Oesophageal cancer: Understanding late effects of radiotherapy

Oesophageal cancer: Understanding late effects of radiotherapy

Late side effects can appear months or years after treatment. They may last a long time, come and go, or happen only once. While some may not be curable, they can often be managed with the right care.

You might have late effects not listed here, because everyone is different. They may also be caused by a different part of your cancer treatment. It is not possible to know 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 there’s a chance you might get late side effects. Your team will use words like “Expected, Common, Less Common and Rare.

This table shows what these words mean.

Possible late side effects (common)

• 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.
• Skin reactions: Sometimes, after radiation treatment, your skin might look different and even change colour. The skin in the treated area could look and feel different, and blood vessels might become more visible.
• Narrowing (stricture) of the food pipe (oesophagus): Radiotherapy may cause your food pipe to narrow, making it harder to swallow. You might feel like food is getting stuck or notice that swallowing feels different. If this happens you must seek medical advice to rule out cancer. Once this is ruled out, further treatment may be needed. Widening the food pipe can be a simple procedure using a tube and balloon to stretch it, or you may need surgery.
• Oesophageal dysmotility: This is where the oesophagus (food pipe) cannot work normally, causing food and liquid to move more slowly or get stuck, and making it difficult to swallow.
• Scarring (fibrosis) of the lungs: This is common within the treatment area and can sometimes cause a cough and some shortness of breath. This can come and go.

Less common and rare late effects

• Hypothyroidism: The thyroid gland near the upper part of the oesophagus (in the neck) can be affected by radiation. You might need to take medication to replace missing hormones.
• Damage to the heart: This depends on how close the treatment was to your heart. Radiotherapy near the heart area can increase the risk of developing heart conditions like inflammation of the heart (pericarditis), heart failure and myocardial infarction (heart attack). This is rare and your treatment is planned carefully to reduce any risk.
• of the food pipe or stomach that can cause : If you notice blood in your sick this may indicate ulceration or a tear (perforation) which may need surgery.
• Oesophageal fistula: This is an abnormal connection that can form between the food pipe and the airways, which may require medical attention.
• Difficulty swallowing: In rare cases you might need to have a feeding tube fitted so you can get the nutrition you need.
• Bleeding: Sometimes, bleeding in the oesophagus or stomach might happen. This might need treatment using a camera procedure (endoscopy) or, in some cases, surgery. This can be an emergency so if you notice a change in your poo (black areas) or blood in sick, then seek medical advice straight away.
• Spinal cord myelitis: Radiotherapy may cause inflammation of the nerves in the spinal cord. This can lead to muscle weakness or changes in sensation.
• Bone damage: Radiotherapy may weaken nearby bones, increasing the risk of fractures in the ribs or spine.
• Reduced spleen function: This can lead to an increased risk of infection. This is where the spleen is affected by the radiation. When this happens it can lower your immunity (ability to fight infection) and may require additional vaccinations and long-term antibiotics to help.
• Kidney function: Radiotherapy may reduce kidney function over time if they are in or near the treatment area.
• 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

• 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.
• 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.
• Nutrition: You may have long term problems with swallowing making it hard to eat well. It’s important to eat and drink enough calories and protein to maintain your weight and strength. You might need extra support from a dietician who can advise on what foods are best. Eating little and often, softer foods, moist foods, chewing well before swallowing and drinking in between mouthfuls are some useful tips.
• Having a feeding tube fitted: In some cases, your team might recommend a long-term feeding tube if you are having difficulty swallowing and getting the nutrition you need.
• 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.
• 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.
• Treatment of ulcers, perforation and strictures: These can be life threatening if not treated. Perforations or tears and strictures (narrowing) can be managed non-surgically by placing a stent (metal mesh tube covered in fabric) in the area to block the tear or widen the narrowed area. Sometime the narrowing can be stretched or opened (dilated) using a long, thin tube called a catheter with a balloon attached. An oesophageal ulcer is an open sore that forms in the wall of the food pipe, this can be treated by dietary changes, antibiotics, and in rare cases may require surgery.
• Monitoring rare side effects: Talk to your treatment team as soon as you notice any changes, this can help catch and treat any serious problems early.
• 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.

1. Royal College of Radiologists consent forms

Further information

Support for patients and families • Radiotherapy UK

Learn more about radiotherapy consent forms (HERE).

Learn more about radiation skin reactions (HERE).

Soft diet | Cancer Research UK

Eating after treatment for oesophageal cancer | Macmillan Cancer Support