Side effects of radiotherapy for anal cancer
Radiotherapy uses high energy waves like x-rays to kill anal cancer cells. This treats the cancer. But it can also damage nearby healthy cells which can cause side effects to the skin, bowel and bladder. You can also get some general side effects from radiotherapy.
It is important to remember that everyone is different, and side effects can vary from person to person. You may not have all the effects mentioned.
When do you get side effects?
Side effects to radiotherapy can be either short term (acute) or long term (chronic).
Acute side effects tend to start 1 to 2 weeks after you start radiotherapy for anal cancer. They can gradually get worse during treatment. And they may continue to get worse after your treatment ends. Side effects usually begin to improve 2 to 3 weeks after treatment finishes. But they may last 2 to 3 months in total.
Side effects if you have chemotherapy with radiotherapy
Radiotherapy combined with chemotherapy is called chemoradiotherapy. It is the main treatment for anal cancer.
Having both treatments together can make it difficult to tell which side effects are caused by the chemotherapy, and which are caused by the radiotherapy. It can also make the side effects worse.
Changes to your bowels
You might open your bowels more often and have loose poos (diarrhoea) after radiotherapy to the anus. This is because radiotherapy can cause swelling and irritation of your anus and rectum (back passage).
Having chemoradiotherapy can make the diarrhoea worse.
Your doctor might prescribe medicines to help reduce the swelling and irritation. This can help reduce the number of times you need to open your bowels.
Drinking plenty of fluids and having a low fibre diet may also help. Your radiographer or radiotherapy nurse can tell you about this. They can give you leaflets about what to eat.
A low fibre diet means:
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cutting out whole grain cereals and wholemeal bread
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avoiding fibrous vegetables, fruit and fruit juice
The irritation and inflammation usually settles down about 2 to 3 weeks after your treatment ends.
Sore skin around the anus and groin
The skin around your anus, genitals and groin can get sore during radiotherapy treatment. This can make it painful, especially when you open your bowels or pee. Your doctor or nurse can prescribe painkillers to help until your skin heals.
Your nurse can tell you how to care for your skin. Keeping the area clean is important. Rubbing while washing can make the soreness worse. Discuss any products you'd like to use first with your specialist, radiotherapy nurse or radiographer.
Tips
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Wash the skin with lukewarm water and simple soaps - don’t use perfumed or medicated soaps or other products.
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Pat the skin dry with a soft towel - or you can use a hairdryer on a cool setting.
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Ask your doctor, nurse or radiographer for creams to protect your skin and help it heal quickly.
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Try using a soft cushion if you have difficulty sitting comfortably.
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Wearing loose, comfortable underwear and clothing can also help.
The soreness should start to improve a few weeks after you finish treatment.
Bladder irritation
The bladder is close to the anus and rectum. Radiotherapy to the anus often irritates the bladder. And you might get symptoms such as:
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feeling like you need to pee often
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not being able to pee when you get to the toilet
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a burning pain when you pee
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needing to pee urgently
Tips
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Try to drink plenty of fluids.
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Avoid drinks that can irritate your bladder - this includes tea, coffee and fizzy drinks.
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Some people find that drinking cranberry juice helps their symptoms - speak to your doctor or pharmacist before you try this as it can affect how some medicines such as warfarin work.
Bladder irritation usually settles down after the treatment is over. Let your doctor or nurse know if bladder symptoms continue. You may need to have a tube into your bladder (a urinary catheter) for a short time.
You might also have an infection that needs treatment with antibiotics. This can be difficult to diagnose as some of the symptoms of a urine infection are the same as those caused by radiotherapy. But you might also have:
- cloudy pee
- blood in your pee
- pain in your lower tummy (abdomen) or back
- a high temperature - you may also feel hot, cold or shivery
- a low temperature
If you are having chemoradiotherapy, contact your advice line immediately if you have signs of infection, a temperature of 37.5C or above or a temperature below 36C.
Loss of pubic hair
Radiotherapy for anal cancer may cause your pubic hair to fall out. The hair can grow back, but it may be thinner than before treatment.
General side effects of radiotherapy
Radiotherapy can also cause general side effects such as tiredness and weakness and emotional changes.
This video shows people affected by cancer talking about the general side effects of radiotherapy. The video is around 7 and a half minutes long
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 general side effects you might have.
On screen text: Tiredness and weakness
Martin (Radiographer): As the normal cells repair themselves from the treatment this can use a lot of the body's resources, causing tiredness.
David: After about four weeks, I started to get tired. The body was starting to weaken.
Laurel: I was tired, day and night. Getting up in the morning was like a chore. I couldn't talk for 5 minutes. I would just sleep and just sleep and just wake up and sleep again.
Martin (Radiographer): Listen to your body. Take rests if you need to. Try not to overdo things.
Laurel: Don't fight with yourself too much. Just like go at a pace and just work with your body. If you can't make it today, you can't make it today.
David: You've got to rest. You have to take the time to rest.
Mary: Just going for them small walks. They really do help you. And even if it is just walking around your house or just walking around the block.
Martin (Radiographer): Doing exercise can help with tiredness by helping you maintain energy levels.
Mary: Being outside, that's a big, massive thing as well because you're feeling the fatigue and I think getting outside, just getting a bit of fresh air that really, really did help me.
Martin (Radiographer): The tiredness you can expect to begin within the first few weeks of treatment. Once it reaches its peak, about two weeks after treatment then it recovers quite quickly after that.
Mary: It's not forever. You're not going to be like this forever and I did have to tell myself that.
Laurel: Two months after treatment, I start to feel less tired and that was a way forward because things start to really improve.
On screen text:
- Rest and have short naps when you need to
- Drink plenty of water
- Eat a balanced diet
- Do some gentle exercise
- Get some fresh air
On screen text: Sore skin
Martin (Radiographer): The radiotherapy can cause soreness of the skin. This only affects the area that you are having treated. This usually starts to appear about two weeks after you start treatment. You may notice this becoming more red and may become more itchy and sore as treatment continues.
David: After about ten days I started to get red on the area that they were targeting and it just progressively got redder and redder.
Laurel: My skin was dry and at the back was just like this triangle shape thing where it was like, okay, I'm a woman of colour, but it was really, really black.
David: Wasn't too painful, it was sort of annoying, rather than painful.
Martin (Radiographer): After treatment’s finished, the skin will remain sore for up to two weeks, but then recovers quite quickly.
Laurel: I haven’t got no scarring now at all.
David: It was maybe three or four weeks and then all the blemishes disappeared front and back.
Martin (Radiographer): When you start treatment we would advise you to carry on with your normal skincare routine but as the side effects develop, then your team will advise you on which products you can use on the skin safely.
Laurel: When I'm washing myself I use a sponge and you're just literally as it were just squirt it down, you don't rub the skin at all because it's already damaged. Pat dry, don't rub.
David: I spoke to the hospital about it and it was them that recommended this cream to put on, just to alleviate the symptoms.
Martin (Radiographer): We'd recommend wearing loose clothing and keeping the treatment area covered up against the sun and wind.
Laurel: I had to change most of my wardrobe. I only wore cotton.
David: Wearing T-shirts, soft clothing, nothing that would rub.
Mary: It's important when you go outside to make sure that you do wear that headscarf, or you do wear a hat or whatever it is.
Laurel: I wouldn't go in the sun at all, at all because my skin was - I know it was too delicate.
On screen text:
- Don’t rub the area, press if it is itchy and dab your skin dry
- Don’t use perfume, perfumed soaps or lotions on the area
- Don’t shave the area
- Only use creams or dressings advised by your specialist or radiographer
- Wear loose fitting clothing
- Avoid strong sun or cold winds
- Make sure you wear sunscreen
On screen text: Hair loss
Martin (Radiographer): Radiotherapy can cause hair loss in the area that's being treated, whereas chemotherapy can cause hair loss all over the body.
Mary: 2 to 3 weeks after the radiotherapy, I was brushing my hair and loads came out on the brush. I knew it was going to happen, but it was just hard when it happened.
Martin (Radiographer): In most cases the hair will grow back. This can take a couple of months and the hair may have a slightly different colour or texture.
Mary: Mine did grow back and there's a lot of grey in it so I have to dye it. This is not my original colour. It's very slow growing back.
Martin (Radiographer): Use a simple soap to clean the area. Be gentle with the skin in that area and after washing pat the area dry with a soft towel.
On screen text:
- Radiotherapy can make hair fall out in the treatment area
- It won’t cause hair to fall out in other parts of your body
- Your hair might grow back a few weeks after treatment ends
- If your hair won’t grow back, then your doctor should tell you
- Don’t use perfume, perfumed soaps, or lotions on the area
On screen text: Your mental health
Laurel: I felt frustrated. Some days were really, really challenging where there were just tears without words.
Mary: It's a mixture of emotions. You feel angry and you feel frustrated. You lose your confidence.
Martin (Radiographer): Radiotherapy can cause a lot of emotions at various times during the treatment. You may feel sad or anxious or depressed, which is quite normal. It's good to talk to people about your experiences, whether that's your team at the hospital or friends and family.
David: I couldn't praise the team highly enough. Everybody that was involved were unbelievable and if it hadn't been for them, I just don't think I would have gotten through with it.
Mary: I did have a nurse as well and she had the experience of dealing with people that went through brain surgery, went through radiotherapy so it was just great that I could reach out.
Martin (Radiographer): Your team will be able to give you information about local patient support services that are available, that includes things like counselling and complementary therapies.
Laurel: A referral from the hospital counselling, which I attended for about a year.
Martin (Radiographer): There's also lots of support available online and in your local area.
Mary: I went on loads of different forums and I spoke to loads of different people and it really, really helped me. If I didn't do that, I don't think I would have got through most days.
Laurel: If you get a bit cranky or feel a bit low, go for it. But there's so much help out there and that's why I'm pushing forward like don't sit down in silence. It's the same thing, just get the help you need.
On screen text:
- There is help available – ask the hospital for support
- Talk to your friends and family about how you are feeling
- Ask about local support groups
- Your GP or hospital can provide counselling
- You can get help and support online through forums
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
