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Radiation to the chest

There is always the potential for some side effects to occur when radiation therapy is given to the chest area. Radiation therapy to treat lymphoma and cancers of the lung, esophagus, spinal cord and breast is often directed at structures within the chest. Most side effects usually begin 2–3 weeks after treatment starts. Many go away once treatment is over, but a few may continue or occur long after radiation treatment.

Skin reactions

Skin reactions occur because external beam radiation travels through the skin to reach the area being targeted for treatment. The skin in the radiated area may become red and dry or change colour (become darker or tanned looking). Most skin reactions occur within the first 2 weeks of receiving radiation treatment. They usually go away a few weeks after treatment, but some skin changes, like skin darkening or scarring, can continue. Some people do not experience any skin reactions with radiation therapy. The radiation therapy team will give instructions for skin care and sun protection.

Sore throat

Rapidly growing cells lining the throat are sensitive to the effects of radiation. They can become inflamed and painful, which can lead to a sore throat. A sore throat may occur if radiation is given to the upper part of the chest. Symptoms usually appear about 2–3 weeks into radiation therapy and often improve a few weeks after treatment is finished.

Changes in taste

Taste changes can occur with radiation therapy to the chest, but it is not clear why this side effect occurs. It is thought to be the result of several factors, including fatigue, chemotherapy given before or at the same time as the radiation and other medications. A variety of taste changes can occur because of radiation therapy.

The radiation therapy team or a registered dietitiandietitianA healthcare professional who specializes in food and nutrition. can suggest ways to deal with taste changes.

Taste may return to normal 1–3 months after radiation treatment is finished.

Loss of appetite

Loss of appetite (anorexia) can be caused by many factors, including:

  • a buildup of waste products as cancer cells die
  • difficulty swallowing
  • nausea and vomiting
  • fatigue
  • changes in taste that make foods less appetizing

Loss of appetite can lead to weight loss and malnutrition. Maintaining good nutrition during and after radiation therapy is important to help a person recover from treatment. A registered dietitian can give advice about how people may increase their appetite, eat more and maintain their nutrition. The dietitian might also suggest nutritional supplements.

Nausea and vomiting

Nausea and vomiting are not common side effects of radiation therapy to the chest, but they can occur if the treatment area is close to the stomach. Nausea and vomiting may occur during the first or second week of radiation therapy and can usually be managed with antinausea medication. Nausea and vomiting usually go away after radiation treatment is finished, but may last for a few weeks.

Heartburn

Heartburn can occur when radiation therapy irritates the lining of the lower esophagus. Spicy and fried foods and foods that cause gas should be avoided. Antacids or other medications may be needed. These symptoms often go away after treatment has ended.

Hoarseness

Hoarseness can occur when radiation therapy irritates the larynx (voice box) and it becomes inflamed (called laryngitis). Hoarseness usually starts 2–3 weeks after radiation therapy begins. The person’s voice usually returns to normal after treatment has ended and the inflammation has decreased.

Difficulty swallowing

Difficult or painful swallowing or heartburn can occur if the pharynx or esophagus is in the treatment area. Radiation can cause inflammationinflammationThe body’s protective response to injury or infection that includes redness, swelling, pain and warmth of the affected area. of the pharynx (called pharyngitis) and esophagus (called esophagitis) that can contribute to difficulty swallowing. Symptoms usually begin 2–3 weeks after radiation treatment starts.

If difficult or painful swallowing cause problems eating, the radiation therapy team can make suggestions that will help. Medications, such as antacids, may be given to lessen pain from an inflamed esophagus or heartburn. Difficulty swallowing because of pharyngitis or esophagitis often goes away when treatment ends and inflammation decreases.

Breast changes

Changes to the breast can occur when radiation treatments are given to the chest. These side effects may continue for 3–6 months, or longer, after radiation therapy is finished. Some changes that may occur include:

  • soreness and swelling
  • breast size
  • skin texture and sensitivity

Report breast changes that continue long after radiation is finished to the health care team.

Lung problems

Lung problems, including increased cough and mucus in the throat and chest, can occur when radiation therapy irritates the tracheatracheaThe tube-shaped airway in the neck and chest that leads from the larynx (voice box) and branches to form the bronchi (the large tubes, or airways, that connect to each of the lungs). and bronchibronchiThe large tubes, or airways, that branch off from the windpipe (trachea) into the lungs, where they branch into smaller tubes (bronchioles) that end in the alveoli (air sacs). Bronchi carry air to and from the lungs.. Lung problems caused by radiation therapy to the chest include:

  • radiation pneumonitis
    • The lung is very sensitive to the effects of radiation and can become inflamed.
    • Radiation pneumonitis is more likely to occur if a large area of one lung or both lungs are treated with radiation.
    • It sometimes starts during radiation treatment, but usually occurs about 1–3 months after treatment is completed.
  • pulmonary fibrosis
    • Radiation therapy can cause scar tissue that makes the lung thick or stiff.
    • Many people do not have symptoms with pulmonary fibrosis, but some will have shortness of breath and lower tolerance for physical activity.
    •  Pulmonary fibrosis can occur months or years after radiation therapy.

Report cough or shortness of breath to the radiation therapy team.

Treatment options for lung problems may include:

  • medicines to treat cough
  • physiotherapy to learn breathing techniques that may be helpful in coping with shortness of breath
  • oxygen therapy for shortness of breath

Heart problems

Radiation therapy to the chest can injure the heart and cause heart disease. Heart problems are not very common with radiation therapy to the chest, but they can occur as a late side effect. Heart problems may occur if the treatment area includes the heart or mediastinummediastinumThe space in the chest between the lungs, breastbone and spine that contains the heart, great blood vessels, thymus, trachea (windpipe), esophagus and lymph nodes., especially if certain chemotherapy drugs are also given.

Tell the healthcare team about shortness of breath, chest pain or swelling of the arms or legs. Heart function may be monitored to check for injury or damage to the heart. Medicines or other treatments may be needed for heart problems. Long-term follow-up is necessary if heart problems occur.

Radiation myelopathy

Radiation myelopathy is damage to the spinal cord caused by radiation therapy. The 2 types of radiation myelopathy are transient and late, or delayed.

Transient radiation myelopathy is characterized by Lhermitte’s sign, which is an electrical shock-like sensation in the neck, back or legs. It usually happens when the neck is bent forward. This side effect most often occurs 2–6 months after radiation therapy. It usually improves without treatment and is not linked with any long-term problems.

Late, or delayed, radiation myelopathy develops months or years after radiation therapy. It is characterized by weakness, not being able to feel temperature or loss of proprioception, which is the sense that deals with feelings of body position, posture, balance and motion. Late radiation myelopathy does not usually improve on its own and may lead to gradual paralysis.

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