Physical Health

Late effects of radiotherapy

Not everyone will have long term side effects after radiotherapy. Most side effects gradually go away in the weeks or months after treatment. But some can continue or start some months or years later

On going cough after radiotherapy:

An ongoing cough after radiotherapy can be a chronic symptom caused by lingering treatment effects, a cough that does not go away can be distressing and tiring. It can interfere with your daily life. For example, coughing may affect your sleep.

Always talk to your GP about an on going cough so they can find the cause of it and know how to treat it

Sometimes a cough and breathlessness can be caused by inflammation or scarring (fibrosis) in the lungs. This can be a late effect of radiotherapy to the chest area. Your doctor may prescribe steroids to treat this.

If you have a chest infection, your doctor will prescribe antibiotics.

Tell your GP straight away if you are coughing up blood

Top tips for managing a cough:

  • Make sure you drink enough. Drinking plenty of fluid can make mucus thinner.
  • Always tell your GP if your cough gets worse, or if you start coughing up yellow or green mucus (phlegm). You may have an infection and need antibiotics..
  • Codeine or morphine are drugs that are usually used to control pain. But they can also be used to treat an ongoing cough, even if you do not have pain. •

If you have a dry, irritable cough, your healthcare team may prescribe a cough medicine to help. You can buy some cough medicines at supermarkets or pharmacies. Talk to your doctor or pharmacist before you buy anything to help with a cough.

  • Sometimes a steam inhalation or breathing in salt water (saline) through a nebuliser can help. This can help clear thick mucus from the airways.
  • Smoking increases your risk of lung problems. If you smoke your doctor will usually advise you to stop smoking. It can be difficult to stop smoking, especially when you are stressed. Using the NHS Stop Smoking Services improves your chances of success. Your GP can also give you support and advice.
  • Relaxation exercises may help you manage a cough

Some people find the stress of a cancer diagnosis or treatment can increase the amount they smoke or vape, which can lead to other health concerns such as an ongoing cough or shortness of breath

For support with this you can speak to your GP or search for local support on the link below:

Repeated Infections 

Repeated infections for most people after cancer treatment should improve as the immune system recovers. As a late effect long after cancer treatment repeated infections or increased infection risk can be due to tissue damage from radiotherapy.

  • Reduced Immunity (Lymphopenia):Radiation can reduce the number of white blood cells (lymphocytes), which are essential for fighting infection. This risk is highest in the first 3 months post-treatment but can persist.
  • Tissue Scarring (Fibrosis):Radiation can cause tissues to become thick, rigid, and have reduced blood flow (vascularity). This reduced blood flow hinders the body’s ability to deliver immune cells to the area, resulting in poor healing and increased infection risk.
  • Damaged Lymphatic System (Lymphoedema):Damage to lymph nodes or channels leads to fluid buildup, swelling, and a higher vulnerability to skin infections (cellulitis) in the affected area.
  • Reduced Spleen Function:If the spleen is within or near the radiation field, its function can be permanently reduced, creating a high risk for severe, life-threatening infections.

Infections by Treatment Area

The location of the radiation determines the types of infections likely to develop.

  • Head and Neck: Permanent dry mouth (xerostomia) and thick saliva can lead to:
    • Oral Candidiasis (Thrush): A fungal infection causing white patches in the mouth.
    • Dental Infections: Rampant tooth decay (radiation caries) due to lack of saliva can lead to dental abscesses and infections of the jaw bone (osteoradionecrosis).
    • Chronic Sinusitis: Chronic inflammation of the sinus tissues.
  • Pelvis and Abdomen: Damage to the intestines and bladder can cause:
    • Bladder Infections (Cystitis): Chronic irritation causing burning and frequent urination, often accompanied by blood in the urine.
    • Bowel Bacterial Overgrowth (SIBO): Bacteria can grow in the damaged small bowel, leading to severe diarrhoea, malabsorption, and infection.
    • Rectal Infections (Proctitis): Chronic bleeding and pain in the back passage.
  • Chest and Lung:
    • Chronic Lung Infections: Scarring (fibrosis) in the lungs can make them more susceptible to infections.

Poor nutrition, lack of sleep, and underlying conditions like diabetes can compound risk.

Management and Prevention Strategies

  • Oral Hygiene:Regular dental checkups every 3–6 months are crucial for those who had head and neck radiation.
  • Antibiotics/Antifungals:Treatment of infections with antibiotics or antifungal medications
  • Preventative Care: Frequent hand washing, avoiding crowded places, and avoiding sick individuals are essential.
  • Vaccinations: Discuss annual flu shots with your doctor.
  • Nutrition: Eat a balanced diet to support immune recovery

Please see your GP to discuss any repeated infections as a result of your treatment

Contact your GP or call 999 for symptoms of sepsis, such as severe shivering, slurred speech, confusion, or no urine output in a day.

Late Effects on the bowel / bladder after radiotherapy

Most people who have treatment for cancer as a young adult will not get bowel or bladder problems. Bowel or bladder problems can develop during or shortly after treatment finishes. They can also happen a long time after treatment.

Radiotherapy to the pelvis can cause late effects on the bowel and bladder. These can often be managed or treated successfully. Some people may need to consult a bowel or bladder specialist for more specialised help. There are different treatments available.

You can often manage late effects on the bowel by changing your diet. This could include reducing how much high-fibre food you eat. You can take medicines to control diarrhoea or constipation.

Pelvic late effects on the bladder may mean you need to pass urine (pee) more often. You may also leak a small amount of urine (incontinence). It is important to drink lots of fluids and avoid things that can irritate the bladder – for example, caffeine and alcohol. Stopping smoking can also help with effects on the bowel and bladder.

If you have problems with bowel or bladder control, ask your nurse for a referral to a continence adviser. They can talk to you about pelvic floor exercises or bladder training to help bladder control. Keeping to a healthy weight will also help. This relieves pressure on your pelvic floor.

For more information on the effects on the bowel and bladder, please follow the below links:

Late Effects on the head and neck after radiotherapy

Most people who have treatment for cancer as a young adult will not get effects of their head and neck. Head and neck problems can develop during or shortly after treatment finishes. They can also happen a long time after treatment.

Radiotherapy to the head and neck can cause late effects to your mouth and throat. These may include a dry mouth because you have less saliva, thicker or stickier saliva, or a loss of sense of taste.

Using artificial saliva and having frequent sips of water can help with a dry mouth. Using a sodium bicarbonate mouthwash may help clear thick saliva.

It is important to follow any advice you have been given. Keeping your teeth and mouth clean can also help. You will need regular visits to your dentist and oral hygienist.

Surgery and radiotherapy can affect eating and speech. Specialist health professionals can help with any changes to eating and speech. These may include dietitians and speech and language therapists (SLTs).

We have more information about managing the late effects of head and neck cancer treatment

For more information, please follow the below links:

Late Effects on the lungs after radiotherapy

Most people who have treatment for cancer as a young adult will not get lung problems. Lung problems can develop during or shortly after treatment finishes. They can also happen a long time after treatment.

Radiotherapy to the chest can cause long-term lung problems

Signs of lung problems include:

  • shortness of breath or wheezing
  • a cough that doesn’t get better
  • getting lung infections regularly
  • chest pain
  • feeling very tired.

If you notice any of these symptoms, it’s important to tell your doctor. Symptoms can vary from person to person. They are often mild but can sometimes be more severe. It is possible for other things to be causing them too.

Your doctor may recommend some medications to help. There are also ways you can help to look after your lungs. These include not smoking, doing breathing exercises, and being active.

Possible lung problems

Your doctor might arrange some tests during treatment to check how well your lungs are working. This means they can adjust treatment if they notice any early changes with your lungs. Lung problems caused by cancer treatment can develop during or shortly after treatment finishes. They can also happen a long time after treatment. Sometimes they can happen many years afterwards. If you think you are getting new symptoms, it’s important to tell your doctor. 

The problems we list here can sound a bit scary. But remember, they do not happen often. If any of these problems affect you, there are treatments to help manage them.

Inflammation in the lungs (acute pneumonitis)

This can happen a few weeks after having radiotherapy. The chance of this happening is increased if you have higher doses of radiotherapy. Remember, the treatment team carefully work out the dose of radiotherapy you need to have. This allows them to treat the cancer, but also to cause as few side effects as possible. 

Pulmonary fibrosis

This is when the tissues between and around the air sacs in your lungs become scarred and grow thicker. This can make it harder for oxygen to get from your lungs into your blood. 

Bronchiectasis and lung infections

The lungs are full of tiny airways called bronchi. The lining of these is covered in a sticky fluid called mucus. After treatment, some of these airways can become too wide (bronchiectasis). This can lead to mucus building up in the airways, making you more likely to get lung infections.

Chronic bronchitis

The airways in your lungs can become swollen and irritated. This can make your lungs produce extra mucus.

Tests for lung problems

If you’re worried you might be getting problems with your lungs, your doctor will examine you. They will check whether any cancer treatments you had could cause lung problems.

They might want to do some tests to look at your lungs in more detail. These might include: 

  • lung function tests
  • a chest X- ray
  • a chest CT scan
  • a bronchoscopy (a tube with a camera that helps the doctor or nurse see inside the airways of the lungs).

Looking after your lungs

It’s not always possible to cure lung problems caused by cancer treatment. But there are lots of things that can help. Your doctor might give you medicines, but there are also things you can do to help. These include:

  • keeping active and exercising
  • using special breathing exercises and techniques – your doctor can refer you to a physiotherapist who can teach you
  • eating well and maintaining a healthy diet
  • stopping smoking – you can ask your GP or local pharmacy for advice or go to the NHS Better Health website
  • having vaccinations to reduce the chance of a lung infection – for example, every winter you could have the flu vaccination.

Support

If you have developed a lung problem after cancer treatment, you may need support. Some people feel angry or upset at having a new problem to cope with after all they have been through. Speak to your doctor or nurse. They can refer you to a counsellor or someone else who can help you understand these feelings. They can also suggest ways to manage them. 

Remember, not everyone has problems with their lungs after treatment. But it’s important to speak to your treatment team if you think you might be getting any problems.

You can find out more about lung problems from Asthma + Lung UK. 

For more information on the effects on the lungs, please follow the below links:

 Late Effects on the heart after radiotherapy

Certain cancer treatments may increase your risk of developing different heart problems in the future. But many people who have these drugs or treatments do not develop any effects.

Radiotherapy to the chest or the mid to upper back (thoracic spine) can sometimes cause heart problems. Total body irradiation (TBI) can also cause heart problems.

Most young people treated for cancer will not develop heart problems.. If you have had treatment that could affect your heart, your doctor would have told you about this before you started treatment. Sometimes, a heart problem can develop many years after finishing treatment.

Even when your treatment has finished, you might still need to have some tests. This means they can find any problems and treat them early.

The symptoms of a heart problem can vary from mild to severe. They can affect people in different ways.

Tell your hospital doctor or GP straight away if you have any of the following symptoms:

  • Shortness of breath
  • Dizziness, light-headedness or fainting
  • Feeling or being sick
  • Swollen feet and ankles
  • Feeling like your heart’s racing or skipping a beat
  • Coughing or wheezing that doesn’t go away
  • Pain in your chest that might spread to your arm
  • A sharp pain on the left side of your chest that’s often worse when taking a deep breath

Possible heart problems

Remember, a lot of these problems are rare and can vary from mild to severe. Here are some of the heart problems that can happen after cancer treatment:

  • Damage to the muscle cells around the heart might mean the heart can’t relax and contract normally (cardiomyopathy or left ventricular dysfunction).
  • The protective covering around the heart might become inflamed (pericarditis). It can also get scarred.
  • The valves in the heart can become stiff or leaky (valvular stenosis or insufficiency).
  • Damage to the heart’s electrical pathways can cause abnormal heart rhythms (arrhythmias), such as a fast, slow or irregular heart rate.
  • If the heart’s blood vessels become scarred or blocked, it can be harder for oxygen and other nutrients to get to the heart and other organs (coronary heart disease)

Tests for heart problems

Your doctor will tell you exactly what follow-up you need. The most common heart test is an echocardiogram (an ultrasound scan of your heart).

Sometimes, you may have other tests, including:

  • An electrocardiogram (ECG)
  • A MUGA scan
  • Blood tests.

If you have any questions about these tests, ask your doctor or nurse. They can tell you what tests you might need, and how long after your treatment you will need them for. It is important that you get the right follow-up.

How often you need these tests depends on what the heart problem is and how severe it is. It also depends on what else is happening in your life. For example, if you're pregnant or planning to have a baby, the doctor might do them more often. This is because of the extra strain pregnancy can cause.

It’s important to know which cancer treatments you’ve had, because some heart problems can happen years later. Your doctor will write them down in your medical records, but it’s helpful if you keep a note of them, too.

Looking after your heart

It can be worrying to read about things going wrong with your heart. But remember, heart problems after cancer treatment are rare. There are things you can help reduce the chance of heart problems.

If you smoke, it’s a good idea to quit. There is lots of help and support for you. You can ask your GP or pharmacy for advice. You can also have a look at the NHS Better Health website.

You can help keep your heart healthy by having a healthy diet and keeping to a healthy weight. Exercising regularly also helps. But if you’ve had certain chemotherapy drugs, your doctor may advise avoiding heavy weight lifting for the rest of your life. This is because it can put too much strain on your heart. These drugs include doxorubicin, idarubicin and epirubicin, which all belong to a group of drugs called anthracyclines.

For more information on the effects on the heart, please follow the below links: