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NCCN Guidelines for Patients



Rectal Cancer, Version 1.2017


Overview of cancer treatments

Radiation therapy

your body for a short period of time following surgery.

This type of treatment is not commonly used for

rectal cancer.

Side effects

Side effects from radiation therapy differ among

people. Factors like radiation dose and length of

treatment play a role. Side effects are cumulative.

This means they build up slowly and are worse at the

end of treatment. Your doctor will check on you every

week during treatment. He or she will review skin

care, medicines, and other options to help you feel


Acute effects

Acute effects are those that happen during treatment

or shortly after the last session. Acute effects will

generally improve after treatment. Fatigue is an

acute effect. Skin changes and hair loss at the

treatment site are expected.

Often, people describe skin changes as like a

sunburn. Unlike a sunburn, skin changes build up

slowly during treatment. Your skin may become red,

irritated, and dry. It may also itch, darken, peel, and

sometimes crack open. Skin in regions of friction or

rubbing is prone to cracking open.

Radiation can affect the wall of your gut. Thus,

another common acute effect is watery stools

(diarrhea). You may also feel nauseated.

Radiation may irritate your urine system. You may

have discomfort when peeing. You may have trouble

starting and maintaining a urine stream.

Late effects

Late effects are those that happen after treatment.

Some do not go away. Rarely, chronic diarrhea or

bloody stools occur. Strong bowel urges or loss of

bowel control also uncommonly occur. There is a

rare risk for weakening of pelvic bones. At worst, they

may fracture. Rarely, scar tissue blocks the gut.

You may have sexual problems. Men may not be

able to get normal erections. Women’s vaginal canal

may not stretch as normal causing dryness and pain

during sex. Vaginal dilators from your doctor may

prevent or reduce this late effect. Women’s sex drive

may also drop due to damage to ovaries.

You may not be able to have children naturally after

treatment. The cells in men that make sperm may

not work well. Likewise, eggs in women may be


Tell your doctor if you want to talk with a fertility

specialist before treatment. A fertility specialist is an

expert in helping people have babies. You and the

fertility specialist can discuss your options for how to

have a baby after treatment.

Not all the side effects of radiation have been listed

here. Please ask your treatment team for a complete

list of side effects. If a side effect bothers you, tell

your treatment team. There may be ways to help you

feel better.