Side effects of anal cancer radiotherapy
Side effects tend to start a few days after the radiotherapy begins. They gradually get worse during treatment. They can continue to get worse after your treatment ends. But they usually begin to improve 1 or 2 weeks after your treatment ends.
Everyone is different, and the side effects vary from person to person. You may not have all the effects mentioned.
Possible side effects
Tiredness and weakness
You might feel tired during your treatment. It tends to get worse as the treatment goes on. You might also feel weak and lack energy. Rest when you need to.
Tiredness can carry on for some weeks after the treatment has ended. But it usually improves gradually.
Various things can help you to reduce tiredness and cope with it, such as exercise. Some research has shown that taking gentle exercise can give you more energy. It's important to balance exercise with resting.
Changes to your bowels
You might open your bowels more often (diarrhoea) after radiotherapy to the anus. This is because radiotherapy can cause irritation and inflammation of your anus and rectum (back passage).
Having chemotherapy alongside radiotherapy can make the diarrhoea worse.
Your doctor might prescribe medicines to help reduce irritation and inflammation. This can 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:
- cutting out whole grain cereals and wholemeal bread
- avoiding fibrous vegetables, fruit and fruit juice
The irritation and inflammation usually settle 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 red and sore during your radiotherapy treatment. This can make opening your bowels painful. 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
- Wash the skin with tepid water and simple soaps - don’t use perfumed or medicated soaps or other products.
- Pat dry the skin with a soft towel - or you can use a hairdryer on a cool setting.
- Ask your doctor, nurse or radiographer for creams to protect your skin and help it heal quickly.
- Try using a soft cushion if you have difficulty sitting comfortably for a while.
- Wearing loose, comfortable underwear and clothing also helps during this time.
After your treatment, the soreness should gradually improve over a few weeks.
Newer radiotherapy machines and ways of giving treatment mean that skin problems happen less often.
Bladder irritation
The bladder is close to the bowel and rectum (back passage). Radiotherapy to the bowel often irritates the bladder. You might feel:
- you have cystitis (bladder inflammation)
- you want to pass urine all the time but when you use the toilet you can't go
- a burning pain when you do pass urine
Tips
- Try to drink plenty of fluids.
- Many people find drinking cranberry juice can be helpful with bladder problems. If you take an anti clotting tablet called warfarin, check with your blood clinic first.
Bladder irritation usually settles down after the treatment is over. Let your doctor or nurse know if it continues. 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.
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 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
Possible long term side effects
Most side effects go away in the weeks or months after treatment. But some side effects can continue or might start months or years later. This might happen if you had higher doses of radiation.
Side effects if you have chemotherapy with radiotherapy
Chemotherapy combined with radiotherapy can make some side effects worse. Combining these treatments is called chemoradiotherapy.
