• Radiation therapy can cause various side effects, which can range in type and severity from person to person.
• Use moisturizers and skin care strategies to help manage skin changes, and stay active to help decrease fatigue and swelling during radiation treatment.
• Listen to your body and discuss any side effects from radiation with your doctor.

Radiation therapy, also known as radiotherapy, is a valuable part of many breast cancer treatment plans. While effective at killing cancer cells and shrinking tumors, radiation therapy — like any medical treatment — does have a potential risk of side effects.

Fortunately, your cancer care team and members of MyBCTeam have useful tips and suggestions for dealing with side effects from radiation therapy. “Take care of yourself — get good nutrition, hydrate, rest, relax, and let everyone pamper you,” one member encouraged another who was about to start radiation treatments.

The occurrence and severity of side effects from radiation therapy affect everyone differently. People who have larger breasts, fair skin, and conditions that affect skin healing may be more prone to side effects.

There are also many different radiation techniques and methods of treatment, and individual side effects can vary widely. Treatment may involve the whole breast or part of the breast, and sometimes radiation is directed at lymph nodes. Undergoing chemotherapy or taking certain medications could also influence the risk of side effects. Be sure to ask your doctor what side effects you should be aware of.

Side effects usually depend on the type of radiation and the treated area. The effects of radiation can be acute (short-term) or long-term, occurring months to years later. Common acute side effects of external beam radiation therapy for breast cancer include:

• Skin changes in the treatment area, often redness and tenderness similar to sunburn
• Enlarged pores
• Edema (swelling) of the breast
• Fatigue

Brachytherapy — internal radiation — can also cause skin changes in the treatment area. Additional side effects of brachytherapy include:

• Breast pain from the device or radiation skin changes
• Damage to fatty tissue in or around the breast
• Seroma (fluid collection in the breast)
• Infection

Although acute side effects may worsen through the duration of treatment, most tend to go away four to eight weeks after finishing radiation therapy. Side effects such as tissue damage and infections are rare and may require medical intervention, but there are ways to help prevent and manage other side effects like skin changes, fatigue, and swelling.

Long-term side effects of radiation may develop six or more months later and could include shrinkage of the treated breast or, rarely, lymphedema (arm swelling). After brachytherapy, long-term side effects include a residual seroma that may feel harder over time.

12 Tips for Managing Skin Changes During Radiation Therapy

Areas of skin treated with radiation may darken or redden and become irritated. Skin changes from radiation therapy are often similar to what you’d experience with a sunburn. You might also develop a rash called “radiation dermatitis” — a common skin reaction of radiation therapy.

Radiation therapy may cause the treated skin to look and feel discolored, swollen, sensitive, dry, or itchy. Skin may also peel, blister, or form sores and present a risk of infection. Tell your doctor about any changes to your skin during radiation therapy — there are always ways to manage these side effects, and the earlier you alert your doctor, the better.

MyBCTeam members have shared their experiences with skin problems during radiation. One member wrote, “You won’t feel much of anything at first. Over time, it’s like a gradual sunburn.”

You can take care of skin in several ways during radiation therapy. Follow these tips and other suggestions from your doctor to help you feel more comfortable and decrease the risk of infections.

1. Moisturize Before and During Radiation Therapy

It’s important to keep your skin moisturized throughout the duration of radiation therapy. Start moisturizing treated areas even before you notice any skin changes. Use fragrance-free lotions, creams, or ointments for sensitive skin, and follow your doctor’s recommendations. You may need to rinse off lotions or ointments before treatment.

A MyBCTeam member recommended, “Use the lotions generously. Be sure to wash them off before treatment, and apply them as soon as possible afterwards. Don’t wait to start using them. If you wait till you think you need them, it’s too late.”

Another member commented, “The key is to hydrate, hydrate, hydrate — put lotion on your skin and drink plenty of water.”

A third member commented on their regret of not using moisturizer sooner, saying, “I made the mistake of not using it enough, and I did get a bad radiation burn.”

2. Dress Comfortably

To avoid irritating your skin, wear comfortable, loose-fitting clothing around the treatment area. Cotton is a good fabric choice because it’s very breathable.

Several MyBCTeam members have recommended not wearing a bra: “Go braless as often as you can — the more you air out the area, the better.”

Another member suggested, “Wear a cotton camisole or loose-fitting cotton top.”

It’s also best to avoid skin-on-skin contact during treatment. Try to keep your arms away from radiation-affected areas. If you don’t wear a bra, put a soft cotton cloth or a washcloth underneath your breasts to prevent rubbing.

3. Skip Antiperspirants

Some doctors recommend skipping antiperspirants, which may cause more skin irritation, during treatment. Instead, try dusting your armpits with cornstarch to absorb extra moisture and reduce friction. But check with your doctor — some health care professionals may allow natural deodorants or recommend that you avoid antiperspirants containing aluminum.

4. Keep the Area Clean

Clean the treated areas daily with a mild, unscented soap. Make sure the water is warm and not hot, which dries out the skin. Try not to let the shower stream directly hit the treated area. To avoid more irritation, wash the area using your hands instead of a loofah or washcloth. Pat dry and avoid rubbing, even with a terry cloth towel.

While cleansing, try to not wash off any marks made by your radiologist. These marks help direct radiation treatment to the right place. Many treatment centers use permanent tattoos so that washing won’t be an issue, but sometimes felt-tipped pens are used for initial planning and could be rubbed off. Ask your doctor if you’re not sure what was used.

5. Use Gentle Skin Care Products

Your skin will be especially sensitive while undergoing radiation. Follow your cancer care team’s recommendations for which products you can use during this time. In general, it’s best to avoid applying strongly scented products, which can cause irritation in some people, directly on the treated breast. You can use lotions or perfumes anywhere else on your body.

Look for packaging that says “fragrance-free” instead of “unscented.” Although unscented products may not have an obvious scent, they may still contain fragrances to mask the smell of other chemicals.

6. Keep Cool

The feeling of cool air can help ease discomfort for many people undergoing radiation therapy. Try using a hair dryer on the cool setting and directing air at the treatment areas. One MyBCTeam member installed a ceiling fan directly over their bed for cooling relief.

Another member recommended, “Get a big bottle of saline from the first aid aisle of the pharmacy and soak a clean cloth. Lay it on your chest for 15 minutes or so, take it off and air-dry, then put cream on. It feels nice, cool, and soothing.”

Although applying ice packs directly to your skin might seem like a good idea, direct contact with ice packs can damage the skin, resulting in frostbite. Always place a towel or sheet or other soft fabric between the ice pack and the skin surface.

7. Avoid the Sun

Keeping the treated area (your chest and breast) out of the sun as much as possible while going through radiation. If you have to go outside, make sure to wear loose-fitting, sun-protective clothing and apply sunscreen with an SPF of at least 30. The treated area of the breast and possibly the upper chest and collarbone could be very sensitive and at risk of sunburn.

Even after radiation therapy is over, the skin in the treated area will burn more easily. You should apply sunscreen every time you go outdoors, even if it doesn’t seem sunny.

8. Let Yourself Rest

Fatigue is a very common side effect for people going through radiation treatment. It’s also a symptom of breast cancer itself as well as of chemotherapy or hormone therapy. Although radiation works to kill cancer cells, it may also kill healthy cells, which can cause symptoms like fatigue and extreme tiredness.

While undergoing radiation, you may notice that you feel tired all the time and that resting doesn’t help. For most people, fatigue will slowly get worse as treatment goes on, peaking at the end of treatment. After that, fatigue should gradually get better, but, for some people, it could last for months or years.

One MyBCTeam member recommended, “Allow yourself time to rest. Make the most of the time when you do sleep at night.”

Keep daily track of your energy levels, and share this information with your cancer care team. You could score your fatigue on a scale of zero to 10 — none, mild, moderate, or severe.

Make sure to talk with your doctor if your fatigue starts to become worse, significantly affects your daily activities, or keeps you in bed for more than a day.

9. Eat Well

Try to eat well during radiation treatment. Fatigue may make it harder to consume a well-balanced diet, but not eating enough or eating poorly can make fatigue worse.

It’s important to make sure that what you eat provides enough calories, vitamins, and nutrients. Ask friends or family to help you keep your pantry stocked with ingredients for easy-to-prepare meals so that you don’t become malnourished.

10. Stay Active

Regular exercise can help boost your energy levels, and studies show that even moderate daily exercise can help combat fatigue from radiation treatment. Several MyBCTeam members have shared that taking short walks helps with fatigue. One member said, “Fatigue is an issue. A short walk helps keep that at bay.”

To manage fatigue, make sure you take regular breaks, and try to plan activities for times of day when you may have more energy.

11. Reduce Swelling

You may notice swelling in your breast, armpit, arm, or hand during radiation therapy. This is commonly caused by lymphedema — a buildup of lymph fluid. Lymph nodes usually clear this fluid, but they may be removed with axillary (underarm) surgery and sometimes become damaged by radiation therapy.

Lymphedema usually starts gradually and can be treated. Let your health care team know right away if you notice any swelling of your hand or arm.

To reduce your risk of lymphedema, avoid overusing the affected arm. Other strategies include:

• Exercising regularly to strengthen your muscles
• Avoiding extreme temperatures
• Managing your weight
• Washing your hands often to avoid infections

If you experience swelling, your doctor may recommend a treatment plan that includes evaluation by a physical therapist, compression bandages, massage therapy, or light exercise. Keeping your arm raised to help drain fluid may also help ease symptoms.

12. Listen to Your Body

During radiation therapy, pay attention to what your body is telling you. You know your body best. Some people find it helpful to keep a daily log of how they are feeling, which can be helpful information when following up with your doctor about side effects.

Make sure to reach out to your cancer treatment team about any concerns before side effects become too difficult to tolerate.

Talk With Others Who Understand

MyBCTeam is the social network for people with breast cancer and their loved ones. On MyBCTeam, more than 72,000 members come together to ask questions, give advice, and share their stories with others who understand life with breast cancer.

Have you undergone radiation therapy for breast cancer? Do you have any tips for managing its side effects? Share your experience in the comments below, or start a conversation by posting on your Activities page.