Radiotherapy for womb cancer (endometrial cancer)
Radiotherapy treats cancer by using high-energy x-rays to destroy the cancer cells, while doing as little harm as possible to normal cells.
You may have radiotherapy:
to reduce the risk of the cancer coming back in the pelvic area after surgery (called adjuvant radiotherapy)
instead of surgery (if your doctor doesn’t think a general anaesthetic or an operation is suitable for you)
to try to cure a cancer that comes back at the top of the vagina or in the pelvic area after surgery
to treat any cancer that wasn’t completely removed with surgery.
Radiotherapy for womb cancer can be given externally or internally, or as a combination of the two. Your cancer specialist (clinical oncologist) can discuss this treatment in detail with you.
Your cancer specialist may talk to you about having radiotherapy after surgery. It’s given to reduce the risk of the cancer coming back in the pelvic area. Your specialist team looks at the stage, the grade and type of womb cancer you have before discussing this with you.
Some women with stage 1 cancer have a higher risk of the cancer coming back. In this situation, your doctors may suggest you have radiotherapy to reduce your risk. Or they may advise that you have regular checks for signs of the cancer coming back in the pelvis (called observation). Most women with stage 2 or 3 womb cancer have radiotherapy after surgery. Adjuvant radiotherapy may be given internally or externally or as a combination of both. Some women are given radiotherapy along with chemotherapy. This is called chemoradiation.
Your specialist will talk over the benefits and disadvantages of radiotherapy in your situation. They will explain the side effects you’re likely to get and the possible long-term effects.
Radiotherapy for symptom control (palliative radiotherapy)
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If the cancer has spread in the pelvic area or to other parts of your body, such as the bones, you may be given radiotherapy to shrink the cancer or to control the symptoms. This can usually be given over about 1–5 sessions, but more may be needed depending on your situation. If you have any side effects of palliative radiotherapy, they will probably be mild.
The treatment is given in the hospital radiotherapy department as a series of short daily sessions. Each treatment takes 10-15 minutes, and they are usually given from Monday to Friday, with a rest at the weekend. Your doctor will discuss the treatment and possible side effects with you.
A course of radiotherapy for womb cancer may last up to five weeks. It’s usually given to you as an outpatient.
External radiotherapy does not make you radioactive and it’s perfectly safe for you to be with other people, including children, after your treatment.
Planning your radiotherapy
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Radiotherapy has to be carefully planned to make sure it’s as effective as possible. It’s planned by a cancer specialist (clinical oncologist) and it may take a few visits.
On your first visit to the radiotherapy department, you’ll be asked to have a CT scan or lie under a machine called a simulator, which takes x-rays of the area to be treated.
You may need to have some small marks made on your skin to help the radiographer (who gives you your treatment) position you accurately. These show where the rays will be directed. These marks must stay visible throughout your treatment, and permanent marks (like tiny tattoos) are normally used. These are very small, and will only be done with your permission. It may be a little uncomfortable while they are done.
At the beginning of each session of radiotherapy, the radiographer will position you carefully on the couch, and make sure you are comfortable. You’ll be alone in the room during your treatment, but you can talk to the radiographer, who will watch you from the next room. Radiotherapy is not painful, but you have to lie still for a few minutes during the treatment.
Internal radiotherapy is sometimes called brachytherapy.
It gives a high dose of radiotherapy directly to the top of the vagina (where the womb was) and to the area close by. The treatment is given by placing hollow tubes (called applicators) in the vagina. A machine, which is operated by a radiographer, delivers a radioactive source that gives off radiation into the correct place through the applicators. The machine is programmed to give you the exact dose your cancer specialist has prescribed for you. When the treatment finishes, a nurse will remove the applicators and you will be able to go home.
Occasionally, women who still have their womb may have a slightly different type of internal treatment. It involves putting a tube into the womb as well as the vagina. This is done under a short general anaesthetic or occasionally a spinal anaesthetic. Your doctor or nurse will explain more about what’s involved.
You can have internal radiotherapy on its own or at the end of your external radiotherapy treatment. Internal radiotherapy can be given in different ways, depending on the system your hospital uses. They all work equally well. Your cancer specialist and specialist nurse will explain more so that you know what to expect.
You may have several short bursts of treatment, which is called high-dose rate or fast treatment. Or you may have one long slow treatment, called low-dose rate or slow treatment.
Fast treatment (high-dose rate)
This is the most common way of giving internal radiotherapy after surgery to treat womb cancer. You can usually have it done as an outpatient. Your doctor will carefully put a hollow plastic or metal tube (applicator) into your vagina.
You won’t usually need any anaesthetic to have this done. But let your nurse or doctor know if you’re worried or have any discomfort. They can help to reassure you or give you painkillers if you need them.
You’ll probably have a CT scan or x-ray to check the position of the applicators. After this, a radiographer will attach a flexible tube to the applicator. This is connected to the machine that delivers the radioactive source into the applicators. The radiographer and nurse will leave the room and switch on the treatment machine. They will still be able to see you and hear you, so if you need anything they can stop the machine and come back in again.
The treatment only lasts a few minutes, and a nurse will gently remove the applicators when it’s over. You’ll need to come back and have it on different days for between two and four treatments. You can usually have it as an outpatient.
Slow treatment (low-dose rate)
This treatment is given in the same way as the fast treatment but much more slowly.
It can be given over 12 to 24 hours, or over a few days. You will usually have your treatment in a room of your own or with another woman who’s having similar treatment. Being in your own room means other people aren’t exposed to unnecessary radiation.
You’ll need to need to stay in bed lying down while the applicators are in place, to make sure they stay in the correct position. Having the applicators in and not being able to move around can be uncomfortable but you’ll be given regular painkillers. Let your nurse or doctor know if you’re in any pain. You’ll also have a catheter (tube) inserted into your bladder because you won’t be able to get out of bed to pass urine.
The radioactive source can be withdrawn from the applicator tubes back into the machine to allow nurses or doctors to come in without being exposed to radiation. The nurses will come in regularly to check the applicators, give you painkillers and make sure you’re comfortable. You’ll have a nurse call system at hand to allow you to contact them at any time.
You can also have some visitors (except pregnant women or children), but only for a short time so that you can get on with the treatment. The machine adds on the time that you’re not being treated, so you’ll still get the same dose. A nurse will go over all this with you beforehand so you know what to expect.
It’s a good idea to take in plenty to read, and an MP3 player or radio to keep you occupied. There will be a television in the room that you can watch. If you get anxious or worried during the treatment because you’re on your own a lot of the time, let the nurse or doctor know how you’re feeling so that they can give you more support.
When your treatment finishes, your nurse will gently remove the applicators and catheter and you will be able to go home.
Side effects of radiotherapy
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You may develop side effects over the course of your treatment. These usually improve gradually over a few weeks or months after treatment finishes. Your doctor, nurse or radiographer will discuss this with you, so you know what to expect. Let them know about any side effects you have during or after treatment, as there are often things that can be done to help.
External radiotherapy causes more side effects than internal radiotherapy. But many women have a combination of both treatments. If you are only having internal treatment, the most common side effects are to the bowel and bladder.
The skin in the area being treated sometimes gets dry and irritated. Avoid using perfumed soaps or body washes during treatment as they could irritate the skin. You’ll be given advice on looking after your skin. Your doctor can prescribe cream to soothe it if it becomes sore.
You may lose some of your pubic hair. After treatment, it will usually grow back, but may be thinner than it was before.
Radiotherapy to the pelvis may irritate the bowel and cause diarrhoea and soreness around the back passage. Your doctor will prescribe anti-diarrhoea medicine to help control this.
Make sure you drink plenty of fluids if you have diarrhoea. Eating a low-fibre diet may help reduce diarrhoea. This means avoiding wholemeal bread and pasta, raw fruit, cereals and vegetables during and for a couple of weeks after treatment.
Radiotherapy can also irritate the bladder, which makes you want to pass urine more often and causes a burning feeling when you pass urine. Your doctor can prescribe medicines to reduce these symptoms. Drinking a least two litres (three pints) of fluid a day will also help.
Tiredness is a common side effect and may continue for months after treatment is over. During treatment, you’ll need to rest more than usual, especially if you have to travel a long way for treatment each day. But it’s good to do gentle exercise, such as walking, when you feel able to. Once your treatment is over, gradually increase your activity and try to balance rest periods with exercise such as walking. This will help build up your energy levels.
You may have a slight vaginal discharge after treatment has finished. If it continues or becomes heavy, let your clinical oncologist or specialist nurse know.
Radiotherapy to the pelvic area can sometimes cause long-term side effects (late effects). However, improvements in how radiotherapy is given have reduced the risk of some late effects. If they do happen, there are lots of ways in which they can be managed or treated.
In women, radiotherapy to the pelvic area can cause vaginal dryness and narrow the vagina, which can make having sex or an internal examination uncomfortable. Your specialist nurse will usually talk to you about ways of trying to prevent narrowing (such as using vaginal dilators) and creams to treat dryness.
Some women may develop some permanent changes to the bowel or bladder. If this happens, symptoms generally develop from six months to two years after radiotherapy treatment, although in some people it may be years later. If your bowel is affected,
you may have to go the toilet more often than usual, or you may have diarrhoea.
Sometimes, the bladder shrinks after radiotherapy and can’t hold as much, so you’ll need to pass urine more often. The blood vessels in the bowel and bladder can become more fragile, and if this happens you may get blood in your urine or bowel movements. Always let your cancer doctor or specialist nurse know if this happens so that the bleeding can be checked out.
Radiotherapy and surgery to remove the pelvic lymph nodes may increase the risk of getting swelling (lymphoedema) in one, or occasionally both, legs. This isn’t common, but you can read about ways to reduce the risk of lymphoedema.