Survivorship: Late Effects After Radiation for Liver Cancer

Side Effects After Cancer Treatment

There are different types of side effects 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 and causing health issues.

This article focuses on the late effects of radiation treatment for liver cancer.

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

Late Effects After Radiation for Liver 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. How 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 liver cancer include:

Liver Damage

Radiation to the liver may be needed for cancer treatment but can cause damage to areas of the liver that are healthy.

• How your liver is working will be measured by a blood test (called LFTs) before and after treatment.
• Avoid drinking alcohol; it can raise the risk of liver damage.
• If you have yellowing of the eyes and/or skin (jaundice), pain or swelling in your belly, itchy skin, or dark-colored urine, call your care team. You may need to see a gastroenterologist (GI Doctor).

Bowel Problems

The bowel is sensitive to the effects of radiation. If the rectum, colon, or small bowel are in the treatment area, late effects  can include:

• Scarring and strictures: Damage to the tissue of the bowel can lead to scar tissue. This scar tissue can lead to a stricture (narrowing of a part of the body) and cause a bowel obstruction. A bowel obstruction is when the normal movement of stool through your bowel is blocked. Call your provider if you are having any abdominal (belly) pain, constipation, vomiting, weight loss, or bloating. If you have severe abdominal pain along with vomiting and constipation you should be seen by a provider right away, either in the office or the emergency department. 
• Ulceration and bleeding: Ulceration and bleeding can be caused by damage to the bowel tissues. Report any dark or black colored stools, bright red blood in your stools, in the toilet water, or on the toilet paper to your provider right away. You may need testing with a colonoscopy to find the area that is bleeding.
• Chronic diarrhea: Report diarrhea that is causing weight loss to your care team. Medications to lessen diarrhea may be helpful. You may benefit from meeting with a gastroenterologist (GI Doctor). You should also meet with a registered dietitian (RD) who can help look at your diet and give you ideas to lessen diarrhea and maintain or gain weight.
• Fistula formation: A fistula is a connection (hole) between two parts of the body that are not normally connected. A fistula can form between the bowel and bladder, the bowel and female reproductive system (uterus/ vagina), or the bowel and the skin. If you have urine, feces, or blood coming out of any opening that it should not be, you should call your provider right away. 
• Colon cancer: Radiation to the bowel can lead to colon cancer years after you finish treatment. If you were treated before the age of 18, you should begin colon cancer screening with colonoscopy or DNA stool testing 5 years after treatment or at age 30, whichever is later.  You may need earlier screening if you have irritable bowel disease, chronic diarrhea or bleeding, ulcerative colitis, colon cancer in your family, or previous gastrointestinal cancers or polyps. Talk with your provider about when you should start colon cancer screening.

Stomach Problems

Indigestion and heartburn can be late effects of radiation that include the stomach. You may also be at risk for gastritis (irritation of the stomach wall), ulcers, and gastric outlet obstruction.

• Signs of stomach problems include new or worsening belly pain, frequent vomiting or heartburn, or blood in your vomit or stool. Call your care team right away if you have any of these problems.
• You may need a referral to a gastroenterologist (GI Doctor) to find the cause.
• If you are having heartburn, your care team may want you to take medicine to lessen the amount of acid being made or to coat/protect your stomach.

Skin Problems

Radiation can lead to changes in the skin that don’t go away.

• 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 hair loss in the treated area that never grows back.
• 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 on 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.