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(14) Cancer Symptoms & Treatment

Radiation Therapy Side Effect

Radiation Therapy Effects

Side Effects of Radiation Therapy



I have heard that radiation therapy causes a skin reaction. Is this true? How should I care for my skin during radiation therapy?

Radiation therapy is administered as a beam of energy directed from a treatment machine at precise angles toward a defined target in your body. It destroys tumor cells in its path by preventing them from dividing. Normal cells that divide rapidly are also very sensitive to radiation therapy. As a result, there may be changes in your skin where the beam enters and exits your body. After about 2 weeks, you may notice redness, tanning, dryness, flaking, and/or itching. If you are being treated in sensitive areas of the body, such as the armpit, the neck, under the breasts, and the perineum (the area between the genitals and the anus), the reactions may become more severe over time, and you may develop blistering and weeping of the skin. Ask your doctor or nurse to explain what you should expect based on the area being treated. These effects are all expected, and they will heal about a month after treatment is completed; however, you may be left with an area of darkened skin in the treated area.

Take special care of your skin from the first day of treatment to ensure that you do not become uncomfortable from any changes. Bathe daily using warm water and a mild, unscented soap, such as Dove, Neutrogena, Basis, or Cetaphil. Do not scrub the skin with a cloth or brush, rinse the skin well to get off all the soap, and gently pat it dry. Your doctor or nurse may recommend the use of a moisturizer, either from the beginning of treatment or if you develop dryness or itching. Examples of products often used during radiation therapy are Aquaphor, Eucerin, Biafine Topical Emulsion, and products with aloe vera gel, calendula, or hyaluronic acid.

There is no compelling evidence that any one product is better than the other. Ask your doctor or nurse for a recommendation on application. The common recommendation is to use the moisturizer twice a day, after your daily treatment and at bedtime. Check before using any other lotions, creams, or ointments in the area being treated because some products can make the skin reaction more severe.

Avoid irritating the skin. Follow these suggestions in the area being treated:

• Avoid tight, constricting clothing.

• If treatment is to the pelvis, wear cotton underwear.

• Avoid the use of tape.

• Avoid scratching the skin. Tell your doctor or nurse if the moisturizers are not effective in relieving the itching so that something else can be prescribed.

• Avoid direct sunlight.

• Avoid the use of ice packs or heating pads.

Radiation therapy will also cause the hair in the treated area to fall out. If you are not being treated in the head or neck area, you will not lose any hair on your head. Your hair will grow back several months after your treatment is completed.

I have heard that chemotherapy may cause me to lose my hair. Can I prevent this? What can I do to feel good about my appearance if I lose my hair?

Chemotherapy destroys tumor cells by preventing them from dividing, and normal cells that divide rapidly are also very sensitive to chemotherapy. The cells at the base of the hair follicle may become unable to divide to make new cells, weakening the hair shaft and resulting in hair loss. Some people experience only a thinning of their hair, but others lose all the hair on their head.

Certain chemotherapy drugs are much more likely than others to cause hair loss. Your doctor or nurse can tell you if you are likely to lose your hair based on the type of chemotherapy drug that you are receiving. If you are receiving chemotherapy drugs that are likely to cause hair loss, you might lose hair from other parts of your body. Hair anywhere on your body can be affected, including your eyebrows, eyelashes, and hair in your underarm and pubic areas. Hair loss usually begins about 3 weeks after chemotherapy begins. Sometimes people notice a gradual thinning and loss of hair, but with some chemotherapy agents the hair can come out in clumps over a period of only a few days.

If you are receiving chemotherapy that causes only a thinning of hair, you can reduce the amount of hair you lose:

• Use a mild shampoo, such as baby shampoo.

• Use a soft-bristled hairbrush.

• Avoid permanents and hair dyes.

• Avoid heated rollers and high-heat hair dryers.

If you are receiving chemotherapy with a high likelihood of causing complete hair loss, there is no way of preventing this. Doctors no longer use ice caps to prevent the chemotherapy from flowing to the scalp because they want to be sure the chemotherapy travels all over your body, not missing any area where there could be cancer cells.

If you are likely to lose your hair from treatment, you may find it helpful to purchase a wig or hairpiece beforehand. Some people like to match their own hairstyle to maintain their usual appearance; others like to try a new look. Wigs can be made with human hair or from synthetic fibers, and they vary considerably in price. Look for stores in your area that specialize in working with people who lose their hair from cancer treatment or you can purchase a wig or hairpiece through the American Cancer Society. Your local American Cancer Society or hospital social work department may also have wigs and hairpieces available on loan. Your insurance company may cover the cost of the hairpiece. Check your policy, and, if it is covered, ask your doctor to write you a prescription for a “hair prosthesis needed for cancer treatment.”

Costs that are not reimbursed are tax deductible. Some people prefer to wear a turban, scarf, or cap to cover their heads, and some prefer to leave their head uncovered. Do whatever makes you feel the most comfortable. The important thing is not to let your changed appearance alter your willingness to interact with family, friends, and coworkers.

Despite the loss of hair, you can take many steps to feel good about your appearance: for example, taking care of the clothes you wear, using makeup if you like, and wearing scarves or caps. The Personal Care Products Council, the National Cosmetology Association, and the American Cancer Society sponsor a free program, “Look Good, Feel Better,” that is dedicated to helping men and women being treated for cancer feel better about their appearance. The program offers beauty techniques that help restore your appearance and enhances your self-image, provides many tips on its Internet site, and presents group programs all over the country. To find out if the program is available in your area, check their Internet site (

 I have heard there may be changes in the color of my skin from my treatment. What does this mean?

Color changes in skin and nails can occur during treatment for cancer. These color changes are usually temporary and can be caused by either chemotherapy or radiation therapy.

Changes in skin and nails include:

• Flushing

• Hyperpigmentation

• Photosensitivity

Flushing is a temporary redness that usually occurs in the face and neck as a result of dilated capillaries, which are small blood vessels located just under the surface of the skin. Flushing can be caused by chemotherapy (paclitaxel, cisplatin, doxorubicin), intravenous contrast (used with CTs), or some oral medications (steroid medicines such as prednisone or dexamethasone). Sometimes flushing is accompanied by a feeling of warmth. Flushing is always temporary and generally lasts for minutes or up to several hours.

Call your doctor or nurse if the flushing is persistent or accompanied by pain, fever (100.5ºF or more), swelling, or another discomfort.

Hyperpigmentation is a darkening of the skin, such as a freckle. This darkening can be generalized, as in a suntan, or localized to certain areas of the body. If localized, you may notice darkening of the skin over finger joints or elbows and knees. The palms of the hands and soles of the feet may also darken, as may the tissue under the fingernails and toenails or the nails themselves. There may even be color changes in your mouth, for example, darkening of your tongue and gums. Certain intravenous chemotherapy (fluorouracil) causes darkening along the length of the vein into which it is given. Hyperpigmentation may be more noticeable in people with darker skin tones. Some types of chemotherapy (paclitaxel or docetaxel) cause white lines, called Beau’s lines, to form horizontally on the fingernails. Radiation therapy can cause the skin to darken in the irradiated area. Sun exposure may increase hyperpigmentation temporarily. Hyperpigmentation usually occurs within several days to 2 to 3 weeks after starting treatment. Sometimes the discoloration is permanent, but usually, it resolves within a few months after treatment is completed.

Photosensitivity means that your skin is more sensitive to the sun (i.e., ultraviolet radiation); you can burn more easily when in the sun or you may develop a rash from it. This reaction can occur whether you have light or dark skin, and it may result from medications, including certain types of chemotherapy and antibiotics.

Radiation therapy can also cause the skin in the treated area to be more sensitive to the sun. Before going out in the sun, ask your doctor or nurse if you are taking any medications that can cause this reaction. Photosensitivity can result in severe sunburn, but this reaction can be prevented. When outside, even on cloudy days, wear protective clothing, including a hat, long-sleeved shirt, and long pants, and always use a sunscreen with an SPF of at least 15. At the beach, sit under an umbrella and use a sun block such as zinc oxide.

If you get a bad sunburn or rash from the sun, call your doctor or nurse. They can prescribe medicines to make you more comfortable. They can also tell you which lotions or creams are best to use for the sunburn.

Lisa’s comment:

I’m a beach bum-love the summer, love the beach, love the ocean. I have a cabana at Malibu Beach (Long Beach, Long Island). Photosensitivity was probably one of the biggest obstacles for me. I had to wear sunscreen (well, that wasn’t new), sit under an umbrella, and not go in the ocean (that wasn’t because of chemotherapy, but because of surgery restrictions). I felt like my one true pleasure was a chore, a burden. I did very well with keeping myself protected from the sun, but I really didn’t entirely enjoy my days at the beach. But, chemotherapy didn’t stop me from going! My fingernails turned a yellowish-orange color with the adriamycin/Cytoxan therapy.

 Take special care of your skin from the first day of treatment.

Certain chemotherapy drugs are much more likely than others to cause hair loss.

Do whatever makes you feel most comfortable

Skin and nail color changes are usually temporary.



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