Rib fracture. 

Fibrosis (scarring) of the underlying lung: Which can cause breathlessness, cough, or changes on X-ray.

Increased risk of heart disease in later life. 

Brachial plexopathy: Nerve damage which may cause pain, numbness, or tingling affecting the arm and shoulder. 

A different cancer in the treatment area.

Definite (100%) 

Early menopause: Symptoms of this may start during or shortly after radiotherapy. 

Egg and hormone production will stop. 

Infertility: You will be unable to carry a pregnancy in the uterus (womb) after radiotherapy.

Expected (50-100%) 

Vaginal narrowing, shortening or dryness: This may impact vaginal intercourse and the comfort and quality of a vaginal examination.

Common (10-50%) 

Urinary frequency (passing urine more often than normal) and urgency (a sudden urge to pass urine).

Urinary incontinence including urine leaking when coughing or straining. 

Bowel frequency (opening your bowels more often than normal) and urgency (a sudden urge to open your bowels). 

Looser stools compared to normal. 

Asymptomatic pelvic bone fractures, particularly when post-menopausal. 

If you received radiotherapy to the lower pelvis/ vulva, there may also be the following late effects: 

* Hair loss in treatment area. 

* Lymphoedema (fluid build-up) in your legs or pubic area. 

* Skin thickening or discoloration: Lighter or darker for any skin tone, or visible blood vessels. 

* Skin thinning.

Less common (less than 10%) 

Cystitis/ pain when you urinate. 

Reduced bladder capacity. 

Rectal pain/ discomfort which may worsen on opening your bowels. This may also affect your sex life if you receive anal sex. 

Faecal discharge/ soiling. 

Bleeding from your bladder, bowel, or vagina 

Bowel/ bladder damage which may require surgery due to stricture (narrowing), fistula (abnormal connection between two parts of your body), and may require stoma formation. 

Duodenal ulceration. 

Symptomatic pelvic bone fractures, particularly when post-menopausal 

Kidney impairment.

Malabsorption problems with nutrient absorption. 

Hair loss in treatment area. 

Lymphoedema (fluid build-up) in your legs or pubic area.

Rare (less than 1%) 

Skin thickening or discoloration: Lighter, darker, or visible blood vessels. 

Ureteric strictures narrowing of tubes running from kidneys and bladder. 

A different cancer in the treatment area. 

Radiation induced nerve damage in the lower back area.

Expected (50-100%) 

Skin colour change in the treatment area: Usually lighter or darker for any skin tone. Lymphoedema: Skin, chin, and soft tissue swelling. 

Dry mouth. 

Altered taste or loss of taste with possibility of some recovery over 18 months. 

Hair loss in the treatment area or patchy re-growth.

Common (10-50%) 

Permanent skin texture changes in treatment area: Thicker or thinner skin. 

Telangiectasia in the treatment area: Small visible blood vessels which look like spidery marks. 

Dental problems. 

Trismus jaw stiffness. 

Voice changes. 

Hypothyroidism: Under-active thyroid gland, which may require you to take medication. Hair loss in the treatment area or patchy re-growth. 

Permanent dryness of nose. 

Nasal crusting. 

Dry mouth. 

Altered taste or loss of taste with possibility of some recovery over 18 months. 

Cataract clouding in the lens of the eye: Which may require surgery to correct.

Less common (less than 10%) 

Dry eye. 

Visual changes and damage to the eye. 

Nasal regurgitation/reflux. 

Loss of smell Hearing loss or hearing changes. 

Dental problems. 

Trismus jaw stiffness. 

Voice changes. 

Osteoradionecrosis of the jaw: Damage to the jawbone. 

Swallowing problems with risk of long-term/permanent feeding tube requirement. Laryngeal chondronecrosis: Irreversible damage to the voice box. 

Increased risk of stroke. 

Pituitary dysfunction: Your pituitary gland not producing enough hormones, this may require you to take medication to replace the hormones. 

Osteoradionecrosis of the jaw: Damage to the jawbone.

Rare (less than 1%) 

Permanent changes to brainstem, spinal cord and nerves to the face, arm or hand. Radionecrosis of the brain: Damage to a small area of the brain which is not repairable 

A different cancer in the treatment area. 

Risk to life. 

Expected (50-100%) 

Infertility: Radiotherapy will affect your fertility. At consent, plans for having children and management options will be discussed.

Common (10-50%) 

Urinary daytime/night-time frequency - passing urine more often than normal. 

Urinary urgency a sudden urge to pass urine. 

Bowel urgency a sudden urge to open your bowels. 

Looser stools with more mucous or wind compared to normal. 

Changes in ejaculate such as reduced amount, dry, altered consistency or blood stained. Loss of orgasm. 

Change to penile length/appearance Inability to achieve an erection.

Less common (less than 10%) 

Cystitis/ pain when you urinate due to bladder inflammation. 

Incomplete emptying of your bladder or reduced bladder capacity. 

Urinary stricture a narrowing in your water pipe which may require surgery. 

Bowel frequency opening your bowels more often than normal. 

Inflammation of the rectum which may cause pain when opening your bowels. This may also affect your sex life if you receive anal sex. 

Bleeding from your bladder or bowel Intermittent abdominal discomfort.

Rare (less than 1%) 

Urinary incontinence including urine leaking.

Pelvis/hip bone thinning and/or fractures. 

Bowel/bladder damage which may require surgery due to perforation (hole), fistula (abnormal connection between two parts of your body), bowel obstruction (blockage), or severe bleeding. 

An increased risk of a different cancer in the treatment area. 

If you received radiotherapy to your pelvic lymph nodes: 

* Lymphoedema: fluid build-up in your legs and potentially your scrotum. 

* Malabsorption: problems with nutrient absorption. 

* Neuropathy: damage to nerves which could cause pain, numbness or weakness in your legs.