Receiving a diagnosis of cancer is typically only the beginning for most patients. Depending upon your type of cancer and how invasive it is you may only have to undergo surgery. For others, radiation therapy with or without chemotherapy is often a necessary course of treatment.
As a survivor of two invasive anal cancers, I am well aware of the effects of both chemotherapy and radiation therapy. For the purposes of this discussion I will limit this to the effects/side effects of radiation therapy and also narrow the scope to those receiving “pelvic” radiation for such cancers as cervical, vaginal or anal.
I can also say, from personal experience, that not all potential side effects (even the most frequent ones) were not discussed with me at any time before or after treatment. Knowing in advance what to expect can help to alleviate anxiety if you understand that what you are experiencing is common and/or to be expected. Perhaps doctors are concerned about overwhelming the patient with what are not very pleasant side effects, but the patient has a right to informed consent which includes being advised of such potential risks and side effects.
Radiation works to destroy cancer cells and in the process kills normal cells as well. One of the most disruptive side effects of this type of radiation is radiation proctitis. This is a condition involving inflammation of the bowel resulting in pain and diarrhea. One of the reasons it can be so disruptive is that you may not have much warning in advance of an episode of radiation proctitis. Incontinence (losing the ability to control one’s bowels) can occur and lead to embarrassing situations when out in public. Depending upon its severity, you may be unable to leave the house at all until symptoms subside.
Another side effect relating to women is vaginal stenosis. This condition results in a decrease in the size of the vagina and can be accompanied by adhesions which although rare can result in complete closure of the vagina. An important thing for women to be informed about is the use of dilators. These will often be provided to female radiation patients by their oncologist. They come in varying sizes and can be used to prevent this type of complication. It is important to utilize these as instructed to prevent any permanent sexual dysfunction in the future. If your doctor does not mention this, it is important that you bring up the subject yourself. Something as simple as utilizing a vaginal dilator can help to prevent more severe complications down the road.
The third issue is bone pain, particularly occurring in the hip joints. This can occur months or years after treatment. At times, pain can be so severe as to awaken you from your sleep and persist throughout the night. For some, your doctor may need only prescribe an anti-inflammatory medication such as Motrin or Aleve. In other cases pain may become so severe as to require stronger medications such as a narcotic. Because radiation therapy can decrease bone density, talk to your doctor about having a bone densitometry study (DEXA) performed to at least determine your baseline findings. This is important to know because decreased bone density can increase your risk for fractures and your doctor may wish to prescribe a medication such as Boniva to help with this.
The effects of radiation can occur within weeks, months and even years after the completion of therapy. This is something that you need to remember especially when others may question your side effects in relation to when you completed treatment. You need to remind them that despite how long ago you may have completed treatment, radiations effects can indeed develop years later.
Cukier, Daniel, MD, McCullough Virginia, Gingerelli, Frank, MD, “Coping With Radiation Therapy”, Third Edition, Lowell House
http://www.ncbi.nlm.nih.gov/pubmed/8244811
http://www.cancer.org/Cancer/CervicalCancer/DetailedGuide/cervical-cancer-treating-radiation
http://emedicine.medscape.com/article/197483-overview
http://www.livestrong.com/radiation-proctitis/
Reviewed June 22, 2011
Edited by Alison Stanton