Side effects of cervical cancer radiotherapy
Radiotherapy for cervical 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 include:
You might have diarrhoea during your treatment. This is normal but can be unpleasant. Talk to the radiographers if you have diarrhoea. They will tell you how to manage it.
Feeling or being sick can start a few hours after treatment and last for a few days. Anti sickness injections and tablets can control it. Tell your doctor or nurse if you feel sick. You might need to try different anti sickness medicines to find one that works.
Tips
- Avoid eating or preparing food when you feel sick.
- Avoid foods that are fried, fatty, or have a strong smell.
- Drink plenty of liquid to stop you from getting dehydrated.
- Relaxation techniques help control sickness for some people.
- Ginger can help – try it as crystallised stem ginger, ginger tea or ginger ale.
- Fizzy drinks help some people when they’re feeling sick.
You might find that you have some stinging when passing water. You might also need to pass urine more often. This is normal but not very comfortable. Tell one of the radiographers if this happens. Make sure you are drinking plenty of water and other fluids.
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.
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.
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.
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.
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.
If you have not already had the menopause, your radiotherapy will cause an early menopause. The radiotherapy stops the production of sex hormones by the ovaries. The hormone levels start to fall from about 3 months after the start of treatment. It is still important to use effective contraception during this time.
Your periods gradually stop, and you get symptoms of the menopause. The symptoms may be more severe than after a natural menopause. It may include:
- sweating – especially at night
- hot flushes
- mood swings
- irritability
- vaginal dryness
- lack of sex drive
- increased urgency to pass urine
You can take hormone replacement therapy (HRT) after treatment for most cervical cancers. There are gels and creams available that can help with vaginal dryness.
If you have already had your menopause, your ovaries will have stopped working before your treatment. So radiotherapy won't make as much difference to you.
Radiotherapy will stop your ovaries from working. This means you will become infertile and will not be able to have children naturally. This can be very difficult to accept if you want to have children in future. Speak to your doctor before you start treatment if you are worried about this.
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.
This is not a common side effect, but sometimes one or both legs can swell if you have radiotherapy to the lymph nodes. Some people might have swelling of the genitals. This swelling is called lymphoedema.
Tell your specialist straight away if you think either of your legs are getting swollen. You will need to see a lymphoedema specialist. The sooner they diagnose lymphoedema, the easier it is to treat.
You may have some permanent effects from your treatment. This doesn't happen to everyone. It's difficult to predict who is going to have a problem.
After any type of radiotherapy for cancer of the cervix, you might find that you have to pass urine more often. The treatment can make the bladder less elastic. So it won't stretch as far and feels full sooner. You may also be more prone to urine infections.
You might have some permanent bowel effects from your treatment. This doesn't happen to everyone. It's difficult to predict whether you will be affected or not.
You may have loose or more frequent bowel motions. This is because the radiotherapy irritates the lining of the bowel. Tell your doctor if you are troubled by these side effects. You might be able to take medicine to firm up your bowel motions and make them less frequent.
In rare cases, radiotherapy can cause constipation, pain, sickness and bloating. Contact your doctor if you have these symptoms. Your doctor needs to check your bowel for a possible blockage.
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.
