Editing Radiation therapy (section)

===Acute side effects===
; Nausea and vomiting
:This is not a general side effect of radiation therapy, and mechanistically is associated only with treatment of the stomach or abdomen (which commonly react a few hours after treatment), or with radiation therapy to certain nausea-producing structures in the head during treatment of certain head and neck tumors, most commonly the [[vestibule of the ear|vestibules of the inner ears]].<ref>{{cite journal | vauthors = Lee VH, Ng SC, Leung TW, Au GK, Kwong DL | title = Dosimetric predictors of radiation-induced acute nausea and vomiting in IMRT for nasopharyngeal cancer | journal = International Journal of Radiation Oncology, Biology, Physics | volume = 84 | issue = 1 | pages = 176–182 | date = September 2012 | pmid = 22245210 | doi = 10.1016/j.ijrobp.2011.10.010 }}</ref> As with any distressing treatment, some patients vomit immediately during radiotherapy, or even in anticipation of it, but this is considered a psychological response. Nausea for any reason can be treated with antiemetics.<ref>{{cite web |url=https://www.caring4cancer.com/go/cancer/effects/side-effects-of-radiation-therapy.htm |title=Side Effects of Radiation Therapy - Caring4Cancer |access-date=2012-05-02 |url-status=dead |archive-url=https://web.archive.org/web/20120330060027/http://www.caring4cancer.com/go/cancer/effects/side-effects-of-radiation-therapy.htm |archive-date=2012-03-30 }} Common radiation side effects</ref>
; Damage to the epithelial surfaces
:[[Epithelium|Epithelial surfaces]] may sustain damage from radiation therapy.<ref>{{cite web|url=http://www.cancer.gov/cancertopics/coping/radiation-therapy-and-you/page8 |title=Radiation Therapy Side Effects and Ways to Manage them|publisher=National Cancer Institute |date=2007-04-20 |access-date=2012-05-02}}</ref> Depending on the area being treated, this may include the skin, oral mucosa, pharyngeal, bowel mucosa, and ureter. The rates of onset of damage and recovery from it depend upon the turnover rate of epithelial cells. Typically the skin starts to become pink and sore several weeks into treatment. The reaction may become more severe during the treatment and for up to about one week following the end of radiation therapy, and the skin may break down. Although this [[moist desquamation]] is uncomfortable, recovery is usually quick. Skin reactions tend to be worse in areas where there are natural folds in the skin, such as underneath the female breast, behind the ear, and in the groin.
; Mouth, throat and stomach sores
:If the head and neck area is treated, temporary soreness and ulceration commonly occur in the mouth and throat.<ref name="radiobiology_for_the_radiologist_5">{{Cite book | vauthors = Hall EJ | title = Radiobiology for the radiologist | year = 2000 | publisher = Lippincott Williams Wilkins | location = Philadelphia | isbn = 9780781726498 | page =351 }}</ref> If severe, this can affect swallowing, and the patient may need painkillers and nutritional support/food supplements. The esophagus can also become sore if it is treated directly, or if, as commonly occurs, it receives a dose of collateral radiation during treatment of lung cancer.  When treating liver malignancies and metastases, it is possible for collateral radiation to cause gastric, stomach, or duodenal ulcers<ref>{{cite journal | vauthors = Carretero C, Munoz-Navas M, Betes M, Angos R, Subtil JC, Fernandez-Urien I, De la Riva S, Sola J, Bilbao JI, de Luis E, Sangro B | display-authors = 6 | title = Gastroduodenal injury after radioembolization of hepatic tumors | journal = The American Journal of Gastroenterology | volume = 102 | issue = 6 | pages = 1216–1220 | date = June 2007 | pmid = 17355414 | doi = 10.1111/j.1572-0241.2007.01172.x | s2cid = 121385 | hdl = 10171/27487 | hdl-access = free }}</ref><ref>{{cite journal | vauthors = Yip D, Allen R, Ashton C, Jain S | title = Radiation-induced ulceration of the stomach secondary to hepatic embolization with radioactive yttrium microspheres in the treatment of metastatic colon cancer | journal = Journal of Gastroenterology and Hepatology | volume = 19 | issue = 3 | pages = 347–349 | date = March 2004 | pmid = 14748889 | doi = 10.1111/j.1440-1746.2003.03322.x | s2cid = 39434006 }}</ref>  This collateral radiation is commonly caused by non-targeted delivery (reflux) of the radioactive agents being infused.<ref>{{cite journal | vauthors = Murthy R, Brown DB, Salem R, Meranze SG, Coldwell DM, Krishnan S, Nunez R, Habbu A, Liu D, Ross W, Cohen AM, Censullo M | display-authors = 6 | title = Gastrointestinal complications associated with hepatic arterial Yttrium-90 microsphere therapy | journal = Journal of Vascular and Interventional Radiology | volume = 18 | issue = 4 | pages = 553–61; quiz 562 | date = April 2007 | pmid = 17446547 | doi = 10.1016/j.jvir.2007.02.002 | doi-access = free }}</ref>  Methods, techniques and devices are available to lower the occurrence of this type of adverse side effect.<ref>{{cite journal | vauthors = Arepally A, Chomas J, Kraitchman D, Hong K | title = Quantification and reduction of reflux during embolotherapy using an antireflux catheter and tantalum microspheres: ex vivo analysis | journal = Journal of Vascular and Interventional Radiology | volume = 24 | issue = 4 | pages = 575–580 | date = April 2013 | pmid = 23462064 | doi = 10.1016/j.jvir.2012.12.018 }}</ref>
; Intestinal discomfort
:The lower bowel may be treated directly with radiation (treatment of rectal or anal cancer) or be exposed by radiation therapy to other pelvic structures (prostate, bladder, female genital tract). Typical symptoms are soreness, diarrhoea, and nausea. Nutritional interventions may be able to help with diarrhoea associated with radiotherapy.<ref name=":0">{{cite journal | vauthors = Henson CC, Burden S, Davidson SE, Lal S | title = Nutritional interventions for reducing gastrointestinal toxicity in adults undergoing radical pelvic radiotherapy | journal = The Cochrane Database of Systematic Reviews | issue = 11 | pages = CD009896 | date = November 2013 | pmid = 24282062 | doi = 10.1002/14651858.cd009896.pub2 | pmc = 11748115 }}</ref> Studies in people having pelvic radiotherapy as part of anticancer treatment for a primary pelvic cancer found that changes in dietary fat, fibre and lactose during radiotherapy reduced diarrhoea at the end of treatment.<ref name=":0" />
; Swelling
:As part of the general [[inflammation]] that occurs, swelling of soft tissues may cause problems during radiation therapy. This is a concern during treatment of brain tumors and brain metastases, especially where there is pre-existing raised [[intracranial pressure]] or where the tumor is causing near-total obstruction of a [[lumen (anatomy)|lumen]] (e.g., [[vertebrate trachea|trachea]] or main [[bronchus]]). Surgical intervention may be considered prior to treatment with radiation. If surgery is deemed unnecessary or inappropriate, the patient may receive [[steroids]] during radiation therapy to reduce swelling.
; Infertility
:The [[gonads]] (ovaries and testicles) are very sensitive to radiation. They may be unable to produce [[gametes]] following '''direct''' exposure to most normal treatment doses of radiation. Treatment planning for all body sites is designed to minimize, if not completely exclude dose to the gonads if they are not the primary area of treatment.