Less common late effects

Pelvic radiotherapy can cause some other, less common changes in your body. Most of these can be treated effectively.

Pelvic lymph nodes can be damaged by radiotherapy. This can cause fluid to build up and legs can become swollen. Protecting your skin, legs and feet, simple massage and compression garments can prevent and reduce swelling.

Pelvic bones can be damaged by radiotherapy; this can cause fine cracks in the bones. Your doctor may prescribe painkillers to control any pain, bone strengthening drugs and vitamin supplements. You may be referred to a specialist bone doctor for further tests and advice.

Pelvic radiotherapy can also cause other changes in women. Early menopause causes symptoms such as hot flushes, mood swings and low sex drive. Your doctor may be able to prescribe hormone replacement therapy to help but it’s not suitable for everyone.

Having pelvic radiotherapy slightly increases your risk of a second cancer but this is outweighed by the benefits of pelvic radiotherapy as initial treatment. Your doctor or nurse will discuss this with you.

Lymphoedema

The lymph nodes (sometimes called lymph glands) are part of our immune system and help us fight infection. Lymph fluid flows along fine channels between the nodes.

Sometimes lymph nodes in the pelvic area become damaged by pelvic radiotherapy or surgery. When this happens, lymph fluid can build up. One or occasionally both legs can become swollen. This is called lymphoedema and it can develop months or years after treatment. Some people get swelling in the genital area or in the lower tummy area, but this is rare.

Lymphoedema is not common after pelvic radiotherapy. But people who had surgery to remove the pelvic lymph nodes as well as pelvic radiotherapy are at a higher risk.

Reducing your lymphoedema risk

There are things you can do to reduce your risk of lymphoedema. In particular, it’s important to protect the skin on your legs and feet. Infections can trigger lymphoedema, so it’s important to avoid damaging your skin.

If you notice swelling in your foot or leg, always get it checked by your doctor or nurse. The earlier lymphoedema is treated, the more effective and straightforward the treatment is.

These are things you can do to reduce your risk of lymphoedema:

  • Keep your skin clean and use moisturisers to keep it supple.
  • Clean grazes or cuts straightaway, and see your GP if the area gets red, hot or swollen.
  • Wear well-fitting shoes.
  • Use nail clippers instead of scissors to cut your toenails.
  • Cover your skin or use a high-factor sun cream (SPF 30 or above) on sunny days.
  • Keep to a healthy weight.
  • Keep physically active and avoid standing for too long in the same position.
  • If you are travelling, wear compression garments such as flight socks.

Managing lymphoedema

If you develop lymphoedema, your GP should refer you to a clinic for specialist advice. There are lots of things that can be done to reduce the swelling and stop it getting worse.

At the lymphoedema clinic, you’ll be given advice on caring for your skin. You’ll also be shown positioning exercises and how to do self-massage. A specialist will measure you for a compression garment to wear on the affected leg to reduce the swelling. They may also recommend other treatments for you.


Bone changes

Most people who have had pelvic radiotherapy won’t have any bone problems. Damage to the bones in the pelvic area is a rare late effect of radiotherapy.

If radiotherapy damages the pelvic bones, it may increase the risk of fine, hair-line cracks (known as pelvic insufficiency fractures).These can be painful. The pain is normally in the lower back or pelvis when you’re moving around, and it can make walking difficult. There isn’t usually pain when you’re resting or sleeping.

Pelvic radiotherapy also causes an early menopause in younger women. The menopause increases the risk of bone thinning (osteoporosis), but only if you can’t take hormone replacement therapy (HRT).

If you have pain or aching in the bones, always let your cancer doctor or nurse know. It can be caused by a number of conditions, but it is very important to get it checked. Because damage to the bones is a rare late effect of pelvic radiotherapy, it’s more likely to be caused by something else.

If you have symptoms that last for more than a few weeks, your doctors will need to do tests, such as a bone scan or an MRI scan. A special scan called a DEXA scan can also be done to check the strength of your bones.

Treatment

Pelvic insufficiency fractures don’t usually need to be treated with an operation, but you’ll be referred to a specialist bone (orthopaedic) doctor for advice. They will prescribe painkillers to control the pain, and they may give you drugs called bisphosphonates to strengthen the bones. They may also advise you to take calcium and vitamin D supplements for your bone health.

A physiotherapist will show you how to limit stress on the bones. They will also give you exercises to do. If you’re having problems with day-to-day tasks, an occupational therapist can advise you on equipment to make things easier.

Bone health

You may want to know more about keeping your bones healthy. Although radiotherapy damage to the bones is rare, other factors may contribute to bone changes. The bones naturally lose some strength with age. And people taking hormonal therapy drugs are more at risk of bone thinning (osteoporosis).

If you have any bone problems, it’s important to follow your doctor’s advice.

These are things you can do to help keep your bones healthy:

  • Keep physically active to keep your bones strong. But if you have bone problems, ask your doctor for advice first.
  • Keep to a healthy weight to avoid strain on your joints.
  • Eat healthily to get plenty of calcium and vitamin D. Avoid having too much caffeine. 
  • Avoid smoking – it’s bad for the bones and it increases the risk of certain cancers and other illnesses.
  • If you drink alcohol, stay within the recommended guidelines. Alcohol can interfere with the balance of calcium in the body. Current guidelines recommend that men should drink no more than 21 units of alcohol a week. Women should drink no more than 14 units of alcohol a week.

‘Your hips can turn very stiff and I had a bad back and pelvis. Everything is so tender now. I’ve been told that it’s just tissue damage but I still have physio.’ Ashley

Ashley


Early menopause

If a woman hasn’t had her natural menopause, pelvic radiotherapy will cause an early menopause. This is because it stops the ovaries working and stops them producing the hormones oestrogen and progesterone. Your periods will gradually stop and you may get the symptoms of the menopause.Doctors usually say it is an early menopause if it happens before the age of 45.

The symptoms of an early menopause can include:

  • hot flushes and sweats
  • vaginal dryness
  • passing urine more often
  • lower interest in sex
  • sleep problems
  • aches and pains
  • mood swings, poor concentration, lower confidence and changes in memory.

The Daisy Network is a support organisation for women who have an early menopause.

Hormone replacement therapy (HRT)

Your doctor may prescribe HRT to replace the hormones that your ovaries are no longer producing. If you had cancer of the cervix or rectum, it’s usually safe to take HRT. But some cancers are dependent on hormones to grow, for example womb cancer.

So in this case, you may not be advised to take HRT. Ask your cancer specialist whether HRT is suitable for you.

HRT can improve some menopausal symptoms. It can also protect your bones and heart. Early menopause increases the risk of bone thinning (osteoporosis).


Managing menopausal symptoms

If your specialist doesn’t advise HRT or you decide not to take it, there are different ways to manage your symptoms. If your symptoms are affecting your day-to-day life, ask your doctor about other medicines that may help reduce them.

Low doses of an anti-depressant drug can reduce hot flushes and sweats. Or you can take a drug called clonidine (Catapres®, Dixarit®), which is used to control blood pressure. Some women find that slow, controlled breathing techniques or acupuncture help with hot flushes.

You can use lubricants or creams to help reduce vaginal dryness and make it easier to have sex.

Making lifestyle changes may help reduce some of your symptoms and improve your general health.


Second cancer

Having pelvic radiotherapy slightly increases the risk of developing a new cancer in the treatment area. But the risk of developing a second cancer is outweighed by the benefits of pelvic radiotherapy as initial treatment.

Some men may be advised by their specialist to have a test 5–10 years after radiotherapy to look for pre-cancerous changes in the bowel. Your doctor or nurse will discuss this with you.

Back to Late effects of pelvic radiotherapy

About late effects

Some people may have long term or late effects of pelvic radiotherapy. These can usually be treated or managed successfully.

Bladder changes

Late effects on the bladder can usually be managed or treated successfully. Talk to your doctor about any symptoms.

Bowel changes

Late bowel effects of pelvic radiotherapy are usually managed or treated successfully. Talk to your doctor if you notice any symptoms.

Late effects and sex life

Pelvic radiotherapy can have some late effects on your sex life. Talk to your doctor for advice on how to manage these.