Radiation Therapy to the Spine

Tumors of the vertebrae (bones that surround the spinal cord) can be a serious problem for some cancer patients. These tumors can cause the bone to collapse and can put pressure on the spinal cord. This pressure may cause pain and/or weakness in your legs and arms and change how your bowel and bladder work.

You are scheduled to receive radiation treatments designed specifically for you. The side effects that you may experience depend on the area being treated.

What to Expect During Treatment

Skin Changes

Skin changes may occur in any area that has been treated with radiation.

Temporary skin changes may occur gradually. These changes usually include redness, dryness, flaking, and itching of the treated area.

• Skin changes usually occur one to two weeks after your treatment begins and may last one to two weeks after your last treatment.
• You may shower or bathe throughout your course of treatment. Your nurse will recommend a mild soap for you to use.
• Moisturizers such as ___________________ may be applied to the following areas: _____________________________________.
• It is important to keep the folds of your skin dry.
• Do not use moisturizers within two hours before your radiation treatment.
• Avoid wearing tight clothing over the area being treated. Tight shirt collars, pantyhose, or girdles can irritate skin in the treatment area. Loose-fitting cotton clothing is recommended.
• Avoid using saunas and hot tubs while you are under treatment with radiation therapy.
• Do not use hot water bottles, heating pads, sun lamps, or ice packs in the treatment area.
• If the area being treated is exposed to the sun, apply sunscreen routinely to the treatment site whenever you are outdoors for more than 10 minutes during the summer or winter.  A PABA-free sunscreen with a minimum sun protections factor (SPF) of 30 or higher is recommended.

Fatigue

Fatigue also may occur after you have received treatment. You may feel more tired than usual.

These tips may help:

• Take frequent rest periods and pace your activities.
• Save time for activities you enjoy. Plan them as part of your day.
• Plan a short period of light activity each day, such as a walk. Inactivity may actually increase fatigue.
• Tell your nurse or doctor if you become extremely tired.

Treatment to the Lumbar and Lower Thoracic Spine

The following side effects may occur when treatment is given to the lower thoracic spine (behind the stomach) or lumbar spine (low back).

• Stomach upset. You may experience nausea, vomiting, diarrhea, or abdominal cramping. Call your nurse or doctor if you have any of these symptoms. A diet may be recommended and medication may be prescribed to help minimize your discomfort.
• Appetite changes. You may notice changes in your appetite. Liquids and foods may not taste the same, and you may not feel as hungry as usual.
• Eat bland foods that are low in fat because these are digested more easily.
• Avoid spicy foods. They will irritate your stomach.
• Eat several small meals a day instead of three large ones.
• Speak with a dietitian about your nutritional needs and for examples of a low-fat diet.

Bowel movement changes. Loose, frequent bowel movements may occur two to three weeks into treatment. Here are some tips to help minimize discomfort:

• Your nurse will give you a low-residue diet to follow throughout your radiation treatment to control side effects of treatment.
• Eat small frequent meals instead of three large meals a day.
• Avoid very hot or cold foods and drinks.
• Registered dietitians are available to discuss your diet with you and your family.
• Keep the anal area (skin around the opening of the rectum) clean and dry. Wash gently after each bowel movement with moisturized, unscented, alcohol-free wipes.
• If the skin is irritated, you may apply ___________________.
• Your doctor may prescribe medications that decrease the frequency of bowel

Treatment to the Cervical and Upper Thoracic Spine

• Your throat may become sore or scratchy.
• You may feel as if you have a lump in your throat. Your throat is not closing, even though it may feel that way.
• Use lozenges, sprays, or other medications to help numb your throat. These may be very helpful before meals and at bedtime. Please ask your nurse about these products.
• Eat soft foods that are easy to chew and swallow.
• Do not eat or drink very hot or very cold foods or drinks. It may be easier to eat foods that are cool or at room temperature.
• Do not eat citrus, spicy, salty, rough, or dry foods.
• Do not drink alcohol. 
• Do not smoke. Smoke can irritate your throat. Avoid being around people who smoke, and avoid smoke-filled rooms.

What to Ask Your Nurse or Doctor

Ask your nurse and doctor any questions you may have about the following:

• Redness and/or tenderness of the skin
• Sore throat
• Discomfort when swallowing
• Nausea or vomiting
• Decrease in appetite
• Fatigue
• More than five loose, watery stools in a 24-hour period
• Any new or unusual symptoms
• Availability of support groups

Things to Report Immediately

Call immediately if you have any of the following symptoms:

• Pain in your back, which may move to the side. The pain may be worse when you lie down, cough, sneeze, or move.
• Band-like pain that wraps around your chest and/or midsection
• Numbness, tingling, or loss of feeling in toes or fingers
• Weakness in your legs or a change in the way you walk
• Change in your bowel or urinary habits, such as constipation or being unable to empty your bladder
• Loss of bowel or bladder control (incontinence)

In an Emergency, Call:

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