Survivorship: Late Effects After Radiation Treatment for Thyroid Cancer.

What is a late effect?

A late effect is a side effect that is caused by treatment that happens months to years after the cancer treatment has finished. 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 damage the parotid glands and lessen the amount of saliva you make. This can be a side effect that is short-term (gets better after treatment) or long-term (lasts a long time, even forever). Loss of saliva can make it hard to eat and speak.

• Saliva kills bacteria in your mouth and on your teeth. Without saliva, you are at risk for tooth decay (cavities). Taking good care of your teeth and gums is important. 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 the fluoride treatment that is best for you.
• Tips to help cope with these side effects include:
  • Use saliva substitutes. These come in gels, lozenges, and sprays. They may be available by prescription or over the counter. Your provider can give you 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 Cahnges

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, use 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.

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 tests (x-ray) 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 your 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. This can help with the healing of the jaw.

Throat and Swallowing Problems

• Radiation to your upper airway and throat area can lead to scar tissue forming in your throat. This can happen many years after treatment. This scar tissue can make your throat narrow, making it difficult to swallow or causing heartburn. If you develop these symptoms, you should be seen by your provider. You may benefit from seeing a gastroenterologist (GI Doctor) or surgeon. They may be able to use a stent or balloon to stretch the scar tissue and widen your throat.
• This scar tissue can also make breathing and speaking difficult. Common symptoms include a hoarse voice or a chronic cough. If you are having 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.