Liver cancer: Understanding late effects of radiotherapy
Late side effects may happen a few months or years after treatment. They might happen once, carry on over the long term or come and go over time. Sometimes they cannot be cured, but it might be possible to manage them.
You might have late effects not listed here, because everyone is different. Try not to compare your experience to others. They may also be caused by a different part of your cancer treatment. It is not possible to predict if you will get them and when they might happen, which can be difficult to come to terms with. Research and support for late effects of radiotherapy is growing.
Joining a support group can be a positive way to share your experiences, feel less alone, and come to terms with the physical and emotional impact of treatment. Ask your clinical team if you need more support or have any late effects at all.
This page looks at late side effects.
How likely am I to get late side effects?
Before treatment you will discuss and sign a consent form with your clinical oncologist or therapeutic radiographer. They will tell you what to expect, and you can ask questions and discuss any concerns you have about late effects. It’s important to know what you are consenting to and can help to take someone with you.
You can read different radiotherapy consent forms (HERE) based on the specific area being treated. These consent forms are packed with useful information about early and late side effects.(1)
When you consent to treatment, you are saying you understand that you have a chance of getting late side effects. Your team will use words like Expected, Common, Less Common and Rare.
This table shows what these words mean.
| Wording on the consent form | % chance of side or late effect | How many patients will get this? |
|---|---|---|
| Expected | 50 to 100% | Between half and all patients |
| Common | 10 to 50% | Up to half of all patients |
| Less common | Less than 10% | Fewer than one in ten patients |
| Rare | Less than 1% | Fewer than one in 100 patients |
Possible late side effects
- Cancer-related fatigue: You might find you still have fatigue after your treatment has finished. For some people this can go on for months or years.
- Inflammation or scarring on the lungs: that can cause you to cough and have shortness of breath. This is only if part of the lungs are within the treatment area so ask your treatment team.
- Chest pain and rib problems: Radiation can sometimes make your ribs weak, which might cause chest pain or even rare rib fractures.
- Effects on the bowels: Your bowels might change after treatment. You might feel the need to use the toilet more often or have constipation or loose poo.
Rare side effects
- Stomach problems: In very rare cases, radiation can cause ulcers or bleeding in your stomach or the area just beyond the stomach.
- Liver changes: Within three months after treatment sometimes the liver can swell up. Blood tests might show your liver isn’t working as well. This is called Radiation Induced Liver Disease (RILD). This is less common, happening in less than 5 out of 100 people.
- Other liver problems: There’s a small chance of getting “nonclassic RILD,” where you might get hepatitis again or your liver function tests get worse. If the cancer is in the center of the liver, there’s a tiny chance the bile ducts (small tubes in the liver) might narrow.
- Second Cancer: There is a very small chance that you could develop another type of cancer. This is rare, and depends on lots of different factors like age, area treated and radiation dose.
What can help with these late effects?
- Regular checkups: You will have follow-up appointments with your clinical oncologist and liver specialist. They’ll check your liver with blood tests and regular scans like MRI or CT scans to see how your liver is doing and to check for any new problems.
- Keeping active: Gentle movement can help you feel better, both during and after treatment. Your clinical team can tell you what is safe for you to do.
- Monitoring rare side effects: Talk to your clinical team as soon as you notice any changes, this can help catch and treat any serious problems early.
- Bowel health: Professional advice on what to eat and drink can help. So can medication. Speak to your clinical team about any bowel changes and watch for any signs of blockage.
- Managing cancer-related fatigue: Food and drink, keeping active, keeping a fatigue diary, medicine like steroids and physiotherapy may all be options for managing fatigue. Speak to your doctor or medical team for advice; and learn more about managing cancer-related fatigue.
- Skin care: The skin in the treatment area will always be more sensitive to the sun. Always protect it by covering up and use a high factor sunblock.
- Drinking fluids: Drinking plenty of fluids such as water and squash can help with fatigue and tiredness caused by your treatment. You can try diluted juice if you don’t like water.
- Alcohol use: Please follow the NHS guidelines on safe drinking levels and any instructions you get from your team on what is right for you, your diagnosis and your treatment. If in doubt, please ask your team.
- Stop smoking: If you are looking to stop or reduce smoking, there are services available to help you.
Always talk to your doctor or treatment team about any late effects you have. Even if they are not mentioned here. Everyone is different and experiences treatment differently. There may be ways they can help you reduce or manage symptoms.
Further information
Support for you – Liver Cancer UK
Support for patients and families • Radiotherapy UK
