Survivorship: Late Effects After Radiation for Esophageal Cancer

Side Effects After Cancer Treatment

There are different types of side effects that you may have during or after cancer treatment.

• Short-term: side effects that happen while you are on treatment and end shortly after treatment. Example: mouth sores that heal within a few weeks after treatment is finished.
• Long-term: side effects that happen while you are on treatment and last for months to years. Some of these side effects will not go away. Example: neuropathy.
• Late effects: side effects that happen months to years after you have finished treatment. Example: scar tissue forming in your throat.

This article focuses on the late effects of radiation treatment for head and neck cancer.

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

Late Effects After Radiation for Esophageal Cancer

Side effects from radiation treatment affect the area of the body in the treatment field. The treatment field includes the cancer and in some cases nearby healthy tissue. The way radiation is given has changed over the years, leading to a lower risk of late effects. Talk with your radiation oncologist to find out which areas were in your treatment field.

Late effects of radiation treatment for esophageal cancer include:

Eating/Swallowing Problems

Radiation therapy for esophageal cancer can cause scar tissue months or years after therapy. 

• This scarring can make the esophagus narrow (called a stricture), making it hard to swallow or causing a feeling of food being "stuck" in your throat that won’t go away. You may also feel like you have heartburn. Esophageal dilatation is a procedure that stretches the area that has narrowed. This can help with the feeling of food being stuck. If you have signs of a stricture, you should be seen by a gastroenterologist (GI Doctor) or surgeon.
• Your weight and nutrition should be checked by your care team. If you are losing weight and/or not eating enough because of eating or swallowing issues, you should see a registered dietitian. A dietitian will work with you to stop your weight loss and to gain some weight back.

Heart Problems

Because the heart is behind the esophagus, radiation can damage the heart.

• This damage can cause the heart to tighten or have scar tissue. This can happen many years after radiation. Surgery can be done to fix this problem. Signs of this can include trouble breathing, racing heart or palpitations, lightheadedness, chest pain, and/or feelings of anxiety.
• Cardiac (heart) disease can develop at a younger age and without other risk factors (such as diabetes, high cholesterol levels, or family history).
• You should maintain a healthy lifestyle with regular exercise, a healthy weight, eating a healthy diet, and not smoking. These can all help lower your risk of heart disease.

Risk of Breast Cancer

Radiation therapy fields that include breast tissue can lead to breast cancer later in life. Because of this, the recommendations for breast cancer screening for you are different than people who have not had chest radiation. 

• Women who received radiation to the chest should have annual mammograms starting 8-10 years after radiation, or at age 40, whichever comes first. 
• If you received radiation to the chest wall between the ages of 10 and 30, your mammograms may start earlier, and you may also need a breast MRI. 
• Each case is unique, and you should talk to your provider about what tests you need and how often you should have them. 
• Make sure that you are familiar with the normal feeling of your breasts. Tell your provider about any changes. Changes can include a new lump or mass, a change in the look and feel of the skin on your breast, or any discharge coming out of your nipple.
• If you are a man who has had radiation to the chest, you also have an increased risk of getting breast cancer. There are no screening tests done for men who have had chest radiation. However, you should tell your provider about any changes such as lumps, skin changes, or nipple discharge..

Lung Problems

Radiation fields involving the lung can lead to scar tissue (called fibrosis), inflammation (pneumonitis), and restrictive or obstructive lung disease. 

• The risk for these problems is higher with higher doses of radiation, if you also got certain chemotherapies (bleomycin, busulfan, BCNU, and CCNU), or if you had part of the lung removed (lobectomy). 
• Radiation can cause scar tissue in the lungs that may affect blood vessels. Damage to the blood vessels can lead to coughing up blood. If you cough up blood, you should be seen by a healthcare provider right away, either in the office or the emergency room. 
• At your yearly visit, your provider will examine your lungs and ask about symptoms (cough, shortness of breath, wheezing). 
• You should get a flu vaccine every year and the pneumococcal vaccine. 
• You should avoid smoking, secondhand smoke, vaping, and hookah products, as these can cause further lung damage.

Skin Changes

Radiation can lead to permanent changes in the skin.

• You may find new scars or 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 cause scarring and/or shrinkage, which can lead to a loss of flexibility and movement or chronic swelling in the area treated.
• You may get chronic or recurring ulcers of the skin in the area treated. Blood vessels of the skin may become dilated (larger) and more visible, but this is not harmful.
• If the skin feels tight or sore, you can put 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, use plenty of sunscreen, wear a wide-brimmed hat, and keep skin in the treated area covered with clothing. Try not to be 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, you should call your provider for an assessment. 

Managing Late Effects 

Tell your care team about any new or worsening symptoms. Some side effects need care from healthcare providers who specialize in working with cancer survivors. There are interdisciplinary survivorship clinics at many cancer centers. If there is not a survivorship clinic near you, talk with your oncology care team about support for managing your late effects.

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