This page was reviewed under our medical and editorial policy by
Sean Cavanaugh, MD, Chair, Department of Radiation Oncology.
This page was updated on September 24, 2021.
For cancer, doctors may recommend radiation therapy, a treatment that attacks cancer cells using high-energy sources such as electron beams, gamma rays or X-rays. It’s regularly used for both early-stage and advanced-stage cancers and often performed in conjunction with other cancer treatments.
Radiation therapy is mainly confined to the cancerous tumor—or targeted areas of treatment—and not the surrounding areas. Still, considering that radiation therapy uses high levels of radioactivity to fight cancer cells, it may also damage nearby healthy cells and tissues. This may trigger troublesome reactions—some short-term and some long-lasting.
Patients should have frequent, consistent and open dialogue with their cancer care team about side effects before, during and after treatment, as this is critical for receiving the appropriate recommendations for side effects management.
The side effects of radiation therapy may depend on the dose and length of treatment. Most patients see side effects subside within a few months post-treatment, but no two people are the same. The American Cancer Society (ACS) has developed a six-week external radiation therapy side effects worksheet to help patients track symptoms. The side effects of radiation therapy are sometimes difficult to identify, especially since they can be subtle in the early days of treatment. That's why it's important to discuss any questions or concerns with your radiation oncologist or nurse as soon as you experience them.
Some side effects may not show up for months or years after completion of treatment, depending on dosage and type of treatment. When discussing follow-up care, patients should ask about any possible late side effects.
There are a few main side effects of radiation therapy. Most symptoms, like hair loss, are only experienced in the area of the body being irradiated. Others, like fatigue, are more common regardless of the area being treated. Knowing as much as possible about the different side effects and what to expect may help put patients more in control and at ease.
Fatigue: Cancer fatigue is different from physical weakness. Cancer fatigue feels more like how you feel after a long day, only it's caused by the treatment. Also, the level of fatigue differs in each person. The larger the area being treated, the more fatigue the patient generally feels.
To manage fatigue, patients should:
Skin irritation and burns: Radiation therapy may cause dry skin, itchiness and, sometimes, radiation burns. In other cases, the skin may become sensitive to sunlight and become red.
To manage skin irritation, patients should:
Nausea and vomiting: Radiation therapy may make you feel queasy and lightheaded, and in rare cases, it may cause you to vomit.
To manage nausea, patients should:
Hair loss (alopecia): Some radiation treatments may cause your hair to thin or fall out in the area of the body being treated. This may include hair throughout the body, not only on the head.
To manage hair loss:
Diarrhea: During radiation treatment, specifically to the abdomen or pelvis, patients may experience diarrhea, or loose stools.
To manage diarrhea:
Sexual issues: These may occur if radiation therapy involved the pelvic area or sexual organs.
Fertility challenges
Urinary and bladder changes: Radiation therapy directed to the pelvic area may also cause urination or bladder issues, including pain or burning sensations while urinating, trouble passing urine, blood in the urine, or an urge to urinate often.
More severe, long-term side effects may occasionally include:
Depending on the side effect, there are many options for management, including surgery to improve incontinence, medications, dietary changes and pelvic floor muscle strengthening.
Considering that radiation is a localized therapy, side effects typically differ depending on the part of the body being treated. Below, find a few more side effects of radiation, specific to the area of treatment.
Brain: After radiation therapy of the brain, patients may experience headaches or trouble with memory and speech. Some side effects of the brain depend on the area being targeted. Some side effects may occur at different times: some may present themselves quickly, and others may not show up until one to two years after treatment. Radiation may cause the brain to swell, which may trigger some of these side effects. Medications may help prevent brain swelling. Patients experiencing any of these side effects should immediately alert their doctor.
Breast: After radiation on the breasts, patients may experience swelling, heaviness, tenderness or dryness. There are also some long-term breast changes to watch out for, including slightly darker skin and larger pores. The skin may also be more or less sensitive and feel thicker or firmer than before treatment. To ease irritation around the breast, women should avoid wearing a bra, or wear a soft cotton bra. Doctors should be alerted if fluid builds up in the breast (lymphedema) or you experience any post-treatment changes.
Radiation therapy to the breasts or chest area has a slight risk of damaging the heart, we use advanced technologies to reduce that risk Some rare side effects impacting the lungs may include radiation pneumonitis, which may include shortness of breath, coughing, chest pain and a low-grade fever. Patients who experience any heart or lung problems should contact their care team immediately.
Head and neck: During radiation therapy in the head and neck, it’s important for patients to take good care of their gums, teeth, mouth and throat, as they may experience pain, soreness or loss of taste in these areas. Some ways to manage these side effects include avoiding spicy or raw foods, extremely hot or cold foods or beverages, and sugary foods. It’s recommended that patients not smoke, drink alcohol to excess or chew tobacco. In addition to their cancer care team, patients should reach out to a dentist for any mouth and teeth issues.
Before treatment, patients should consult with their care team about the potential side effects and late effects related to their specific area of radiation therapy. Those who experience any other noticeable or irregular changes in physical appearance or physiological state during or after radiation treatment should contact their doctors—the earlier, the better.