Radiation therapy, also known as radiotherapy, is a key part of many breast cancer treatment plans. Although radiation therapy is effective at killing cancer cells and shrinking tumors, like any medical treatment, it can cause side effects.

Fortunately, your cancer care team and members of MyBCTeam have useful tips and suggestions for managing 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.

Radiation therapy side effects are different for everyone, and some people have more serious side effects than others. For example, 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 side effects can be different in everyone. Treatment may involve the whole breast or part of the breast, and sometimes radiation is directed at the lymph nodes (small glands that filter fluid in your body). 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 part of the body being treated. Radiation can cause short-term side effects or long-term ones that show up months or even years later. Common short-term side effects of external beam radiation therapy for breast cancer include:

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

Brachytherapy is a type of internal radiation in which a small radioactive source is placed inside the body near the cancer. This treatment 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 short-term side effects may get worse through the duration of treatment, most tend to go away four to eight weeks after finishing radiation therapy. Side effects like tissue damage and infections are rare. In some cases, they may need treatment from a doctor. 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 or thickening of the skin of the treated breast or, rarely, lymphedema (a buildup of lymph fluid, often in the arms or legs). After brachytherapy, long-term side effects include a seroma that remains after treatment and may feel harder over time.

12 Tips for Managing Skin Changes During Radiation Therapy

Areas of skin treated with radiation may become darker or red, and the skin may feel warm, sore, or irritated. These changes can look different depending on your skin tone.

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. The skin may also peel, blister, or form sores, which can be more likely to get infected. Tell your doctor about any changes to your skin during radiation therapy. There are many 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 your skin in several ways before, during, and after 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

Keep your skin moisturized throughout 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 afterward. 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 a good idea to avoid skin-on-skin contact during treatment. Try to keep your arms away from the areas treated with radiation. 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 healthcare 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 or too cold, 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.

When washing, try not to scrub off any marks made by your radiologist. These marks help guide the radiation to the right spot. Some treatment centers use small permanent tattoos so the marks don’t wash away. However, this is becoming less common because permanent marks can be a lasting reminder of a difficult time. Sometimes, felt-tipped markers are used for planning, and these can rub off more easily. If you’re not sure what kind of marks you have, ask your doctor.

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 putting strongly scented products directly on the treated breast, as they can cause irritation for some people. 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

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, sheet, or other soft fabric between the ice pack and your skin.

7. Avoid the Sun

Keep the treated area (your chest, breast, and armpit) out of the sun as much as possible during radiation treatment. If you need to go outside, wear loose, sun-protective clothing and put on sunscreen with an SPF of 30 or higher. 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 ends, the treated skin may remain more sensitive to sunburn. Apply sunscreen whenever you go outdoors, even on cloudy days.

8. Let Yourself Rest

Radiation therapy is designed to destroy cancer cells, but it can also affect healthy cells. This can lead to fatigue — a deep, persistent tiredness that doesn’t go away with rest. Fatigue is one of the most common side effects of radiation, and it can also be caused by breast cancer itself, as well as by treatments like chemotherapy and hormone therapy.

During radiation, many people find themselves feeling exhausted all the time, even after sleeping or resting. For most, this fatigue builds gradually and peaks near the end of treatment. After radiation ends, energy levels usually start to improve, but for some people, fatigue may continue for months or even years.

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

Keep track of your energy levels each day, and share this with your cancer care team. You can rate your fatigue on a scale from 0 to 10 and write it down in a journal, using words like 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.

Make sure you’re eating enough calories, vitamins, and nutrients to stay healthy. Ask friends or family to help keep your pantry filled with ingredients for simple meals, so you don’t risk becoming malnourished.

10. Stay Active

Regular exercise can help ease fatigue, 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. 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 often be treated. Let your healthcare team know right away if you notice any swelling in your hand or arm.

To lower your risk of lymphedema, try not to overuse the arm that was treated.

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 yourself best. Some people find it helpful to keep a daily log of how they are feeling. It gives your doctor useful details when checking in about side effects.

Be sure to talk to your cancer care team about any concerns before side effects become too hard to handle.

Talk With Others Who Understand

On MyBCTeam, the social network for people with breast cancer and their loved ones, 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.