Radiotherapy for ovarian cancer
Radiotherapy uses high energy x-rays to destroy ovarian cancer cells.
You usually have external beam radiotherapy for ovarian cancer. External beam radiotherapy directs radiotherapy beams at the cancer from a machine outside of the body.
When do you have radiotherapy?
Doctors don't often use radiotherapy to treat ovarian cancer. The main treatment is surgery, and most women will also have chemotherapy.
You might have radiotherapy to try and shrink the cancer. Or to reduce the symptoms of advanced ovarian cancer. This is called palliative radiotherapy.
Where do you have it?
You have external radiotherapy in the hospital radiotherapy department, usually as an outpatient. Some hospitals have rooms nearby that you can stay in if you have a long way to travel. You go to the radiotherapy department from your ward if you’re already in hospital.
Planning radiotherapy
The radiotherapy team plan your external radiotherapy before you start treatment. This means working out the dose of radiotherapy you need and exactly where you need it.
Your planning appointment takes up to 2 hours.
You usually have a planning CT scan in the radiotherapy department.
The scan shows the cancer and the area around it. You might have other types of scans or x-rays to help your treatment team plan your radiotherapy. The plan they create is just for you.
Before the scan
You will need to prepare your bladder and bowels for the planning scan and treatment. You will get information about this before your scan. Following this advice can help reduce long term side effects to your bladder and bowels.
Before the scan you need to empty your bowels. Your radiographer might give you an 
to help you empty your bowels. You will also need to drink a certain amount of water before you have the scan. They will tell you how much.
You may need to prepare your bowels and bladder in the same way before each treatment. This helps to improve the accuracy of the treatment and reduce the possible side effects.
Your radiographer will ask you to put on a hospital gown. When you’re ready, the radiographers help you to position yourself on the scanning couch. This is the same type of bed that you lie on for your treatment sessions.
You need to lie very still. You might have a type of firm cushion called a vacbag to help as you may be in this position for a little while. Let the radiographers know if you are uncomfortable.
Injection of dye
You might need an injection of through a small thin tube (cannula) in your arm.
Before you have the contrast medium, the radiographer asks you about any medical conditions or allergies. Some people are allergic to the dye.
For some people the dye might:
- make you feel hot and flushed for a minute or two
- give you a metallic taste in your mouth, but this will not last long
- make you feel like you’re passing urine but you aren’t. This feeling usually passes quickly
Having the scan
Once you're in position the radiographers move the couch up and through the scanner. They then leave the room and the scan starts.
The scan takes about 20 minutes. You won't feel anything. The radiographers can see you from the CT control area where they operate the scanner.
Ink and tattoo marks
The radiographers make pin point sized tattoo marks on your skin. They use these marks to line you up into the same position every day. The tattoos make sure they treat exactly the same area for all of your treatments. They may also draw marks around the tattoos with a permanent ink pen, so that they are clear to see when the lights are low.
The radiotherapy staff tell you how to look after the markings. The pen marks might start to rub off in time, but the tattoos won’t. Tell your radiographer if that happens. Don't try to redraw them yourself.
After the scan
The radiographers will then help you off the CT scanner couch and you can get changed back into your clothes. You stay in the department for about 15 to 30 minutes if you had an injection of the dye. This is in case it makes you feel unwell, which is rare.
The radiographer removes the tube from the vein in your arm before you go home.
You should be able to go home or back to work. You can eat and drink normally.
After your planning session
You might have to wait a few days or up to 3 weeks before you start treatment.
During this time the physicists and your radiotherapy doctor (clinical oncologist) decide the final details of your radiotherapy plan. They make sure that the area of the cancer will receive a high dose and nearby areas receive a low dose. This reduces the side effects you might get during and after treatment.
Having radiotherapy
Radiotherapy machines are very big and could make you feel nervous when you see them for the first time. The machine might be fixed in one position. Or it might rotate around your body to give treatment from different directions. The machine doesn't touch you at any point.
Before your first treatment, your will explain what you will see and hear. In some departments, the treatment rooms have docks for you to plug in music players. So you can listen to your own music while you have treatment.
Before your treatment
Before each treatment you need to empty your bowels. Your radiographer might give you an enema to help you.
You will also need to drink a certain amount of water before treatment. They will tell you how much, and when to drink it.
During the treatment
You need to lie very still. Your radiographers might take images (x-rays or scans) before your treatment to make sure that you're in the right position. The machine makes whirring and beeping sounds. You won’t feel anything when you have the treatment.
Your radiographers can see and hear you on a CCTV screen in the next room. They can talk to you over an intercom and might ask you to hold your breath or take shallow breaths at times. You can also talk to them through the intercom or raise your hand if you need to stop or if you're uncomfortable.
You won't be radioactive
This type of radiotherapy won't make you radioactive. It's safe to be around other people, including pregnant women and children.
Travelling to radiotherapy appointments
You might have to travel a long way each day for your radiotherapy. This depends on where your nearest cancer centre is. This can make you very tired, especially if you have side effects from the treatment.
You can ask your radiographers for an appointment time to suit you. They will do their best, but some departments might be very busy. Some radiotherapy departments are open from 7 am till 9 pm.
Car parking can be difficult at hospitals. Ask the radiotherapy staff if you are able to get free parking or discounted parking. They may be able to give you tips on free places to park nearby.
Hospital transport may be available if you have no other way to get to the hospital. But it might not always be at convenient times. It is usually for people who struggle to use public transport or have any other illnesses or disabilities. You might need to arrange hospital transport yourself.
Some people are able to claim back a refund for healthcare travel costs. This is based on the type of appointment and whether you claim certain benefits. Ask the radiotherapy staff for more information about this and hospital transport.
Some hospitals have their own drivers and local charities might offer hospital transport. So do ask if any help is available in your area.
Side effects of radiotherapy
Radiotherapy for ovarian cancer can cause diarrhoea and sickness, inflamed bladder and tiredness.
These side effects usually start a few days after the radiotherapy begins. They might gradually get worse during your treatment or after treatment ends. You usually start to get better 1 to 2 weeks after you finish treatment.
The side effects are usually less severe if your treatment is for a short period of time. And more severe if treatment is longer, for example over a few weeks.
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
Tiredness and weakness
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.
Feeling or being sick
You might feel sick at times. This can start a few hours after treatment and last for a few days. Anti sickness injections and tablets can help. Tell your doctor or nurse if you feel sick. You might need to try different anti sickness medicines to find one that works.
Contact your doctor or nurse straight away if you’ve been sick more than once in a day.
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.
Diarrhoea
Radiotherapy to the tummy (abdomen) or pelvic area can cause diarrhoea. Your poo (stool) may be very watery. You might need to poo more often or need to go the toilet more urgently.
Your healthcare team can give you medicine to slow down your bowel can help to reduce diarrhoea. Drink at least 2.5 litres of fluid a day to help keep you hydrated. Let your doctor or nurse know straight away if the diarrhoea is severe or getting worse.
Ask your nurse about soothing creams to apply around your back passage (anus). The skin in that area can get very sore.
Inflamed bladder (radiation cystitis)
Radiotherapy can make the lining of the bladder inflamed. This is called radiation cystitis.
It can make you very uncomfortable. You might have bladder pain or a burning feeling when you pee. It may feel as though you need to pee all the time, even though you know you’ve only just been. Try to drink plenty of fluids because this will help.
Speak to your healthcare team if you have pain or feel you need to pee more often.
