Survivorship: Late Effects After Radiation Treatment for Thyroid Cancer.

Autor: OncoLink Team
Fecha de la última revisión: 13 de febrero de 2020

What is a late effect?

A late effect is as a side effect related to a cancer diagnosis or treatment that happens months to years after treatment. Some side effects that you develop during treatment can last for months to years after treatment is completed (for example, fatigue or neuropathy). These are often called long term side effects.

Late effects can be health issues or psychological, emotional and practical challenges.

Late Effects After Radiation for Thyroid Cancer

Side effects from radiation treatment are directly related to the area of the body being treated. Any area in the treatment field has a risk of being damaged, causing side effects. As radiation techniques have improved over the years, the risk of late effects has decreased.

Oral Health

The parotid glands are the largest of the salivary glands. They are found behind the jaw, below and in front of the ears, as well as in the floor of the mouth. Their job is to make saliva. Radiation to these areas can affect the parotid glands and decrease saliva production. This can be a short- or long-term side effect. Loss of saliva can make it hard to eat and speak.

  • Saliva is important for killing bacteria in the mouth and on the teeth. Without saliva, you are at risk for tooth decay. It is important to perform good dental hygiene. This includes brushing twice a day and flossing. Avoid sugary foods, candy, and drinks.
  • Visit your dentist for cleanings and oral exams every 6 months. Fluoride treatments can help prevent cavities and decay. Your dentist and oncology team will help you decide what method of fluoride treatment is best for you.
  • Strategies to help manage these side effects include:
    • Using saliva substitutes. These come in gels, lozenges, and sprays. They may be available by prescription or over the counter. Your provider can provide suggestions for these products.
    • Chew on sugarless gum or suck on sugarless candy. This can help stimulate saliva production.
    • Drink plenty of water; keep a water bottle on hand.
    • Suck on ice chips.
    • Avoid soda, caffeinated beverages, alcohol, and tobacco.
    • Eat moist foods and sip liquids with your meals.
  • Changes in, or a loss of, taste or smell can occur during treatment and can become permanent. You also could have a hard time chewing or swallowing. Ask to speak with a dietitian if you are having any of these issues, as nutrition is an important part of health.

Skin Problems

Radiation can lead to permanent changes in the skin.

  • You may develop new scars or notice changes in the color or texture of your skin. Radiation can also change the color and texture of your hair or can cause permanent hair loss in the treated area.
  • The soft tissue and muscles under the skin can develop scarring and/or shrinkage, which can lead to a loss of flexibility and movement or chronic swelling in this area.
  • You may develop chronic or recurring ulcers of the skin in the area treated. Blood vessels of the skin may become dilated and more visible, although this is not harmful.
  • If the skin feels tight or sore, you can apply vitamin E to the skin.
  • Use fragrance and dye-free soaps and moisturizers in the area if your skin is sensitive after radiation.
  • After radiation, the skin in the treated area is more sensitive to sunlight. This sensitivity will last for your lifetime. Practice sun safety, using plenty of sunscreen, wear a wide-brimmed hat, and keep skin in the treated area covered with clothing. Try to avoid being out in the sun between the hours of 10 am-4 pm when it is the strongest.

If you notice any new or worsening skin issues anywhere on your body, you should contact your provider for an assessment.

Damage to the Bones

  • Radiation can cause small cracks (fractures) in the bones that are in the treatment field. Try to avoid trauma including falls or accidents. If you do get hurt, ask your provider if you need any imaging tests to check for bone damage.
    • If you received radiation to the jaw, you are at risk for osteoradionecrosis (ORN) of the jawbone. ORN is an inability of bone to heal after minor trauma. ORN can happen after a dental procedure (such as pulling a tooth). It may start as jaw pain or not being able to open the jaw. Make sure your dentist knows that you have had radiation to the jaw. In some cases, your provider may recommend high-dose oxygen treatments, called hyperbaric oxygen, if you need a dental procedure as this can help with healing of the jaw.

Throat and Swallowing Problems

  • Radiation to the upper airway and throat area can lead to developing scar tissue in the throat. This can happen many years after treatment. This scarring can make the throat narrow, making it difficult to swallow or cause heartburn. If you develop these symptoms, you should be seen by your provider. You may benefit from seeing a gastroenterologist or surgeon. They may be able to use a stent or balloon to stretch the scar tissue and eliminate the narrowing.
  • This scar tissue can also make breathing and speaking difficult. Common symptoms include a hoarse voice or a chronic cough. If you are having severe trouble breathing or are coughing up blood, contact your care team immediately.

Managing Late Effects 

If you experience any concerning or persistent symptoms, contact your care team. Some side effects require specialized care from healthcare providers experienced in working with cancer survivors. 

Interdisciplinary survivorship clinics are available at many cancer treatment sites. If a clinic is not available near you, talk with your oncology care team about resources for managing your late effects.

After treatment, talk with your oncology team about receiving a survivorship care plan, which can help you manage the transition to survivorship and learn about life after cancer. You can create your own survivorship care plan using the OncoLife Survivorship Care Plan.

Referencias

Epstein, J. B., Smith, D. K., & Murphy, B. A. (2018). Oral Health and Survivorship: Late Effects of Cancer and Cancer Therapy. In The MASCC Textbook of Cancer Supportive Care and Survivorship (pp. 653-664). Springer, Cham.

Feuerstein, M., & Nekhlyudov, L. (2018). Handbook of Cancer Survivorship, 2nd. Ed. Springer,  https://doi.org/10.1007/978-3-319-77432

Koontz, B. F. (2017). Radiation Therapy Treatment Effects: An Evidence-based Guide to Managing Toxicity. Springer Publishing Company.

Omolehinwa, T. T., & Akintoye, S. O. (2016). Chemical and radiation-associated jaw lesions. Dental Clinics60(1), 265-277.

Sroussi, H. Y., Epstein, J. B., Bensadoun, R. J., Saunders, D. P., Lalla, R. V., Migliorati, C. A., ... & Zumsteg, Z. S. (2017). Common oral complications of head and neck cancer radiation therapy: mucositis, infections, saliva change, fibrosis, sensory dysfunctions, dental caries, periodontal disease, and osteoradionecrosis. Cancer Medicine6(12), 2918-2931.

Wei, J., Meng, L., Hou, X., Qu, C., Wang, B., Xin, Y., & Jiang, X. (2018). Radiation-induced skin reactions: Mechanism and treatment. Cancer Management and Research11, 167–177. https://doi.org/10.2147/CMAR.S188655

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