Pelvic radiation disease

Pelvic radiation disease (PRD) is a complicated group of symptoms that can affect women who have had radiotherapy to treat their cervical cancer [1]. These symptoms range from mild to severe. PRD is also called ‘late effects’ or long term side effects.

PRD affects the tissues and organs within the area of the pelvis (see image below) that is exposed to radiation during treatment for cervical cancer [2][3]. The organs and tissues in the pelvis include the bowel, rectum, bladder and vagina. It can also affect the bones and lymph nodes. The physical symptoms caused by PRD may impact on a woman’s quality of life.

It is difficult to give accurate statistics on the number of women who are affected by PRD after treatment for cervical cancer for several reasons:

  • PRD is made up of lots of different symptoms, each of which may be diagnosed differently and this means that in the past PRD has been very under diagnosed
  • Many women do not report the symptoms to their medical team [4][5]
  • Most of the research done into PRD looks at pelvic radiation treatment for all types of cancer, not just at women affected by cervical cancer. 

From research conducted by Jo’s Cervical Cancer Trust, we found that around half (46%) of the 325 women who took our survey said that they had suffered from bowel or bladder changes that affected their quality of life, half had changes to their sex life (56%), four out of 10 had bone problems (41%), one out of five were affected by lymphoedema (26%) and four out of 10 suffered from pain (41%) [6].

*The uterus may not be present if you have undergone a hysterectomy

How is PRD caused?

Radiotherapy treats cancer using high-energy rays which destroy the cancer cells, while doing as little harm as possible to normal cells. Radiotherapy for cervical cancer can be given externally or internally (Brachytherapy), and often as a combination of the two. Sometimes the healthy cells near to the cancer become damaged during radiotherapy. The body then attempts to repair the damage, which causes inflammation. This is likely to be the cause of the initial symptoms that most women experience during radiotherapy [7][8]. These initial symptoms are called short term effects and usually clear up after treatment has finished.

The long term effects of PRD to the bowel, bladder and vagina are thought to be caused by the body’s own healing process continuing after the radiotherapy has ended. This continued inflammation can cause damage to the blood vessels, which affects their ability to supply blood properly. This can cause thickening or scarring (called fibrosis) to the organs and tissues making them less flexible [9]. This means they do not work as well as they are supposed to, which causes the symptoms of PRD related to the bowel, bladder and vagina [2][3].

Radiotherapy can also cause: 

  • Hormonal changes – which may cause early menopause
  • Damage to the bones within the pelvis – which can cause tiny cracks (called hair-line fractures) in these bones 
  • Damage to the lymph (fluid) channels within the pelvis – which can lead to a build-up of lymph fluid, causing swelling in the legs known as lymphoedema. This is rarer.

This section will cover:


References

  1. Andreyev JN et al, 2011. ‘Pelvic radiation disease’: new understanding and new solutions for a new disease in the era of cancer survivorship. Scandinavian Journal of Gastroenterology 46, 389–397.
  2. Macmillan, 2015. Managing the late effects of pelvic radiotherapy in women. http://be.macmillan.org.uk/Downloads/CancerInformation/CancerTypes/MAC13826pelviclateeffectswomenE2cover20150119TRlowres.pdf. Accessed: 04.04.2016. 
  3. Pelvic Radiation Disease Association. What is Pelvic Radiation Disease? www.prda.org.uk/what-pelvic-radiation-disease. Accessed: 04.04.2016.
  4. Andreyev JN, 2005. Gastrointestinal complications of pelvic radiotherapy: are they of any importance? Gut 54 (8), 1051–1054.
  5. DeWitt t et al, 2014. Nutrition in pelvic radiation disease and inflammatory bowel disease: similarities and differences. BioMed Research International 2014, 716579.
  6. Jo’s Cervical Cancer Trust, 2015. Long term effects and consequences of cervical cancer and its treatment survey 2015. 
  7. Macmillan, 2014. Guidance on long term consequences of treatment for gynaecological cancer. Part 1: pelvic radiotherapy. www.macmillan.org.uk/Documents/AboutUs/Health_professionals/MAC14942_GYNAE_GUIDE.pdf. Accessed: 04.04.2016.
  8. Macmillan, 2013. Pelvic radiotherapy in women – managing side effects during treatment. http://be.macmillan.org.uk/Downloads/CancerInformation/LivingWithAndAfterCancer/MAC13944pelviceffectswomenE2lowrespdf20151222.pdf. Accessed: 04.04.2016.
  9. Stacey R et al, 2014. Radiation-induced small bowel disease: latest developments and clinical guidance. Therapeutic Advances in Chronic Disease 5 (1), 15–29.
Date last updated: 
04 Apr 2016
Date due for review: 
04 Apr 2019

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