Side effects of radiotherapy for Hodgkin lymphoma
Radiotherapy uses radiation to treat cancer. The side effects you have depend on the area that you’re having treatment for.
Doctors can give radiotherapy to a very precise area containing the lymphoma. They also try to plan your treatment so that it causes as few side effects as possible.
Healthy cells in the treatment area are also affected and this causes side effects. While radiation kills the cancer cells, the normal cells are usually able to recover.
Side effects tend to start a week or so after the radiotherapy begins. They can gradually get worse during the treatment but they usually begin to improve 1 or 2 weeks after your treatment ends.
Most side effects go away after your treatment finishes, but some side effects might continue or start months or years later. These are called long term side effects. Most people don’t have serious long term side effects from radiotherapy.
Everyone is different and the side effects vary from person to person. You may not have all the side effects mentioned. Some people only have mild side effects but for other people they can be more severe.
Short term side effects
Most side effects are short term and gradually go away in the weeks or months after treatment. Short term side effects include:
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skin changes
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tiredness and weakness
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loss of body hair in the treatment area
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loose or watery poo (diarrhoea)
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feeling or being sick
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dry mouth and changes in taste
Skin changes
Radiotherapy can cause changes to your skin in the area that is having treatment. Some people don’t have any problems at all, but others have very sore skin. This may start after your radiotherapy is completed.
If you have a skin reaction your skin might:
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feel sore
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turn red or darker than your normal skin tone
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feel dry and itchy
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look like sunburn, peel and blister
You may also get redness or darkening on the other side of your body to your treatment area. This is because the skin can also be affected in the area where the radiotherapy beam leaves the body. This is called the exit site.
Skin reactions usually settle down within 4 weeks of ending the treatment. But some changes can continue for longer. Your skin might always be darker or look permanently sunburnt in the treatment area. Or you might develop tiny blood vessels near the surface. For some people the skin will always be more sensitive to the sun than it was before treatment.
Tell the radiotherapy staff if you notice any skin changes. There are lots of ways to care for your skin when having radiotherapy. Your radiotherapy team may give you some creams to soothe the skin. Your skin will be more sensitive so it is important to protect it from the sun.
Tiredness and weakness
You might feel tired during your radiotherapy. It tends to get worse as you progress through your treatment. 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. It is important to balance exercise with resting. Some people keep working during treatment. Whether you can or not depends on how you feel.
There are some things that can help with tiredness. Try some of the following:
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drink plenty of water
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eat a balanced diet
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take short naps if you need to
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do things you enjoy to relax
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ask family and friends for help with physical tasks
Loss of body hair in the treatment area
Radiotherapy can make your hair fall out in the treatment area. You might also have some hair loss on the opposite side of your body to your treatment area, where the radiotherapy beams leave your body.
Radiotherapy won’t cause your hair to fall out in other parts of your body and it will usually grow back when you finish treatment.
Diarrhoea
Radiotherapy can cause inflammation of the lining of your bowel if you are having radiotherapy to your tummy (abdomen). This can cause diarrhoea. You may also have:
- cramping pain
- an increase in wind (flatulence)
- feeling that you need to go to the toilet urgently
- having to go to the toilet several times
- some mucus or blood in your poo (stool)
Let your doctor, nurse or radiographer know if you have any of these side effects.
There are several things that can help you cope with diarrhoea, such as:
- drinking plenty so you don’t become dehydrated
- take anti diarrhoea medicine, which your healthcare team can give you
- changing your diet, you can discuss this with your dietitian
- apply soothing creams to your back passage
Diarrhoea should gradually get better a few weeks after your treatment has finished. But it can also be a long term side effect. It varies from person to person. Let your doctor or nurse know if it continues.
Feeling sick or being sick
You might feel sick (nausea) or be sick (vomit) if you have radiotherapy to your abdomen.
Tell your doctor or nurse if you feel sick. They can give you 
or an injection to help. There are lots of different anti sickness drugs and you might need to try a few different ones to find one that works best for you.
Contact your doctor or nurse straight away if you have been sick more than once in a day.
Tips for if you are feeling sick
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Avoid eating or preparing food when you feel sick.
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Avoid foods that are fried, fatty, or have a strong smell.
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Drink plenty, taking small sips throughout the day to stop you from getting dehydrated.
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Relaxation techniques help control sickness for some people.
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Ginger can help, try it as crystallised stem ginger, ginger tea or ginger ale.
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Fizzy drinks help some people when they’re feeling sick.
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Ask your doctor about food supplements if you are worried you are losing weight.
Dry mouth and taste changes
You might have a dry or a sore mouth if you have radiotherapy to your head and neck area. You may also notice that things taste differently. Or it might be painful to swallow because of mouth ulcers.
Talk to your healthcare team if you have this. It is usually temporary and goes away a few weeks or months after treatment.
General side effects of radiotherapy
The video below talks about some of the general radiotherapy side effects. The video lasts around 8 minutes.
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
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. It’s important to remember that most people don’t have serious long term side effects from radiotherapy.
Doctors and researchers are developing and changing treatments to reduce the risk of long term side effects while giving the best chance of curing Hodgkin lymphoma.
Long term side effects can include:
- heart problems
- inflammation of the lungs
- changes to the way your
thyroid gland works infertility - an increased risk of developing a second cancer
Heart problems
Radiotherapy to the chest can increase the risk of heart disease later in life. Doctors give radiotherapy to smaller areas and in lower doses to reduce any effects on the heart. And they can teach you a breathing technique to do during radiotherapy to help protect your heart.
It is important to be aware of this side effect, particularly if there is heart disease in your family.
You can help to reduce your risk of heart disease by:
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having a healthy diet
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exercising regularly
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stopping smoking
Inflammation of the lungs
Radiotherapy to the chest can cause a long term cough and sometimes breathlessness. This is called chronic radiation pneumonitis. Let your doctor or nurse know if you notice changes in your breathing any time after your radiotherapy.
Thyroid gland changes
If you have radiotherapy to the neck, some people can develop a condition of the thyroid gland called hypothyroidism. Hypothyroidism means that the thyroid gland stops producing enough . You might need to take thyroid hormone tablets such as levothyroxine if this happens.
Infertility and pregnancy
Radiotherapy to your or can affect your fertility and sex life.
It can be distressing to find out that the treatment you need can affect your ability to have children. It can seem unfair to have to cope with this as well as with your cancer. Sometimes radiographers can use a shield to protect your ovaries or testicles, the organs needed to have children. Or you might be able to store your eggs, embryos or sperm before treatment.
Radiation can be harmful to an unborn child. It is important that you do not become pregnant during radiotherapy. Your doctor will discuss this with you.
Even for people who have not yet thought about having children, losing fertility can be very difficult to come to terms with. It can affect the way you feel about yourself. It can take time to come to terms with this change in your life. Talking to someone close can help.
You may want to talk to someone other than your partner, family or friends. Some people find it helpful to talk to a therapist or counsellor.
Second cancer
You have an increased risk of developing another cancer later in life after radiotherapy treatment. This is rare and your doctor will talk to you about this risk.
Children treated with radiotherapy for Hodgkin lymphoma also have a risk of developing another cancer later in life. Researchers and doctors are currently doing research trials to see which children need radiotherapy after chemotherapy and which children don't need it.
Breast screening
Women treated with radiotherapy to the chest have an increased risk of developing breast cancer later in life. If this is your case, your doctor might arrange for you to have yearly breast screening from around 8 years after treatment. This could be an , a or both.
It is possible for men treated with radiotherapy to the chest to also get breast cancer, but it is much rarer.
If you are worried at all, speak to your specialist. You can also call the Cancer Research UK nurses on freephone 0808 800 4040. The lines are open from 9am to 5pm, Monday to Friday.
