Side effects of chemoradiotherapy
Most people will have some side effects from chemoradiotherapy for oesophageal cancer.
Everyone is different and the side effects vary from person to person. You might not have all of the effects mentioned. Side effects depend on the type of chemotherapy you have. They also depend on the radiotherapy treatment area.
The side effects gradually get worse during the treatment. They can continue to get worse after your treatment ends. But most of the effects begin to improve after 1 or 2 weeks.
Tests
You have blood tests before and during your treatment. They check your levels of blood cells and other substances in the blood. They also check how well your liver and kidneys are working.
Common side effects
These effects happen in more than 1 out of 10 people.
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.
Increased risk of getting an infection
Signs of an infection include headaches, aching muscles, a cough, a sore throat, pain passing urine, or feeling cold and shivery.
Chemotherapy reduces the number of white blood cells in the blood. This increases your risk of infections. White blood cells help fight infections.
When the level is very low it is called neutropenia (pronounced new-troh-pee-nee-ah).
You have antibiotics if you develop an infection. You might have them as tablets or as injections into the bloodstream (intravenously). To have them into your bloodstream you need to go into hospital.
Breathlessness and looking pale
Chemotherapy makes the level of red blood cells fall (anaemia). Red blood cells contain haemoglobin, which carries oxygen around the body. When the level of red blood cells is low you have less oxygen going to your cells. This can make you breathless and look pale. Tell your doctor or nurse if you feel breathless.
You have regular blood tests to check your red blood cell levels. You might need a blood transfusion if the level is very low. After a transfusion, you will be less breathless and less pale.
You can also feel tired and depressed when your blood count is low and feel better once it is back to normal. The levels can rise and fall during your treatment. So it can feel like you are on an emotional and physical roller coaster.
Bruising, bleeding gums or nosebleeds
You might notice you:
- bruise more easily
- have nosebleeds
- have bleeding gums when you brush your teeth
This is due to a drop in the number of platelets that help clot your blood.
If your platelets get very low you may have lots of tiny red spots or bruises on your arms or legs called petechiae.
Tell your doctor or nurse straight away if you have petechiae.
You have a platelet transfusion if your platelet count is very low. It is a drip of a clear fluid containing platelets. It takes about 15 to 30 minutes. The new platelets start to work right away.
Mouth sores and ulcers
Your mouth might become sore about 5 to 10 days after you start treatment. It usually clears up gradually 3 to 4 weeks after your treatment ends.
Your doctor or nurse can give you mouthwashes to help prevent infection. You have to use these regularly to get the most protection.
Tell your doctor or nurse straight away if your mouth is really sore. They can help to reduce the discomfort. Some people need strong painkillers to help control mouth pain so they can eat and drink.
Tips
- Clean your mouth and teeth gently every morning and evening and after each meal.
- Use mouthwashes as advised by your doctor or nurse. Let them know if the mouthwash stings. They can tell you to stop using it or dilute it with water.
- Use dental floss daily but be gentle so that you don't harm your gums, and don't floss if you have very low platelets.
- Avoid neat spirits, tobacco, hot spices, garlic, onion, vinegar and salty food.
- Moisten meals with gravies and sauces to make swallowing easier.
- Avoid acidic fruits such as oranges, grapefruit or lemons.
Difficulty swallowing
During and after treatment, you might have a feeling of a lump in the throat when you swallow. This can make it difficult to swallow solid foods.
This problem is often at its worst about 10 days to 2 weeks after you finish treatment.
Tips for eating and drinking
- Drink about 3 litres of water a day while having treatment.
- Eat soft foods.
- Eat slowly and avoid eating late in the day.
- Drink plenty during and after meals to soften your food.
- Eat small amounts often rather than big meals.
- Try different foods to find out which are easiest to swallow.
- You can have high calorie drinks to boost your calorie intake if you need them.
You might need to have liquid food through a tube into your nose or stomach if you can’t eat enough. This is called tube feeding.
Loss of taste or a metallic taste in your mouth
Changes in taste may make you go off certain foods. Many people go off tea and coffee, for example. You may also find that some foods taste different from usual. Some people find that they prefer to eat spicier foods.
Your taste usually gradually goes back to normal when your treatment is over. It may take a few weeks.
Tips
- Choose foods that have strong flavours, such as herbs, spices, marinades and sauces if all your food tastes the same.
- Season your food with spices or herbs, such as rosemary, basil and mint.
- Garnish cold meat or cheese with pickle or chutney.
- Try lemon or green tea if tea or coffee taste strange.
- Sharp tasting fizzy drinks such as lemonade or ginger beer are refreshing.
- Some people find that cold foods taste better than hot foods.
Feeling or being sick
Feeling or being sick can be severe. It can start a few hours after treatment and last for a few days. Anti sickness injections and tablets can control it. Tell your doctor or nurse if you feel sick. You may need to try different anti sickness medicines to find one that works.
Tips
- Avoid eating or preparing food when you feel sick.
- Avoid fried foods, fatty foods or foods with a strong smell.
- Drink plenty of liquid to stop you from getting dehydrated.
- Relaxation techniques help control sickness for some people.
- Ginger can help – try it as crystallised stem ginger, ginger tea or ginger ale.
- Fizzy drinks help some people when they are feeling sick.
Loss of appetite and weight loss
You might not feel like eating and may lose weight. It is important to eat as much as you can.
Tips
- Eating several small meals and snacks throughout the day can be easier to manage.
- Ask your doctor to recommend high calorie drinks to sip between treatments if you are worried about losing weight.
- Eat whatever you feel like eating rather than what you think you should eat.
- Make up calories between treatments for the days when you really don’t feel like eating.
- Drink plenty of fluids even if you can't eat.
- Don't fill your stomach with a large amount of liquid before eating.
- Try to eat high calorie foods to keep your weight up.
Reddened or darker skin in the treatment area
Your skin might go red or darker in the radiotherapy treatment area. You may also get redness or darkening on the other side of your body. This is where the radiotherapy beams leave the body.
The red or darker areas can also be sore. The skin usually starts to slowly change after several radiotherapy sessions. Your nurse or radiographer will give you cream to soothe the area.
If the skin gets very sore it might peel and blister. This usually starts to settle down within 2 to 4 weeks of ending the treatment.
Don’t use sunbeds or sit in the sun. Cover up or use a sun block if you go out in the sun. Remember to put sun cream on your head or wear a hat if you have lost any hair there.
Hair loss or thinning
Your hair might thin or it may fall out completely. This includes your eyelashes, eyebrows, underarm, leg and sometimes pubic hair. It usually begins falling out within 2 to 3 weeks after treatment starts.
Your hair usually falls out in the radiotherapy treatment area (the chest or the top of the neck).
The hair grows back once your chemotherapy treatment has finished. It can take several months and your hair is likely to be softer. It can also grow back a different colour or be curlier than before.
Tips
- Ask about getting a wig before you start treatment so you can match the colour and texture of your real hair.
- You could choose a wig for a whole new look and something completely different.
- Think about having your hair cut short before your treatment starts.
- You can shave your hair off completely before it starts to fall out.
- Wear a hair net at night so you won't wake up with hair all over your pillow.
Voice changes
Your voice might get husky or croaky and sound weaker. This can last for a while after your treatment.
Diarrhoea
Tell your doctor or nurse if you have diarrhoea. Drink at least 2.5 litres of fluid a day to help keep you hydrated. Let your doctor or nurse know straight away if the diarrhoea is severe or getting worse.
Ask your nurse about soothing creams to apply around your back passage (anus). The skin in that area can get very sore.
Occasional side effects
Between 1 and 10 in every 100 people have one or more of these effects.
Soreness, redness and peeling on palms and soles of feet
The skin on your hands and feet can become sore, red, and peel. You might also have tingling, numbness, pain and dryness. This is called hand-foot syndrome or palmar plantar syndrome.
Tips
- Take medicines that your doctor or nurse can prescribe.
- Keep your hands and feet cool.
- Avoid very hot water.
- Don’t wear tight fitting gloves or socks.
- Moisturise your skin with non perfumed creams.
Numbness or tingling in fingers and toes
Numbness or tingling in fingers and toes can make it difficult to do fiddly things such as doing up buttons. This starts within a few days or weeks and can last for a few months. Rarely, the numbness may be permanent.
Tips
- Keep your hands and feet warm.
- Wear well fitting, protective shoes.
- Take care when using hot water as you may not be able to feel how hot it is and could burn yourself.
- Use oven gloves when cooking and protective gloves when gardening.
- Moisturise your skin at least a couple of times a day.
- Take care when cutting your nails.
Periods stopping
Women might stop having periods (amenorrhoea) but this may be temporary.
Loss of fertility
Talk to your doctor before starting treatment if you think you may want to have a baby in the future.
Men
You may be able to store sperm before starting treatment.
It can take a few months or sometimes years for fertility to return to normal. You can have sperm counts to check your fertility when your treatment is over. Ask your doctor about it.
Women
Chemotherapy can cause an early menopause. This stops you from being able to become pregnant in the future. Talk to your doctor about this before your treatment. It’s sometimes possible to store eggs or embryos before treatment.
Heart problems
Heart problems include changes to how your heart works. This can cause changes to your heart rhythm and your ankles can swell.
Tell your doctor or nurse straight away if you have any chest pain. Your doctor might ask you to have tests to check your heart, such as an electrocardiogram (ECG).
Ringing in your ears (tinnitus)
You might notice a ringing sound in your ears (tinnitus). This often gets better on its own once the treatment ends.
Brittle, chipped and ridged nails
Your nails can have a blue tinge or become darker. Or they might flake, be painful and thicken where the nail starts growing (the nail bed).
Tips
- Use nail oils or moisturising creams if your nails are flaking.
- Don't worry about marks on your nails as they will grow out in time.
- You can cover marked nails with nail varnish but avoid quick drying varnishes as they can make your nails even drier.
Constipation
Constipation is easier to sort out if you treat it early. Drink plenty of fluids and eat as much fresh fruit and vegetables as you can. Try to take gentle exercise, such as walking.
Tell your doctor or nurse if you are constipated for more than 3 days. They can prescribe a laxative.
Watery or sore eyes
Watery eyes is also called excessive tearing or epiphora (pronounced ep-if-or-ah). It may be due to a blockage in the drainage system of the eye, caused by swelling of the nearby tissues. Or your eyes may make too many tears.
Tell your doctor or nurse if this is a problem. They can prescribe medicines to help reduce swelling.
Some irritants can make the watering worse. These can include dust, pollen or animal hairs. Try to avoid them or wear protective goggles.
Your eyes may be sore because the drugs cause a reaction on the inside of your eyelids. Or you may not be making enough tears. Your eyes can feel sore and gritty and might be red.
Tell your doctor or nurse if you have dry eyes. They can prescribe eye drops, ointments or artificial tears for you.
Warm compresses can help your eye to drain if you have an infection.
Rare side effects
Fewer than 1 in 100 people have these effects.
Changes to your hearing
You might have some hearing loss, especially with high pitched sounds. Tell your doctor or nurse if you notice any changes.
Eyesight changes
You might have blurred vision but it usually goes back to normal once the treatment has finished.
Second cancers
There is a small risk that you may get a second cancer some years after this treatment. Your doctor will discuss this with you.
Long term side effects
Most side effects gradually go away in the weeks or months after treatment. But some side effects can continue or might start some months or years later.
