Late or delayed effects of radiation treatment can become apparent months to years after radiation treatment, and are related mainly to vascular and connective tissue changes as a result of chronic inflammatory effects.30, 72
Skin and mucous membranes changes
Normal skin functions such as elasticity, flexibility, and protection against physical trauma may be impaired as a result of radiation damage to the skin and its appendages.83 Late skin effects include:75
- altered pigmentation
- slow healing of trauma
- telangectasia (dilated vascular channels which may be seen within one to two years after completion of treatment).
With high doses of radiation there may be:
- loss of sebaceous and sweat gland activity
- fibrosis of the subcutaneous tissues
- impairment of lymphatic drainage.
Late effects of radiation to the oral cavity may result in tooth decay and changes in the structure of the gums. Trismus is the reduced capacity to open the mouth due to the result of scar formation following surgery which leads to contraction of the muscles of mastication.84
Tooth decay and caries may occur as a result of the decreased saliva and from radiation damage. The ultimate radiation insult to the structure of the mouth is osteoradionecrosis.72
Late effects of radiation enteritis occur from six to 18 months following treatment. Symptoms may be insidious in onset and include colicky abdominal pain, weight loss, bleeding from the rectum, or diarrhoea. Late effects include proctitis, colitis, enteritis, ulceration, fistular formation, and obstruction.30
Radiation to the female pelvis may result in:85
- mucosal atrophy
- lack of elasticity
- ulceration of the vaginal tissue
- vaginal stenosis.
Vaginal stenosis is a late effect following external beam and/or brachytherapy radiation and occurs as a result of the formation of adhesions and fibrosis of upper vaginal tissues, which in turn leads to contraction of the vaginal vault, and finally to a shortened vagina. This may result in discomfort and difficulty with penetration in sexual intercourse, and can hinder medical examination of this area of the body during routine follow up.86
Access a current text, and:
- Describe the pathogenesis of osteoradionecrosis of the mouth
- Summarise prevention and management strategies of osteoradionecrosis.
Provide evidence based rationale for the following interventions in the management on chronic radiation enteritis:
Access the article A study to investigate women's experiences of radiation enteritis following radiotherapy for cervical cancer88, and summarise the impact of chronic radiation enteritis and the role of nurses in managing this symptom.
Outline information resources you could give to a woman following treatment for a gynaecological cancer to prevent vaginal stenosis.
Access a current text and describe the late effects associated with the following sites:
- Central nervous system
Discuss the role of the MDT in the management of late effects.