Rectal/Colon Cancer: Before Start of External Beam Radiation Treatment (EBRT)

While radiation therapy is safe, there are few possible short and long term side effects of EBRT. Side effects vary from patient to patient and according to the exact location of the radiation. Most side effects are due to the fact that the radiation beam affects normal tissues around the tumor area.

Normal daily activities can usually be continued during treatment. 

With colon and rectal cancer, the most common side effects include the following:

• Diarrhea 
  • If diarrhea appears, it may continue for a few weeks after the end of treatment. 
  • Drink plenty of clear liquids to make up for the fluids being lost due to diarrhea.
  • Avoid spicy foods.
  • Concentrate on easily digestible foods that are not excessively high in roughage or fiber.
  • For additional tips on how to deal with diarrhea, click here.
• Nausea and vomiting
  • Consider fasting for a few hours before and after treatment.
  • Speak with your doctor about medications that may help. 
  • Review the information in the document in "To Learn More" for additional tips.
• Bladder irritation - which generally appears as a need to urinate more frequently than normally.  If this symptom appears, it can continue for a while after the end of treatment. There is generally no need for a catheter (a tube through to the bladder to ease urination). People with severe urinary problems before starting EBRT are at risk for needing a catheter during EBRT.
• Fatigue
  • Generally there is no fatigue during the first weeks of treatment.
  • Whether fatigue appears after that, and to what degree, depends on the individual.
  • If fatigue does appear, it generally plateaus around week 5.
  • Techniques are available for decreasing the effects of fatigue. 
  • Fatigue generally goes away within a week to a week and a half after end of treatment.
  • Fatigue does not generally keep people from working during treatment.
  • For tips about how to deal with fatigue, click here.
• Skin changes
  • The energy waves used in radiation therapy can have the same effect on the skin as being in sunlight at noon. 
  • Irritation and redness may appear by the third or fourth week of treatment.
  • When washing, use mild soap (while being sure not to remove the marks used for the radiation treatment). 
  • Wear soft clothing - preferably cotton.
  • Protect the area from sunlight.
  • If your skin cracks or blisters, speak with your nurse or oncologist about a suitable moisturizer.
  • For additional information about radiation caused skin changes, click here. 
• Erectile dysfunction in men
  • Radiation treatment to the pelvis can damage the blood vessels necessary to achieve an erection which can result in erectile dysfunction.
  • Whether you experience erectile dysfunction after EBRT depends on your potency level prior to the start of treatment, your age and other medical conditions which could effect erectile function such as diabetes, hypertension or cardio vascular disease.
  • If erectile dysfunction occurs, there is assistance available.See the Survivorship A to Z document about erectile dysfunction.
  • Keep in mind that there are ways to be intimate other than by having intercourse. Plus there is plenty of stimulation you can get and receive that doesn't involve an erection. Speak with your doctor for more information or for a referral to an expert in the area. 
  • If your medical condition is interfering with your sexual relations with your significant other, tell your significant other about your feelings and what you would like to change. Ask for your significant other's point of view. Listen to it rather than prepare your response. If the two of you can't work it out, speak with your doctor or seek counseling.
  • For more information about sex and intimacy, click here.
• Women may experience:
  • Vaginal dryness as a result of radiation .  If this occurs talk with your doctor about lubricants that may be helpful.
  • Vaginal stenosis or narrowing of the vagina, there are vaginal dilators that your doctor can recommend for stretching the walls of the vagina thereby decreasing the discomfort associated with penetration.
• Incontinence (in the sense that urine leaks unintentionally). For some people, incontinence happens when doing activities such as sitting. For some people it only happens when there is increased abdominal pressure – such as from laughing, coughing, sneezing or exercise.
  • EBRT rarely causes incontinence.
  • If a person is already incontinent before EBRT, incontinence tends to remain.
  • Sometimes urinary frequency can feel like incontinence.  As noted above, this goes away over time when caused by EBRT.
  • There are tips for dealing with incontinence. Click here.
• White blood cell counts may drop during radiation treatment. White blood cells fight infection and prevent bleeding. If blood tests show this problem, you may have to put treatments on hold for a week or two to allow your blood counts to come back up. 
• Radiation colitis 
  • Radiation colitis is inflammation of the colon. If it occurs, radiation colitis may become permanent.
  • Radiation colitis may include complications such as:
    • Deep ulcers in the lining of the colon which can cause bleeding which shows up as blood in the stool. If bleeding continues, it can lead to fatigue.
    • Ulcers may create fistulas - a tunnel through the affected area into surrounding areas.Fistulas may become infected.
    • Scar tissue may prevent absorption of nutrients from foods which can lead to protein and vitamin deficiency or cause bowel obstruction which can only be corrected by surgery.

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