This information is for patients who are going to receive radiotherapy for cancer of the cervix or cancer of the uterus (womb).
You might find it helpful to read our booklet called ‘Radiotherapy’ which describes what to expect when you come to the hospital.
Radiotherapy for cancer of the cervix and cancer of the uterus (womb) is similar and is usually done in two ‘phases’. The first phase is external beam radiotherapy (EBRT) which is radiation delivered from outside the body, given to the whole pelvis to include the pelvic lymph node areas, followed by radiation given internally, known as brachytherapy.
When radiotherapy is used
Radiotherapy is used as a radical (curative) treatment for cervical cancer.
It is sometimes given after a hysterectomy to reduce the risk of the cancer returning (adjuvant treatment). Treatment of cancer of the cervix often includes chemotherapy; we will discuss this with you in detail if it applies to you. If you do require chemotherapy you will need to attend one of our wards weekly on one of the days you have radiotherapy. This approach is likely to cause increased side effects and so your recovery may be slower.
Radiotherapy is also used as an adjuvant treatment after a hysterectomy for treatment of cancer of the uterus.
Your oncology doctor will explain why radiotherapy is recommended for you.
External beam radiotherapy is given as a course of treatment; the usual length of treatment being 4-5 weeks.
Clinical Nurse Specialist (CNS) in gynaecological cancer
This service is available to patients with a diagnosis of gynaecological cancer and their carers to ensure they receive written and verbal information on the management of their cancer and any symptoms, advice on treatment options and psychological support.
Appointments into this service may be automatically booked as part of your care. If you do not receive an appointment to see our clinical nurse specialist, please discuss this with your therapeutic radiographers. During one of the appointments we will give you more information about brachytherapy.
Before you start your radiotherapy, you will have a CT scan of the pelvis which is used to design the radiotherapy. This process is called ‘planning’. Before the scan, we will ask drink some fluid (called ‘oral contrast’), used to help identify the bowel. During the scan, a dye will be injected into a vein (called IV contrast) which highlights the blood vessels in the pelvis.
At the end of the scan we will ask your permission to make a few permanent marks (tattoo’s) on your pelvis, which are used in the design of the treatment. The planning scan takes only a few minutes but you should expect to be in the hospital for a couple of hours. Patients should expect to start their radiotherapy approximately 2 weeks later.
See our booklet called ‘Radiotherapy’ for more information about planning (and treatment). The staff will explain what to expect etc in more detail when you attend.
Treatment procedure
The treatment procedure takes about 10 minutes with the treatment machine being ‘on’ for only a few minutes. You will lie in the same position as the scan and not feel anything as the treatment is given. The use of contrast agents is not required for treatment. The therapeutic radiographers will talk to you about what to expect when you attend.
Every patient is different and you may not have the same side effects as somebody else. Most side effects are temporary. They usually start around the second week of treatment and will continue for several weeks after your radiotherapy has finished. They then start to settle, taking a few weeks to do so. Sometimes it takes a few months for the effects to settle completely.
During your treatment, a therapeutic radiographer or nurse will be able to answer any questions and deal with most of your problems. However, your doctor will also see you regularly throughout your treatment. It is important to tell us how you are feeling so that we can give you medicines and advice on how to cope. Most people come from home to have their treatment, but admission to one of our wards is possible if you need additional support.
Your bladder
Radiotherapy can irritate your bladder so you may feel the need to pass urine more often (frequency), get an urgent sensation to do so (urgency) and you may feel a burning sensation. Tell your doctor, therapeutic radiographer or nurse if this sensation lasts for a few days. We may need to test your urine to rule out a urinary infection.
You can help yourself by drinking more fluid, at least 10 mugs of fluid each day until the symptoms settle. Water is best; avoid fizzy drinks. Avoid, each day, taking large quantities of drinks which contain caffeine; e.g. strong tea or coffee, cola-type and energy drinks. You can drink alcoholic drinks in moderation if you wish but stop if you notice any irritation. Cut down on the amount you drink in the evening if you find you need to use the toilet more during the night.
Your bowels
The treatment can irritate your bowels causing cramp-like discomfort. You may have to open your bowels more often, sometimes only passing small amounts. You may also get the urge to open your bowels, but pass only wind and mucus. A few people find their bowels become stubborn, reducing the frequency or ease of bowel movements. We may ask you to change your diet if these effects are troublesome. Tell us if you have any known bowel-related conditions and if your bowel habits are changing.
Feeling sickly (nausea)
This can happen and we will give you medication to help ease the symptoms. It is important to treat so that it does not affect your eating and drinking.
Tiredness and fatigue (low energy levels)
It is quite common to feel tired during treatment. Let us know if this affects you. It may persist for several weeks afterwards. It is important to rest when you feel you need to. Ask for, or accept, offers of help. If you live alone, only do the things that are necessary until you feel stronger.
Your skin
Your skin in the treatment area may become slightly red, dry and itchy, not unlike sunburn, though this is not common. The groin and skin between your buttocks are usually affected. The area around the back passage (anus) can become sore especially if your bowels become loose (due to cleansing). If your skin becomes uncomfortable, ask the therapeutic radiographers or nurse for advice.
Hair loss
The loss of pubic hair is a possibility, but it should start to return soon after you have finished treatment.
Eating well
Eating as well as you can, helps you to cope with, and recover from, the treatment. Our dietitians have written a leaflet ‘Eating well and coping with side effects’ which is available to you. If you need further advice from a dietician, this can be arranged.
Contraception and sexual activity
If you are sexually active and pregnancy is a possibility, it is recommended that you use effective contraception, i.e. a condom from the beginning of, and for one year after, radiotherapy. You can continue to have sex during radiotherapy. Be aware that it may be uncomfortable; using additional lubrication can help.
Early menopause
Radiotherapy to the pelvis will bring on the menopause in those who are still having periods. The symptoms of the menopause (periods stopping, hot flushes, dry skin, vaginal dryness and difficulty in concentrating) often start during, or soon after, your radiotherapy. Your oncology doctor may advise the use of hormone replacement therapy (HRT), if your symptoms are troublesome.
The majority usually develop within the 1st or 2nd year, but can start many years later.
Changes to bowel
It may take 6 months or more for the bowel to settle into a regular pattern.
There is a moderate risk of long term changes to bowel habits. This includes having an urgent sensation for a bowel movement (urgency), more frequent bowel movements, which could be loose and contain blood. (See information later about the RADAR key scheme).
In some, looseness of the bowel is related to the type of foods eaten. The ability of the bowel to digest foods can also be affected.
There can be serious damage to the bowel that may require surgery and the possibility of a colostomy. Approximately less than 1 in 20 people go on to need a colostomy after radiotherapy for cervical/uterine cancer.
Changes to the bladder
There is a small risk of long term changes to the bladder. Your bladder function may be different after treatment and possibly not return to normal. You may:
- Need to empty your bladder more frequently, especially at night.
- Be unable to hold as much urine for as long, due to the loss of elasticity (ability to stretch) of the bladder wall.
Changes to your diet, bladder training and the use of medicines can often help, but occasionally these problems can be more troublesome. Referral to specialist staff can be helpful and will be discussed at your follow-up appointments.
Sexual health
The tissues of the vagina will be affected causing it to become narrow, shorter and stretch less than before treatment. To lessen these effects we ask all patients to regularly use a vaginal dilator (smooth plastic tube). Even if you are sexually active, their use is recommended so that internal examinations cause as little discomfort as possible. You will be offered more information, advice and a set of dilators during your course of radiotherapy. Vaginal dryness can occur, but the use of a water-based lubricant during intercourse can be helpful.
These changes can lead to discomfort during intercourse. The diagnosis and treatment can affect you in many ways, including sexual intimacy. If this affects you and/or your relationships, please talk to your GP or Gynaecological CNS who can refer you to a specialist service, e.g. counselling (as a couple or alone).
Macmillan Cancer Support has a number of useful information booklets. See “Useful contact details” at the end of this leaflet.
Noticing blood
Radiotherapy can affect the tissues causing slight shows of blood in the urine, bowels motion or after sex. If you notice you are passing more than this, see your GP as it needs to be investigated further.
Risk of lymphoedema
Treatment can affect the lymph glands in the pelvis, causing permanent swelling of the legs. This is called lymphoedema and is more likely if you have had surgery to the pelvic nodes, though the addition of pelvic radiotherapy in theory increases the risk. It is rare, but can start many months or years later.
To reduce the risk, it is important to avoid infection or inflammation of the legs and pelvis, so avoid cuts / grazes, nicks from shaving, insect bites / stings, sunburn. Do regular gentle exercise; swimming or walking. The use of a moisturising lotion on your legs is recommended.
Some early signs include persistent tightness of your shoes, the ankles being swollen or heaviness of the legs. If you develop these signs or are concerned, talk to your GP, or oncology doctor / gynaecological CNS at the follow-up appointments. Referral to a specialist practitioner in lymphoedema may be appropriate. For more information about lymphoedema see Macmillan Cancer Support in useful contacts.
Changes to bones
There is a risk of developing changes in the pelvic bones which may occur in the future. This is called a pelvic insufficiency fracture, which may cause a hair-line fracture. It may cause dull pain which can be helped by rest or may require pain killers. Insufficiency fractures generally heal slowly and may be investigated by a scan, if necessary.
Side effects can continue for a few weeks after finishing radiotherapy. In the meantime, continue to use any medicines we have given you. If you have any new nursing needs at the end of your radiotherapy, we will discuss this with you and can arrange for an appropriate member of staff to contact you, e.g. district or Macmillan nurse. Contact them or your GP if you are in difficulty, especially with pain or have problems that affect your eating and drinking. You can also contact staff at the radiotherapy centre for advice.
It is important to attend follow-up appointments with your oncology doctor. The first appointment is usually about 6 weeks after finishing treatment.
It may take many months before you feel that you have recovered fully. If you are feeling low or experience mood swings, talk to your GP, oncology doctor or key worker. Some people find it useful to have the support of others who have experience of cancer by attending a local support group. You can contact the local Cancer Information and Support Centre for more details. Alternatively, if you are familiar with using the internet, the major cancer charity websites have online communities.
Macmillan booklets about coping and living with cancer and treatment side effects are available free of charge. These can be ordered by telephoning 0808 808 0000 or by visiting a Cancer Information and Support Centre (sited in the main entrances of all Clatterbridge Cancer Centres).
The Clatterbridge Cancer Centre Hotline
Clatterbridge Cancer Centre - Liverpool
65 Pembroke Place, Liverpool, L7 8YA
Tel: 0151 556 5000
www.
Clatterbridge Cancer Centre - Wirral
Clatterbridge Road, Bebington, Wirral, CH63 4JY
Tel: 0151 556 5000
www.
Clatterbridge Cancer Centre - Aintree
Lower Lane, Fazakerley, Liverpool, L9 7AL
Tel: 0151 556 5959
www.
Gynaecological Cancer Clinical Nurse Specialist
Brachytherapy Clinical Specialist Radiographer
Lymphoedema service at The Clatterbridge Cancer Centre
The Clatterbridge Cancer Centre patient information leaflets
Visit the patient information leaflets section of our website for copies of these leaflets:
- Radiotherapy booklet
- Use of vaginal dilators whist receiving radiotherapy to the pelvis
- High Dose Rate (HDR) Brachytherapy to the vaginal vault
- High Dose Rate (HDR) Brachytherapy for cancer of the cervix
- Lymphoedema advice
Macmillan Cancer Support
www.
Tel: 0808 808 0000
Cancer Information and Support
Clatterbridge Cancer Centre Liverpool
Tel: 0151 318 8805
Jo’s Cervical Cancer Trust
jostrust.org.uk
Tel: 0808 802 8000
Womb Cancer Support UK
wombcancersupportuk.weebly.com
The Eve Appeal
EVOC support group, Liverpool (Endometrial Vulval Ovarian Cervical)
Gynaecological Oncology Team at Liverpool Women’s Hospital
Tel: 0151 702 4186
Support Groups at Maggie’s
Maggie's Wirral website
Tel: 0151 334 4301
Disability Rights UK (RADAR key scheme; access to locked public toilets)
Disability Rights UK produce a key which gives access to over 9000 locked public toilets found in UK shopping centres, bus and train stations, department stores etc. Cost (July 2021) is £6 (including delivery).
Tel: 0330 995 0400
Email Disability Rights UK