Side effects of womb cancer radiotherapy
Radiotherapy for womb cancer can cause side effects. The side effects vary from person to person. You may not have all of the effects mentioned.
Side effects tend to start a week after the radiotherapy begins. They gradually get worse during the treatment and for a couple of weeks after the treatment ends. But they usually begin to improve after around 2 weeks or so.
Voice over: Radiotherapy can cause many different side effects, such as tiredness. The side effects you get will depend on the area you're having treatment to.
This video is about the side effects you might have if you are a woman having radiotherapy to the pelvis or abdomen.
Louise: The abdomen, the tummy, can be affected by radiotherapy, but it depends on which particular part of that we are treating as to what side effects you may experience. If we are treating the upper part of your abdomen and we are irritating your stomach, sometimes you can experience a little bit of nausea, potentially a little bit of vomiting.
This would normally start quite early on if it is going to be a problem and the doctor would prescribe you some medication to help with that.
Carla: I felt sick constantly. I was having Complan drinks and smoothies and milkshakes with fruit and things in. Jelly sweets, anything that had got sugar in that I could suck on or chew on.
And ice cream. I know it was like October/November when I had my treatment, but I was having ice cream every day.
Louise: If your bowels are being irritated by the radiotherapy, you may find you end up a little bit more gassy. Flatulence might be a bit of an issue and sometimes you can find you can end up with some diarrhoea.
Carla: I started to get really, really bad diarrhoea. And they were giving me Imodium-type tablets to combat that.
With the wind, the wind's horrible. It's not nice at all, as a lady, to have wind. There’s tablets available that I can take for that.
Louise: If you do find that you are having some issues with your bowels, always consult with the team before you take any action. It might be they recommend you make some small dietary changes to help with this, cutting out foods which are very high in fibre or very spicy foods.
If you're having issues with diarrhoea, they may also recommend some particular medication to help with that.
Some radiation treatments to the pelvis may also cause some irritation to your bladder, so you might find you need to pass urine more regularly. It may also be more urgent with you passing smaller volumes. Sometimes you may find that there's a little pain or discomfort when you're urinating, or you can't fully empty your bladder like you would do normally.
Carla: If I need to go, I need to go, and if I can't go, I've got to have pant-liners in.
Louise: We would highly recommend during your radiotherapy that you stay well hydrated. We would recommend you drink up to 2 litres of water or squash a day to ensure that this happens.
Drinks to avoid would include anything containing caffeine, so any kind of tea or coffee or decaffeinated drinks, fizzy drinks and alcohol as they all naturally aggravate your bladder.
Radiotherapy can unfortunately have an impact on a woman's sex life. This is because you can end up with some vaginal drying and also you can find that the tissues in the vagina can become a little bit tight as a result of the treatment. The radiotherapy team will support you during treatment to help with any of these particular symptoms.
Carla: You're given dilators when you first finish your treatment and you have to use it for 10 minutes every day just to keep the scar tissue from sticking together and causing an obstruction.
Louise: These are little tubes that are inserted into the vagina that just gently help stretch the tissue to prevent any scar tissue from building and any shrinkage of the muscles. We can also give you some lubrication to help with any sexual activity as well. This can help you moving forward with both your sex life, but also with future internal examinations.
Infertility is a possible side effect of radiotherapy. If you are concerned about infertility after treatment, before you do start any radiotherapy, it's best to talk to the team and they can talk you through potential fertility treatments, such as storing your eggs prior to starting treatment.
It's always best to be open with partners when you're going through any kind of treatment, especially as this may have an impact on them too. It means that you can work through the problems together.
Voice over: If you’re experiencing a side effect that hasn't been covered in this video, you can find more information on the Cancer Research UK website.
Side effects can include:
Radiotherapy can inflame the lining of your bowel. This can cause diarrhoea. You may also have:
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griping or cramping pain
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an increase in wind
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feeling you need to go to the toilet urgently
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some mucus or blood in your poo (stool)
It’s important to drink plenty if you have diarrhoea, so you don't become dehydrated. Your doctor might prescribe tablets to help slow down your bowel if you need them. This should help to reduce the number of times you have diarrhoea. Changing your diet might also help lessen the number of times you need to go, such as reducing the amount of fibre if you have been following a diet very high in fibre. Ask your nurse or doctor about this.
Ask your nurse or radiographer for soothing creams to apply around your back passage (anus). The skin in that area can get very sore and might break if you have severe diarrhoea.
Diarrhoea should gradually get better a few weeks after your treatment has finished. Let your doctor or nurse know if it continues.
Some people might have urine leakage or difficulty controlling their bladder. Learning pelvic floor exercises, re-training your bladder or following lifestyle changes can help. Speak to your doctor or specialist nurse. They can refer you to a physiotherapist.
Radiotherapy can inflame the lining of your bladder. This might get worse as you go through your course of treatment. But it should get better within a few weeks or months of finishing.
Symptoms of bladder inflammation include:
- a burning feeling or pain when you pass urine
- feeling that you need to pass urine more often than usual
- feeling that you haven't finished passing urine when you have
- feeling as though you need to pass urine again as soon as you've been
You might also get an infection in your urine, which can make your urine look cloudy or smell strongly.
It helps to drink plenty of fluids. Some people think that cranberry juice can help. Cranberry juice can interact with some medicines, so talk to your doctor or pharmacist before taking it.
You might find that some drinks increase your symptoms, such as tea and coffee. You can experiment for yourself and see what works for you. Don’t take potassium citrate, which is an old fashioned remedy for cystitis. This drug can be very harmful if taken in large amounts.
Tell your doctor or nurse if you have any bladder problems. They can prescribe medicines to help.
During your treatment the skin in the treatment area might become quite sore and red. This might include your vulva and the area around your back passage.
Use a moisturiser on the skin in the treatment area every day. This will help to keep the skin hydrated and more comfortable. Your radiographers will tell you which cream you should use. Don't use any other type of cream or lotion.
The skin reaction can look and feel like a burn, but it is inflammation due to the radiation. It usually starts about 5 to 7 days into treatment and continues for about 10 days after your last treatment. It then starts to improve.
Ask your radiographers for advice on how to manage the sore skin. There are things you can do to make yourself more comfortable.
After internal radiotherapy, you may have some bleeding from the vagina. This is usually when your doctor removes the applicators. Bleeding should clear up within 48 hours (2 days).
Tell your radiotherapy doctor or nurse if the bleeding becomes heavy or goes on for longer than this.
Your vagina may become irritated and sore during radiotherapy. You may also notice an increase in vaginal discharge.
Tell your nurse or radiographer if the discharge becomes heavy or is smelly. You may need antibiotics. They can give you painkillers if your vagina is very sore.
You might feel sick at times. You can have anti sickness medicines. Let your treatment team know if you still feel sick, as they can give you another type.
You might feel tired during your treatment. It tends to get worse as the treatment goes on. You might also feel weak and lack energy. Rest when you need to.
Tiredness can carry on for some weeks after the treatment has ended. But it usually improves gradually.
Various things can help you to reduce tiredness and cope with it, such as exercise. Some research has shown that taking gentle exercise can give you more energy. It's important to balance exercise with resting.
Radiotherapy can cause many different side effects, such as tiredness. The side effects you get will depend on the area you're having treatment to, but there are some general side effects you might experience regardless of where your cancer is. This video is about the general side effects you might have.
On screen text: Tiredness and weakness
Martin (Radiographer): As the normal cells repair themselves from the treatment this can use a lot of the body's resources, causing tiredness.
David: After about four weeks, I started to get tired. The body was starting to weaken.
Laurel: I was tired, day and night. Getting up in the morning was like a chore. I couldn't talk for 5 minutes. I would just sleep and just sleep and just wake up and sleep again.
Martin (Radiographer): Listen to your body. Take rests if you need to. Try not to overdo things.
Laurel: Don't fight with yourself too much. Just like go at a pace and just work with your body. If you can't make it today, you can't make it today.
David: You've got to rest. You have to take the time to rest.
Mary: Just going for them small walks. They really do help you. And even if it is just walking around your house or just walking around the block.
Martin (Radiographer): Doing exercise can help with tiredness by helping you maintain energy levels.
Mary: Being outside, that's a big, massive thing as well because you're feeling the fatigue and I think getting outside, just getting a bit of fresh air that really, really did help me.
Martin (Radiographer): The tiredness you can expect to begin within the first few weeks of treatment. Once it reaches its peak, about two weeks after treatment it recovers quite quickly after that.
Mary: It's not forever. You're not going to be like this forever and I did have to tell myself that.
Laurel: Two months after treatment, I start to feel less tired and that was a way forward because things start to really improve.
On screen text:
- Rest and have short naps when you need to
- Drink plenty of water
- Eat a balanced diet
- Do some gentle exercise
- Get some fresh air
On screen text: Sore skin
Martin (Radiographer): The radiotherapy can cause soreness of the skin. This only affects the area that you are having treated. This usually starts to appear about two weeks after you start treatment. You may notice this becoming more red and may become more itchy and sore as treatment continues.
David: After about ten days I started to get red on the area that they were targeting and it just progressively got redder and redder.
Laurel: My skin was dry and at the back was just like this triangle shape thing where it was like, okay, I'm a woman of colour, but it was really, really black.
David: Wasn't too painful, it was sort of annoying, rather than painful.
Martin (Radiographer): After treatment’s finished, the skin will remain sore for up to two weeks, but then recovers quite quickly.
Laurel: I haven’t got no scarring now at all.
David: It was maybe three or four weeks and then all the blemishes disappeared front and back.
Martin (Radiographer): When you start treatment we would advise you to carry on with your normal skincare routine but as the side effects develop, then your team will advise you on which products you can use on the skin safely.
Laurel: When I'm washing myself I use a sponge and you're just literally as it were just squirt it down, you don't rub the skin at all because it's already damaged. Pat dry, don't rub.
David: I spoke to the hospital about it and it was them that recommended this cream to put on, just to alleviate the symptoms.
Martin (Radiographer): We'd recommend wearing loose clothing and keeping the treatment area covered up against the sun and wind.
Laurel: I had to change most of my wardrobe. I only wore cotton.
David: Wearing T-shirts, soft clothing, nothing that would rub.
Mary: It's important when you go outside to make sure that you do wear that headscarf, or you do wear a hat or whatever it is.
Laurel: I wouldn't go in the sun at all, at all because my skin was - I know it was too delicate.
On screen text:
- Don’t rub the area, press if it is itchy and dab your skin dry
- Don’t use perfume, perfumed soaps or lotions on the area
- Don’t shave the area
- Only use creams or dressings advised by your specialist or radiographer
- Wear loose fitting clothing
- Avoid strong sun or cold winds
- Make sure you wear sunscreen
On screen text: Hair loss
Martin (Radiographer): Radiotherapy can cause hair loss in the area that's being treated, whereas chemotherapy can cause hair loss all over the body.
Mary: 2 to 3 weeks after the radiotherapy, I was brushing my hair and loads came out on the brush. I knew it was going to happen, but it was just hard when it happened.
Martin (Radiographer): In most cases the hair will grow back. This can take a couple of months and the hair may have a slightly different colour or texture.
Mary: Mine did grow back and there's a lot of grey in it so I have to dye it. This is not my original colour. It's very slow growing back.
Martin (Radiographer): Use a simple soap to clean the area. Be gentle with the skin in that area and after washing pat the area dry with a soft towel.
On screen text:
- Radiotherapy can make hair fall out in the treatment area
- It won’t cause hair to fall out in other parts of your body
- Your hair might grow back a few weeks after treatment ends
- If your hair won’t grow back, then your doctor should tell you
- Don’t use perfume, perfumed soaps, or lotions on the area
On screen text: Your mental health
Laurel: I felt frustrated. Some days were really, really challenging where there were just tears without words.
Mary: It's a mixture of emotions. You feel angry and you feel frustrated. You lose your confidence.
Martin (Radiographer): Radiotherapy can cause a lot of emotions at various times during the treatment. You may feel sad or anxious or depressed, which is quite normal. It's good to talk to people about your experiences, whether that's your team at the hospital or friends and family.
David: I couldn't praise the team highly enough. Everybody that was involved were unbelievable and if it hadn't been for them, I just don't think I would have gotten through with it.
Mary: I did have a nurse as well and she had the experience of dealing with people that went through brain surgery, went through radiotherapy so it was just great that I could reach out.
Martin (Radiographer): Your team will be able to give you information about local patient support services that are available, that includes things like counselling and complementary therapies.
Laurel: A referral from the hospital counselling, which I attended for about a year.
Martin (Radiographer): There's also lots of support available online and in your local area.
Mary: I went on loads of different forums and I spoke to loads of different people and it really, really helped me. If I didn't do that, I don't think I would have got through most days.
Laurel: If you get a bit cranky or feel a bit low, go for it. But there's so much help out there and that's why I'm pushing forward like don't sit down in silence. It's the same thing, just get the help you need.
On screen text:
- There is help available – ask the hospital for support
- Talk to your friends and family about how you are feeling
- Ask about local support groups
- Your GP or hospital can provide counselling
- You can get help and support online through forums
If you're experiencing a side effect that hasn't been covered in this video, you can find more information on the Cancer Research UK website.
On screen text: For more information go to: cruk.org/radiotherapy/side-effects
Long term side effects
Most side effects gradually go away in the weeks or months after treatment. But some side effects can continue or might start some months or years later.
Your doctors will try their best to make sure you have as few side effects as possible. But some people are more sensitive than others to radiation.
Talk to your doctor if you think you have developed any of these effects. It may be that your symptoms are due to something else, such as a bowel or bladder infection. If you do have a side effect, your doctor or nurse can help to manage your symptoms.
Generally, radiotherapy can make body tissues tighter and less elastic. Doctors call this fibrosis. It can have some lasting effects, depending on the part of the body being treated. For example, it can cause skin thickening in the treatment area.
Your skin might always be slightly darker in the area of treatment.
After your treatment, your vagina can become narrower and shorter. You might also have vaginal dryness. This can affect your sex life.
Your doctor will need to do a physical examination of your vagina during your follow up appointments. Using dilators can help to ensure you can still have sex and vaginal examinations comfortably. Dilators can help to prevent or minimise narrowing and stiffening of the vaginal tissues. So, it is important to start using them after your radiotherapy treatment. Your radiotherapy team will tell you how and when to start using dilators and suggest suitable lubricants.
Dilators
Dilators are tube shaped objects, made of plastic or metal. They come in different sizes. You gently put the dilator into your vagina for 5 to 10 minutes about 3 times a week. This stretches the vagina and helps to stop it from narrowing. It is important to be gentle and not force this.
You could switch to a smaller size if you find it difficult to get the dilator in. You might find it easier with a water soluble lubricant such as Astroglide, Durex lube or KY jelly. Some people may find an oil based lubricant such as Yes OB better. Unfortunately, these are not available on prescription. You can buy them directly from the company or shops.
You can use the dilator in the bath if you prefer. You can also use a moisturiser such as Replens 2 or 3 times a week.
If you find the dilator you have been using is getting a tighter fit, you may need to use it more often. You can talk to your doctor or nurse about this. You may have slight bleeding or spotting after using your dilator. This is normal.
However, it isn't normal to have heavy bleeding or pain. Contact your doctor or nurse If you have either of these.
You usually start using your dilator around 4 weeks after your radiotherapy ends. This varies depending on your radiotherapy centre. Your doctor might advise you to use the dilators for 2 years or more, even if you are sexually active.
Some people may experience changes to the bladder, causing:
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the bladder wall to become less stretchy, so you have to pass urine more often
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fragile blood vessels to form in the wall of your bladder, causing blood in the urine
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difficulty passing urine because the tube from the bladder to outside your body narrows
Speak to your doctor if you are worried about any symptoms.
'Just can’t wait' card
You can get a card to show to staff in shops, pubs, etc. It allows you to use their toilets without them asking awkward questions. You can get the card from the Bladder and Bowel Community. Toilet Map UK has a map of all the public toilets in the UK.
Disability Rights UK can give you a key for disabled-access toilets, so you won't have to ask for one when you're out.
Rarely, you may have more frequent or looser poo (stools) in the long term. This can be all the time. Or it may come and go.
Your doctor can give you medicines to slow down the bowel and help control the diarrhoea. You might need to avoid high fibre foods.
Let your doctor know if you have ongoing problems with frequent bowel movements or bleeding. They can refer you to a specialist team. The team includes cancer doctors, digestive system specialists, bowel surgeons, dietitians and specialist nurses.
The team can carry out tests to see what is causing the problem. Then they can give you treatment to control it.
'Just can’t wait' card
You can get a card to show to staff in shops, pubs, etc. It allows you to use their toilets without them asking awkward questions. You can get the card from the Bladder and Bowel Community. Toilet Map UK has a map of all the public toilets in the UK.
Disability Rights UK can give you a key for disabled-access toilets, so you won't have to ask for one when you're out.
Radiotherapy to the pelvic area can include the lymph nodes. This may affect the flow of lymphatic fluid around your body. The fluid may build up and cause swelling in one or both legs, or rarely the genital area. The swelling is called lymphoedema. The risk of developing lymphoedema is greater if you've also had surgery to remove lymph nodes in the area.
You are at risk of developing lymphoedema any time after treatment, even years afterwards. Your nurse will give you information about how to reduce your risk of this happening.
Tell your doctor or nurse if you notice any swelling.
Occasionally, radiotherapy to the pelvis can cause bleeding. This will show up in your bowel movements or urine, or from your vagina. It is usually caused by an increased growth of small blood vessels in that area after the treatment.
If you notice this, tell your doctor. Your doctor may call this problem telangiectasia (pronounced teel-an-gee-ek-tay-zee-a).
Some people with piles may find that their piles come back after radiotherapy.
Radiotherapy to the pelvis can damage the bones in the pelvic area. The bones can become weaker. This can cause pain and also increases the risk of breaks (fractures) of the pelvis or hip.
Tell your doctor if you have any hip or pelvic pain.
There is a small risk of developing a second cancer in the treatment area years after radiotherapy. But the benefits of treatment far outweigh this risk. You doctor will talk to you about this.
