1. Common side effects
Skin reactions
Most people have some skin reactions around the area being treated. Skin reactions are sometimes called radiation dermatitis.
Your skin may:
- Become pinker or darker over time
- Feel tender, dry, itchy and sore
- Peel or flake as treatment goes on
- Blister or become moist and weepy
Skin changes may look different on different skin tones. You can find images of skin changes on different skin tones on RadChat’s image library.
Skin reactions may start during or after treatment. Most skin reactions are mild. They are normally at their worst 2 to 3 weeks after treatment. They should heal within 3 to 4 weeks of your last treatment, but some may need treating or monitoring more closely. For example, skin that has blistered or is peeling will take longer to heal.
It’s important to know how your skin normally looks before you start radiotherapy. This will help you notice any skin changes. Let your treatment team know if you develop a skin reaction.
The Society and College of Radiographers has information on their website about skin reactions and how to care for your skin.
Caring for your skin during radiotherapy
It’s important to look after your skin during treatment. This will help prevent infection, reduce pain and help keep the area being treated comfortable.
Speak to your treatment team or therapeutic radiographer about skincare products before using them on the skin in the treatment area. They may suggest you continue to use your regular soap, deodorant and moisturiser on the area.
You’ll be given skincare instructions by your treatment team. The following tips may also help:
- Wash your skin gently with warm water and pat dry with a soft towel
- Avoid exposing the treatment area to very hot or cold temperatures, such as heat pads, hot water bottles, saunas or ice packs
- Avoid exposing the treatment area to the sun during radiotherapy. Use a high factor suncream, like factor 50, on your skin and under clothes during after radiotherapy
Swimming
Skin changes from radiotherapy can be irritated by chlorine or chemicals in swimming pools. Speak to your treatment team if you want to go swimming during or shortly after treatment.
Bras after surgery for breast cancer
Find out about bras after breast cancer surgery, including what type to wear, where to buy them and support with paying for post-surgery bra...
Clothing, bras and prostheses
Clothes rubbing on your skin can cause skin reactions or make existing skin reactions worse.
Wearing loose fitting clothing made from natural fibres, such as a soft cotton bra or vest, may help.
If your skin is affected, you’ll usually be advised not to wear an underwired bra until your skin heals. You may prefer to not wear a bra.
If you’ve had breast reconstruction, your treatment team may recommend you wear a post-surgery bra for 6 to 8 weeks after your surgery.
If you’ve had a mastectomy, you may find it more comfortable to wear the soft, lightweight prosthesis (softie or comfie) you used after surgery than a silicone prosthesis.
Swelling (oedema) of the breast
Your breast or chest area may look swollen and feel uncomfortable. This usually settles within a few weeks after treatment. If it continues after this time, talk to your treatment team. You may need to be assessed by a lymphoedema specialist.
Pain in the breast or chest area
You may have aches, twinges or sharp pains in your breast or chest area. These are usually mild.
They may continue for months or years, but they usually become milder and less frequent over time.
You may also have stiffness and discomfort around your shoulder and breast or chest area during and after treatment. Continuing to do arm and shoulder exercises during radiotherapy and for several months afterwards may help minimise or prevent any stiffness or discomfort.
See more about exercises after breast cancer surgery.
Hair loss in the armpit
If you have radiotherapy to the armpit, you will lose your underarm hair on that side. You will also lose any hair on the area of the chest that’s being treated.
Hair in the treatment area usually starts to fall out 2 to 3 weeks after treatment begins. It may take several months to grow back. For some people, hair loss from radiotherapy may never grow back.
Sore throat
If you have treatment to the area around your collarbone or near your breastbone, you may develop a sore throat or discomfort when swallowing. If this happens, talk to your treatment team.
It may help to take pain relief in liquid form, particularly before eating, until the discomfort improves.
Extreme tiredness (cancer-related fatigue)
Fatigue is extreme tiredness that does not go away with rest or sleep. It’s a common side effect of radiotherapy and may last for weeks or months after your treatment has finished.
If you think you have fatigue, tell your GP or treatment team. They can assess you and offer advice on how to manage your energy levels.
Find out more about managing fatigue.
Managing lymphoedema
Find out more about managing lymphoedema, including lymphoedema treatment, skincare and compression garments - and how to get more support.
Lymphoedema
Lymphoedema is swelling of the arm, hand, breast or chest area. It’s caused by a build-up of lymph fluid in the surface tissues of the body.
It can happen because of damage to the lymphatic system, for example because of surgery or radiotherapy to the lymph nodes under the arm and surrounding area.
Lymphoedema can occur at any time after treatment, sometimes years later.
Lymphoedema is a long-term condition. This means it can be controlled after it has developed but it’s unlikely to go away completely.
Contact your treatment team or GP if the arm, hand, breast or chest area on the side where you had radiotherapy or surgery swells or feels uncomfortable and heavy.
Change in breast shape, size and colour
If you’ve had radiotherapy after , the breast tissue and nipple on the treated side may:
- Feel firmer than before
- Change colour
Your breast may be smaller and look different.
Although this is normal, you may be concerned about differences in the size of your breasts or worry the difference is noticeable.
You can discuss this with your breast surgeon to see if anything can be done to make the difference less noticeable. You can also talk to your treatment team or call our helpline on 0808 800 6000 to discuss how you feel about your new shape.
It’s completely natural if side effects change how you feel about your body, including how you feel about intimacy and sex. See more about intimate relationships and breast cancer.
Tenderness over the ribs
You may have tenderness over the ribs during treatment. This discomfort can be long-lasting, but it usually improves over time.
2. Late side effects
Some side effects can develop months or years after radiotherapy treatment ends. But these side effects are much less common.
Serious side effects are very rare and the benefits of the treatment in reducing the chances of breast cancer returning outweigh the risk of possible side effects.
Hardening of the tissue
Although rare, it’s possible for breast tissue to harden (called fibrosis) several months or years after radiotherapy has finished. If this is severe, you may notice your breast become smaller and firmer.
Changes to the reconstructed breast
If you have a breast reconstruction using an implant, radiotherapy can cause the reconstructed breast to:
- Become firmer
- Change shape
- Become uncomfortable
You may hear this called capsular contracture.
If you have a breast reconstruction using your own tissue (tissue flap), radiotherapy can cause the tissue of the reconstruction to change shape or shrink.
If you notice changes to your reconstructed breast, talk to your treatment team.
Broken blood vessels
You may see tiny broken blood vessels under your skin in the area radiotherapy was given. This is known as telangiectasia. Although it’s harmless, it’s permanent and there’s no treatment for it.
Changes to the lungs
Sometimes, part of the lung behind the treatment area can become inflamed. This may cause a dry cough or shortness of breath. It usually heals by itself over time.
More rarely, hardening of the upper lung tissue can occur. This is known as lung fibrosis. This can also cause a dry cough or shortness of breath, but it may need treatment.
Speak to your treatment team if you notice any of these symptoms.
Heart problems
If you have radiotherapy on the left side, there is a small risk of heart problems in the future. The risk is very low because radiotherapy is carefully planned to make sure it avoids the heart as much as possible.
Speak to your treatment team if you’re worried about possible heart problems.
Risk of another cancer developing
If you have radiotherapy, there is a small risk of developing another cancer in the future. However, this is very rare and much less of a risk than your breast cancer returning if you do not have radiotherapy. Your treatment team will discuss this risk with you.
Other side effects
Other side effects include:
- Weakening of the bones in the treated area – this can lead to rib and collarbone fractures
- Damage to the nerves in the arm on the treated side – may cause tingling, numbness, pain, weakness and possibly some loss of movement
- Long-term skin reactions (chronic radiation dermatitis)
If you’re concerned about late side effects, speak to your treatment team.
3. Further support
If you’re worried about any side effects, regardless of whether they are listed here, talk to your treatment team. You can also talk things through with one of our nurses on our free helpline - please see below.
You can also find somebody who understands what you’re going through with Someone Like Me – see below.
