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Risks and side effects of brachytherapy
Brachytherapy can cause short-term and long-term effects that may affect your physical and emotional wellbeing.
We know that the thought of treatment having a long-term impact can be worrying. If you want to know more about what to expect or how to manage any effects, we are here for you.
Common short-term side effects of brachytherapy
Some side effects of brachytherapy start during or just after treatment and usually begin to get better after about 2 weeks. You may already be feeling tired and generally unwell if you are having brachytherapy after chemotherapy and radiotherapy (chemoradiation), so it may help to know what else to expect.
We have listed the most common short-term side effects of brachytherapy below.
Sore skin in the treatment area
Your skin may be sore on the inside and outside of your genitals (vulva) and the area around your bottom (back passage). It can help to use a moisturiser on the outside everyday.
While you are having radiotherapy, do not:
- shave
- wax
- use hair removal cream.
If you want to use these products, wait until radiotherapy has finished and your skin is no longer red or sore.
Be extra careful to protect the skin in the area where you’ve had radiotherapy for at least the first year afterwards. Don’t use sunbeds and use high factor sunscreen if part or all of the area will be exposed – for example, if you are wearing a bikini.
This sore skin may also cause pain (stinging) when you wee. Let your healthcare team know about your symptoms as soon as possible, so they can help.
Feeling very tired (fatigue)
Brachytherapy can make you feel very tired and physically weak. This is called fatigue. It is not like usual tiredness – you may feel exhausted after doing nothing. This is simply your body responding to the treatment, as it tries to repair any healthy cells the brachytherapy has damaged.
Fatigue may only last for a few days or weeks after treatment, but it can last for months. Speak with your healthcare team if you feel fatigued, as they may be able suggest things to help. Tips from our community include:
- getting moving – gentle exercise like a walk or yoga can help
- getting some fresh air – even if it’s sitting by an open window.
Bowel changes
Brachytherapy can make you have runny poo (diarrhoea) or feel like you need to go to toilet urgently. This might start about a week into treatment. You might also have stomach cramps and wind (gas).
Let your healthcare team know if you have these changes or other bowel problems. They might be able to suggest things that may help.
Bladder changes
Brachytherapy can make you feel like you need to wee more often or urgently. You may also have a stinging or burning pain when you wee. This is because the applicators and radiation can cause bruising and damage where you had the treatment.
You may also see some blood in your wee for a few days after treatment has finished. Tell your healthcare team straight away if you:
- notice heavy bleeding
- have blood clots in your urine
- have a fever.
Let your healthcare team know if you have these changes or other bladder problems. They may be able to prescribe antibiotics if you have a urinary tract infection (UTI) or suggest other ways to help.
Pain
After brachytherapy, you may have pain between your hipbones (pelvis) or in your lower back. This may be because the radiotherapy has caused bowel changes, which may lead to cramping in the stomach, or because it has damaged the bones.
It’s important to tell your healthcare team about any pain you have. They can assess the problem and help diagnose any underlying reason for the pain.
Changes to your vagina
During your treatment your vagina may become tighter, shorter and drier. This is called vaginal stenosis. It can make sex and internal examinations of your vagina painful.
Your healthcare team should offer you vaginal dilators to help prevent vaginal stenosis. A dilator is a smooth tube made of plastic, rubber or silicone. Dilators come in different sizes that are placed inside the vagina to help keep it open. Your healthcare team should tell you more about how to use them. You may be advised to start using dilators between 2 to 8 weeks after radiotherapy, but you should wait until your vagina is no longer sore.
There is not enough research evidence to say for sure whether vaginal dilators can improve sex after brachytherapy, but some women find them helpful and they are recommended by experts. .
Lubrication can help with vaginal dryness. These are usually liquids, gels or creams that you can buy from pharmacies, online or get free as a prescription. Talk to your healthcare team if you think a lubricant would be helpful.
You may also experience bleeding from your vagina after brachytherapy. The treatment can weaken the vaginal walls, which brings the blood vessels closer to the surface. If this area is irritated, it can bleed. The bleeding should only be light.
Read more about vaginal changes after radiotherapy >
Less common side effects of brachytherapy
There are some other side effects that may happen after treatment, but they aren’t as common.
Brachytherapy can weaken the tissue and internal walls between organs close to where the treatment it given. This can create an opening between organs or spaces inside the body – for example, between the bladder and vagina. This opening is called a fistula.
There is not much research about fistulas caused by brachytherapy, but we know they can happen. Any symptoms will depend on where the fistula is, but could include:
- leaking wee through the vagina
- vaginal discharge that smells badly
- passing wind (gas) through the vagina.
It’s important to tell your healthcare team about any symptoms, as they can check for a fistula and offer you treatment.
Read more about fistulas on the Macmillan Cancer Support website >
There is limited research to suggest that having brachytherapy increases the risk of developing another cancer. This is sometimes called second cancer.
We know that this will be worrying, so it is best to speak with your healthcare team to understand more about this risk and find out any symptoms to look out for. Remember that you will be in the care of your healthcare team for follow up, so they will make sure you are well and can check out any problems.
Long-term effects of brachytherapy
Brachytherapy can have a long-term impact on your body and day-to-day life. It can cause effects that start or last for months or years after treatment. In some cases, these effects can last for the rest of your life.
You may hear these effects called pelvic radiation disease or PRD. They can include:
- early menopause
- bladder and bowel problems
- changes to your vagina
- changes to your sex life
- swelling in your groin or legs (lymphoedema)
- bone problems
- pain
- nerve damage.
We have detailed information about different symptoms of PRD that may be helpful.
Who to tell about side effects
It is important to tell your healthcare team know about your symptoms and how you are feeling. This could be your team at the hospital or your GP. They will be able to assess you and possible refer you for specialist support.
If you are struggling with side effects between appointments, it is important to call the hospital or 111 and let them know.
More information and support
Brachytherapy and its effects can have a huge impact on your physical and emotional wellbeing. You may be dealing with the effects of other treatments, such as chemoradiation, as well as continuing to process a cervical cancer diagnosis and all that can bring.
Your healthcare team, both at the hospital and at your GP surgery, are there to support you with any questions or worries you have. Remember that we are here for you too, whether you are waiting for radiotherapy, in the middle of treatment, or years past it. Our trained volunteers can listen and help you understand what’s going on via our free Helpline on 0808 802 8000.
Check our Helpline opening hours >
Sometimes connecting with others who have gone through a similar experience can be helpful. Our online Forum lets our community give and get support. You can read through the messages or post your own – whichever feels most comfortable.
If you have general questions about the effects of brachytherapy, our panel of medical experts may be able to help. They can’t give you answers about your individual situation or health – it’s best to speak with your GP or healthcare team for that.
Thank you to all the experts who checked the accuracy of this information, and the volunteers who shared their personal experience to help us develop it.
References
- Yen, A. et al (2018). Risk factors for fistula formation after interstitial brachytherapy for locally advanced gynecological cancers involving vagina. Journal of Contemporary Brachytherapy. 10;6. pp.510-515.
- Lee, B. et al (2016). Secondary cancer‐incidence risk estimates for external radiotherapy and high‐dose‐rate brachytherapy in cervical cancer: phantom study. Journal of Applied Medical Physics. 17;5. pp.124-132.
- Morris, L. et al (2017). Radiation-induced vaginal stenosis: current perspectives. International Journal of Women's Health. 9. pp.273-279.
- Macmillan Cancer Support (2014). Guidance on long term consequences of treatment for gynaecological cancer. Part 1: Pelvic Radiotherapy.
- British Gynaecological Cancer Society (2020). Framework for care of patients with gynaecological cancer during the COVID-19 Pandemic. Web: www.rcog.org.uk/globalassets/documents/guidelines/2020-05-05-bgcs-covid-19-framework-v3.pdf. Accessed October 2020.
- Pfaendler, KS. et al (2015). Cervical cancer survivorship: long-term quality of life and social support. Clinical Therapies. 37;1. pp.39-48.
We write our information based on literature searches and expert review. For more information about the references we used, please contact info@jostrust.org.uk.
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