Radiotherapy should not be painful while you are having treatment. However, you may find that you do experience some short term side effects that begin to appear two to three weeks after the start of treatment and can come on quite gradually. In some cases radiotherapy in the pelvic area can also go on to cause longer term side effects that may being many months or years after the treatment has ended.
Common short-term side effects of pelvic radiotherapy can be:
- Diarrhoea or nausea
- A burning sensation when passing urine (similar to cystitis)
- Passing urine more frequently than usual
- Sore skin.
These side effects can range from very mild to more troublesome depending on the strength of the dose of the radiotherapy, the length of your treatment and the size of the area being treated. Your consultant or specialist nurse can advise you further on what to expect.
It is not unusual to have slight vaginal bleeding or discharge once radiotherapy treatment has ended. It is important to report any and all side effects to your consultant or nurse as they may be able to treat some of them with medicines and help you manage others.
These initial side effects (sometimes called acute side effects) should gradually disappear over the next few weeks or months after your treatment has finished.
After a few days of finishing treatment, many women report feeling a significant improvement with the above symptoms and the majority of side effects have settled by six weeks.
Radiotherapy can make you very tired. It is important to drink plenty of fluids and get as much rest as you can, especially if you have to travel a long way for treatment each day. Do not be surprised if some days you feel fine and other days you feel exhausted. You will also find that this tiredness will increase towards the end of treatment. If you do experience tiredness it should decrease within a couple of months of finishing your treatment.
It is important that you drink plenty of fluids and eat as healthily as possible during your treatment. If your diarrhoea is not controlled with medicines, let your doctor or nurse know. Many patients find that it can help to reduce their intake of fibre as this can impact on the severity of the diarrhoea. You may feel sick during treatment. If you don’t feel like eating, you can have nutritious high calorie drinks instead of meals.
It is important during treatment to drink plenty of fluids. Some patients report symptoms similar to cystitis towards the end of treatment, such as needing to pass urine more frequently or in a rush (urgency), burning sensation when passing urine, and some urinary incontinence. Once treatment has finished, these symptoms should decrease within the first month.
Your skin may get sore in the area being treated, particularly if the groin and the area around the vulva are being treated. Perfumed soaps, creams or deodorants may irritate the skin and should not be used during the treatment. Your radiographer or nurse can advise you on skin care during this time. You may find that in the first few weeks after finishing treatment, your skin may feel worse before it improves; so continuing to use products without perfume or chemicals can help to reduce these effects. You will also be advised to stay out of the sun and to avoid sunbathing. You may find that your skin is, in general, a little more sensitive for a few months after treatment.
Pelvic radiotherapy can also sometimes lead to long-term side effects. These symptoms can include:
- Effects on the bowel or bladder
- Effects on the vagina
- Lymphoedema (swelling of the leg/groin).
The name given to this complicated set of symptoms, which may only begin many months or years after treatment has ended and can last for a long time, is late effects or sometimes pelvic radiation disease (PRD). It is very difficult to understand exactly how many women may go on to have long term side effects from radiotherapy. Each patient will be affected differently according to how much treatment they have received, the location of their cancer and how well their body has tolerated the treatment. This means the symptoms can vary a lot from woman to woman, with some women reporting only very mild changes that do not impact on their quality of life, and other women experiencing changes that greatly affect their lives. Also, many women do not report these symptoms to their health care team and often the symptoms are not recognised or diagnosed as being related to the radiotherapy treatment women have had.
Despite this, it is generally accepted that you are likely to notice some changes in your bowel, bladder and vagina in the months and years after treatment, but these will vary from person to person. If you are experiencing any persistent changes, please discuss them with either your GP or at follow-up appointments with your gynae-oncologist. One thing that may help decrease the chances of developing side effects is to stop smoking during and after the treatment. So if you do smoke, you should try cutting down or stopping.
Effects on the bowel or bladder
After radiotherapy, the bowel or bladder may be permanently affected. These changes vary a lot between women and can range from very minor symptoms that are easily manageable to more severe side effects that interfere with quality of life. In a recent study we found that around half (46%) of the 325 women we talked to had experienced some form of bowel or bladder changes after their treatment.
The symptoms of PRD related to the bowel and bladder are thought to be caused by the bodies’ own immune system continuing the healing process after the radiotherapy treatment has ended. This causes continued inflammation that may damage the blood vessels. The damage to the blood vessels can cause scarring and thickening of the affected tissues and organs, which effects their flexibly, stops them working properly and causes the symptoms.
The most common symptoms include:
- Increase in the frequency or urgency of bowel and bladder movements
- Diarrhoea or constipation
- Cystitis-like symptoms when passing urine
- Blood in the stool or urine
- Sometimes difficulty controlling your bowels or bladder leading to accidents (incontinence).
If you notice any of these symptoms it is very important to let your health care professional know. It can feel embarrassing to discuss these kinds of problems, but please remember that your health care team will have heard these things many times before and they will not be shocked or uncomfortable, and they will be able to help you with managing the problem. They may refer you to bowel and bladder specialists so that they can carry out tests to find the specific cause of the symptoms. It may be worth keeping a diary to help you describe the symptoms you are having and how often you are experiencing them.
For more information on the late effects of radiotherapy on the bowel and bladder, including advice on how to get diagnosed, treatment options, management strategies and tips from other women who have been affected, please visit our information pages on PRD.
You may also want to visit the Pelvic Radiation Disease Association (PRDA) website. PRDA is a charity formed of volunteer patients, carers and health professionals who want to help people who are suffering from problems after pelvic radiotherapy – most common in rectal, gynaecological, bladder and prostate cancer patients. They also have support groups where you can meet other people affected by these changes.
Radiation treatment, whether by external beam radiation or by internal radiotherapy (brachytherapy), will cause changes to the vagina. The walls of the vagina may become more fragile with the blood vessels becoming closer to the surface, which together can cause bleeding. Some women may also experience drying of the vaginal lining as well as a reduction in the amount of vaginal lubrication, fibrosis (the formation of scar tissue), or shortening and narrowing of the vagina. It is also likely to reduce the size and number of small blood vessels within the vagina. This can lead to the tissue in the vagina losing some of its elasticity. In the first few months after treatment finishes you may also find that you experience a change in vaginal discharge (which might also smell unpleasant). It is important to let your doctor know as it is possible that you could have an infection that will need a course of antibiotics.
After treatment, you might find that sexual intercourse is more difficult or painful. Your specialist nurse will discuss with you the use of dilators and hormone creams to help keep the vagina supple. It is important to follow the nurse’s instructions on using the dilators as not only will this help allow you to continue a normal sex life with your partner (or future partner), but it also ensures that you are able to be properly examined at your follow-up appointments post treatment. Some women find it easier both physically and psychologically to use a vibrator instead of the dilators as this can make the process less ‘medical’.
You can download the best practice guidelines on the use of vaginal dilators in women receiving pelvic radiotherapy.
Many women find this one of the most challenging aspects of coping with changes to life after cervical cancer, so please do ask for support from your health care team.
You may also want to use our online Forum to find shared support from others who understand what you are going through.
Unfortunately, radiotherapy for cervical cancer can affect the ovaries and bring on the menopause, usually about three months after the treatment starts. This means that your periods will stop and you will have menopausal side effects, such as hot flushes, dry skin and possibly a loss of concentration. Some women become less interested in sex and notice that their vagina is dry. Sometimes radiotherapy causes a narrowing of the vagina, which can make sexual intercourse uncomfortable.
Menopausal side effects can be reduced by taking hormone replacement therapy (HRT) as tablets or skin patches. These can be prescribed by your gynaecologist or GP during the radiotherapy treatment or shortly after it has ended. For those wishing to opt for a more natural approach, a qualified homeopath/naturopath can advise.
Sometimes it is possible, through keyhole surgery, to move the ovaries outside the pelvis and try to reduce the risk of radiotherapy-induced menopause, but this is no guarantee that the menopause will be avoided. Your gynae-oncologist can advise you about this treatment.
Find out more about the menopause and HRT on our information pages.
Some women find that radiotherapy treatment affects the lymph glands in their pelvic area and can cause swelling in the legs and/or groin. This is called secondary lymphoedema and is more likely if you have had surgery as well as radiotherapy. It is not always possible to predict who will get lymphoedema. However, women who have had lymph nodes removed prior to their radiotherapy treatment may have a higher risk of lymphoedema and may benefit from seeing a lymphoedema specialist to discuss preventive measures.
It is essential that lymphoedema is correctly diagnosed and appropriately assessed. Whilst there is no cure for lymphoedema, in many cases it can be managed by one of the following:
- Skin care – to keep the skin and tissues in good condition and to prevent/reduce the risk of infection
- External support/compression – in the form of elastic compression garments to help prevent the swelling from building up in the limb
- A programme of exercise and movement – to try and maximise lymph drainage without over exertion (this would cause the swelling to worsen)
- Simple lymphatic drainage – a gentle massage technique that is based on the principles of manual lymphatic drainage. It involves the use of simple hand movements to try and move the swelling out of the affected area. It is designed to be carried out by patients themselves, or by their relatives or carers.
If you experience any swelling and/or pain in the groin or legs make sure you discuss it with your health care team.
For more information on life after cancer please visit our moving forward information pages.