Side effects of lung cancer radiotherapy
Side effects tend to start a week after the radiotherapy begins. They gradually get worse during the treatment and for a couple of weeks after the treatment ends. But they usually begin to improve after around 2 weeks or so.
If you have had stereotactic radiotherapy, you might get side effects during treatment or up to 12 weeks after treatment.
These side effects vary from person to person. You may not have all of the effects mentioned.
Side effects can include:
You might feel tired during your treatment. It tends to get worse as the treatment goes on. You might also feel weak and lack energy. Rest when you need to.
Tiredness can carry on for some weeks after the treatment has ended. But it usually improves gradually.
Various things can help you to reduce tiredness and cope with it, such as exercise. Some research has shown that taking gentle exercise can give you more energy. It's important to balance exercise with resting.
You might feel sick at times. You can have anti sickness medicines. Let your treatment team know if you still feel sick, as they can give you another type.
Your skin might go red or darker in the treatment area. You might also get slight redness or darkening on the other side of your body. This is where the radiotherapy beams leave the body.
The red or darker areas can feel sore. This may start after your radiotherapy treatment is completed. Your radiographers may give you creams to soothe your skin. The soreness usually goes away within 2 to 4 weeks of ending the treatment. But your skin might always be slightly darker in that area.
Radiotherapy to the chest area might cause some inflammation of your lungs. Soon after the treatment, you might have a dry cough or shortness of breath. This is called acute radiation pneumonitis (pronounced new-mon-eye-tiss).
Let your doctor or radiographer know if you feel breathless.
You might find that having a soft diet is easier to swallow until a few weeks after your treatment is over. Foods such as soups and stews are easier to swallow than more solid foods like meat or toast.
Your radiotherapy department can give you an information sheet to help advise you.
Tell your doctor or radiographers if you have problems swallowing. They can advise you on ways to reduce this.
Ask to see a dietitian if you have problems with eating and drinking.
Tips for eating and drinking
- Drink about 8 glasses of water a day while having treatment.
- Make sure that you eat slowly and avoid eating late in the day.
- Drink plenty during and after meals to soften your food.
- Eat small amounts often rather than big meals.
- Try different foods to find out which are easiest to swallow.
- You can have high calorie drinks to boost your calorie intake if you need them.
Your hair may fall out in the treatment area.
Some people may have mild chest discomfort, shivering and a raised temperature a few hours after treatment. This usually settles quickly.
If you had stereotactic radiotherapy, you might experience chest pain.
A painkiller such as paracetamol can help to relieve discomfort or pain.
Your appetite may vary during treatment. Try to eat well where possible and keep hydrated.
Radiotherapy can cause many different side effects, such as tiredness. The side effects you get will depend on the area you're having treatment to but there are some general side effects you might experience regardless of where your cancer is. This video is about the side effects you might have when having radiotherapy to the chest.
On screen text: Difficulty swallowing
Martin (Radiographer): Radiotherapy can irritate the lining of your oesophagus, also known as your food pipe, which can cause soreness and swelling and make it more difficult to swallow.
David: After about two weeks it started to get more difficult to swallow. The more it progressed, the worse it got and ended up couldn't eat anything solid at all so it was virtually down to liquids.
Laurel: I wasn't physically able to swallow anything whatsoever and that was quite challenging because I was thirsty and I was hungry, but, you know, nothing was happening.
Martin (Radiographer): Eating foods which are softer and easier to swallow can be helpful. Things such as soup and porridge or mashed potatoes.
Laurel: Yoghurt or custard were easier because I don't need to chew on anything.
David: Soups, trifles, tiramisus. It's down to trial and error and keep trying to eat what you can because you really have to keep your body up to scratch.
Martin (Radiographer): I'd recommend avoiding very spicy foods and avoiding foods which are very hot or very cold.
Laurel: Spicy food, definitely avoid the peppers and stuff like that.
Martin (Radiographer): For chest radiotherapy, we would recommend that you avoid alcohol as this can cause more irritation in the area we're treating.
Laurel: I had a dietitian and either on the phone or they'd pop in.
David: So they noticed that my weight was coming down so they got a dietitian in and she prescribed all these protein drinks.
Martin (Radiographer): You can replace the calories by swapping foods for high calorie alternatives, or your dietitian can recommend high calorie drinks and food supplements. If you're experiencing pain or heartburn during treatment, speak to your team and they can prescribe medication that can help with that.
On screen text:
- Try different foods to find out which are easiest to swallow
- Avoid eating foods that may irritate your throat
- Avoid smoking and alcohol, particularly spirits
- You might need high calorie drinks to boost your calorie intake
- Drink lots of water
- Let your team know if you need painkillers
- Ask to see a dietician
On screen text: Feeling or being sick
Laurel: Yes, being sick was one of the worst things happening.
David: I was just constantly being sick. I would have my porridge in the morning, wait a couple of minutes and it would be up again so it was just one of these things.
Martin (Radiographer): What you eat and drink can affect how sick you feel during treatment. You can drink fizzy drinks and eat ginger, which can help reduce sickness and we'd recommend avoiding fatty foods or big heavy meals, which can make you feel more sick.
Laurel: But I didn't realise, okay, you can get medication for the anti-sickness until the medical team realises that's what was needed. It's helped me slowing not being sick as often as I would have done because a lot of things I would just be gagging.
Martin (Radiographer): If you are having problems eating and drinking during your treatment, there are dieticians available which can help you.
On screen text:
- Your doctor can prescribe anti sickness medication
- Relaxation techniques such as mindfulness and visualisation might help
- Avoid certain foods
- Eating a few hours before treatment can help
- Drink lots of liquid, taking small sips slowly throughout the day
- See a dietician for advice – there is help available
On screen text: Shortness of breath
Martin (Radiographer): Having radiotherapy to the chest can affect your breathing. This may come on about two weeks after treatment begins and will continue throughout the rest of treatment. Once you've finished treatment, the breathlessness may continue for a couple of weeks, but then recovers after that. Depending on your diagnosis and treatment you may experience long term breathing problems and your doctor will discuss that with you before you start treatment.
David: So I've been constantly shortness of breath and I take inhalers twice a day now. I just have to be careful in what I do. I can walk for miles on the flat but as soon as an incline, that's when I start to get short of breath. I go out walking or cycling everyday, so that's just a constant to try and keep it going.
Martin (Radiographer): If you are experiencing shortness of breath, we would recommend speaking to your team as soon as you notice it, just to make sure there isn't something else going on, such as an infection or blood clots.
On screen text:
- Shortness of breath can happen during and after radiotherapy
- It usually improves after treatment finishes
- It can continue long term
- Always let your specialist or radiographer know if you are short of breath
If you're experiencing a side effect that hasn't been covered in this video, you can find more information on the Cancer Research UK website.
On screen text: For more information go to: cruk.org/radiotherapy/side-effects
Long term side effects
Most side effects gradually go away in the weeks or months after treatment. But some side effects can continue or might start some months or years later.
Rarely, your food pipe might become narrower and less stretchy over some months or years. This is called an oesophageal stricture. It can make it difficult for you to swallow.
If you develop a stricture, your doctor can stretch the food pipe slightly. They call this oesophageal dilatation. Stretching the food pipe opens it up again so that you can swallow food and drink more easily.
You have medicine to make you sleepy (sedation). Your doctor puts a tube called an endoscope down your throat. It has an area on it called a balloon. Your doctor expands the balloon to widen the food pipe. They repeat this a few times until the narrowing has gone.
You might need to have this repeated if the narrowing happens again.
A cough and breathlessness happen in about 1 out of 25 people (4%) who have radiotherapy to the chest area. This is due to changes in the lung tissue called chronic radiation pneumonitis. It might start many months or a few years after treatment.
Let your doctor know if you notice any changes in your breathing or if you cough up a lot of mucus.
You might have regular tests to check how well your lungs work. Treatment with steroids or other medicines can help you to breathe more easily.
If your cancer is in the top of the lung, a group of nerves called the brachial plexus might receive some radiation. This group of nerves supply the arm. Your radiotherapy will be carefully planned to limit the dose to this area as much as possible.
Scarring of the lung in the treatment area could happen months to years after radiotherapy treatment.
Scarring is usually permanent and can cause a small portion of the lung to collapse. This might make you more short of breath, and you may need to use oxygen.
If your cancer is close to the ribs, radiotherapy may weaken the ribs, cause pain and cause ribs to break (fracture). This does not always cause any symptoms and may be found on a scan after your treatment.
Rarely the broken ribs can cause pain that requires painkillers for a long period of time.
Very rarely radiation can cause inflammation to the covering layer of your heart (pericardium). This is called pericarditis. It can cause:
- chest pain that starts suddenly, often on the left side under your breastbone
- tightness in your chest that gets worse when you lie down or breathe in
Very rarely lung radiotherapy can cause damage to your spinal cord.
Your doctor will talk to you about this possible side effect before you have treatment but it is extremely rare.
Side effects if you have chemotherapy with radiotherapy
Chemotherapy combined with radiotherapy can make some side effects worse. Combining these treatments is called chemoradiotherapy.
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