Managing the late effects of pelvic radiotherapy in women

Late effects are side effects that are affecting you six months or longer after radiotherapy. They can also be side effects| that start months or years after treatment has finished.

This section explains how late effects can be managed or treated, what you can do to help yourself and the support that’s available to you. You won’t have all of the late effects we’ve included, although some women have more than one. You can use the menu bar on the left to guide you to the information you need. It can be worrying to read about late effects, but most can be treated successfully. Very few women suffer severe late effects.

Radiotherapy is an effective and successful treatment for many cancers that start in the pelvic area, and the benefits of treatment with radiotherapy usually far outweigh the risks. Newer ways of giving radiotherapy are designed to limit the chance of late effects as much as possible.

If you’re deciding whether to have radiotherapy and are worried about the risk of late effects, it’s important to talk to your cancer specialist (clinical oncologist) before treatment starts.

Radiotherapy| treats cancer by using high-energy x-rays to destroy cancer cells. Normal cells in the treatment area can also be damaged by radiotherapy, but usually they can repair themselves.

Pelvic radiotherapy Back to top

Radiotherapy to the pelvic area may be given externally| (from outside the body). This is done using a machine called a linear accelerator. It can also be given internally| (called brachytherapy), using a radioactive source. Radiotherapy is often used in combination with surgery| or chemotherapy|, which can increase the risk of late effects developing.

Cancers treated with pelvic radiotherapy

Pelvic radiotherapy is usually given to cure or control cervical cancer, womb (endometrial) cancer, vaginal cancer and vulval cancer. It’s also used to treat cancers of the bladder, rectum and anus.

Pelvic radiotherapy may affect the female organs (the vagina, womb and ovaries), and the bladder. It can also affect parts of the digestive system, including the small bowel, colon, rectum and anus.

Radiotherapy to the pelvic area can also affect:

• the lymph nodes (also known as lymph glands)
• the pelvic bones (made up of the two hip bones joined together by
  smaller bones).

 

Most women have side effects during radiotherapy and for a few weeks afterwards. Usually these gradually improve over a few weeks or months after treatment has finished.

We have a section on pelvic radiotherapy in women – side effects during treatment|, which explains short-term side effects.

Late effects of pelvic radiotherapy Back to top

Late effects are:

• side effects that begin during or shortly after treatment and don’t go away within six months (sometimes called long-term effects) – occasionally these effects become permanent
• side effects that don’t affect you during treatment but begin months or even years later, as a delayed response to treatment.  

Some late effects improve over time and may eventually go away on their own. The following sections introduce ways in which late effects can be managed and improved.

The most common late effects after pelvic radiotherapy are changes to the way the bladder and bowel work. Some women may also have changes to the vagina and changes in the physical and emotional feelings associated with sex|.

The impact of late effects varies:

• They may be minor, not affecting your day-to-day life much.
• They can be more troublesome or difficult to live with, and can restrict or interfere with your day-to-day life. 

If you do have late effects, there are usually lots of things that can help you cope with them, so that you can live life as fully as possible.

Pelvic radiotherapy slightly increases the risk of developing a new cancer in the treatment area, for example bowel cancer.

Talk to your doctor

Always let your cancer doctor or specialist nurse know if the side effects of radiotherapy don’t go away, or if you develop new symptoms or problems after treatment is over. The more information you can give your doctor, the more likely it is they will be able to help you. You may feel embarrassed at the thought of talking about problems with your bowel, bladder or sex life. But doctors and nurses are very used to discussing intimate problems like this, so don’t be put off.

It can be frightening to get symptoms after treatment and you may worry that the cancer has come back. Some of the symptoms of late effects are similar to symptoms you may have had when you were diagnosed with cancer (for example, blood in the urine or bleeding from the back passage).

Your cancer specialist will assess your symptoms and explain if they’re likely to be a result of the radiotherapy. You may need to have tests to find out the cause and to rule out anything more serious, such as the cancer coming back or a new cancer. Your symptoms may be due to another condition not related to the cancer or its treatment. 

Remember you can always arrange to see your cancer specialist or specialist nurse in between appointments and contact your GP at any time.

Getting expert help

Depending on the late effects you have and how much they affect you, you may be referred to a doctor or nurse with expertise in that area. For example, if you’re having bowel problems you may be referred to a doctor who specialises in bowel problems, called a gastroenterologist.

There are also doctors who specialise in treating late effects of radiotherapy. This is a specialist area, so there aren’t many of these doctors – you may need to travel to see one. A few hospitals have special clinics for people with late effects.

Your doctor or nurse can also refer you to a specialist nurse or physiotherapist for continence advice, or to a relationship or sex therapist if needed. The Bladder and Bowel Foundation| can also put you in touch with a specialist nurse or a physiotherapist for continence advice.