What is pelvic radiotherapy?

Radiotherapy treats cancer by using high-energy rays to destroy the cancer cells. The pelvis is the lower part of the tummy (abdomen) between the hips. Using radiotherapy to treat cancer in the pelvis is called pelvic radiotherapy.

Why am I having pelvic radiotherapy?

You may have pelvic radiotherapy to treat:

Sometimes radiotherapy is used to treat cancer that has spread to the pelvic area from somewhere else in the body. For example, this may include breast or lung cancer that has spread to bones in the pelvic area.

How will I have pelvic radiotherapy?

You may have radiotherapy from outside the body. This is called external beam radiotherapy. Or you can have it from inside the body. This is called internal radiotherapy or brachytherapy. Some people have both types.

You may also find it helpful to read our information about the type of cancer you are having treatment for. This has more detail about your treatment and how it is given.

Before pelvic radiotherapy

A team of specialists plan and give you radiotherapy. They will give you information, practical help and support throughout your treatment. Your team will usually include:

  • a cancer doctor (clinical oncologist) or a consultant radiographer – who is an expert in treating cancer with radiotherapy
  • therapeutic radiographers – who help plan and give each radiotherapy treatment and offer advice and support
  • a specialist nurse – who can give information, advice and support. 

Your team will explain your treatment and what to expect. This may include information about the following. 

Contraception

Your radiotherapy team will advise you not to become pregnant or make someone pregnant during radiotherapy and for some time afterwards. This is because radiotherapy can harm an unborn baby. They will give you information about this before you start treatment.

  • If you take the contraceptive pill

    The contraceptive pill can be less effective during pelvic radiotherapy if you have side effects such as diarrhoea. The best contraception to use during treatment is a condom or cap (diaphragm).

  • If you are having prostate seed brachytherapy

    You should wear a condom during sex for the first few weeks after this treatment. This is in case a radioactive seed moves from the prostate into the semen. But it is very rare for this to happen. Your doctor or nurse can explain more about this to you.

We have more information on sex and cancer.

Fertility

Radiotherapy to the pelvis can affect being able to get pregnant or make someone pregnant. Your team will give you information about this. If you would like to have children in the future, talk to your doctor or specialist nurse before you start treatment. There may be options for preserving your fertility.

  • Effects on being on being able to get pregnant

    Pelvic radiotherapy usually affects the ovaries and the lining of the womb. This often means you will not be able to get pregnant or carry a pregnancy after treatment. Your team will give you information about this.

    You may meet with a fertility specialist to discuss the possibility of storing embryos, eggs or ovarian tissue. It may be possible to use these to start a pregnancy that someone else carries (a surrogate).

    You may have surgery to move the ovaries away from the area having treatment. This is called ovarian transposition. It is sometimes possible to use eggs from the ovaries after radiotherapy to start a pregnancy. But this is very rare. We have more information about fertility.

  • Effects on being able to get someone pregnant

    Pelvic radiotherapy may make you unable to make someone pregnant (infertile). Before you decide to have treatment, your team will explain any risks to your fertility. For some people, radiotherapy causes changes that may get better with time. For others, the changes may be permanent.

    Your team may talk to you about preserving your fertility if this is possible for you. Preserving fertility usually means collecting and freezing sperm.

    Preserving fertility is not always possible. But it may mean some people who lose their fertility are still able to have a baby in the future. We have more information about fertility.

Getting support

Losing your fertility can be hard to cope with, especially if you had planned to have children. It can help to get the right support. If you have a partner, it may be a good idea to include them too.

Your doctor or nurse can usually arrange for you to talk to a fertility counsellor or therapist. Talking to other people who are in a similar position may be helpful.

Organisations such as the British Infertility Counselling Association (BICA) can offer support and counselling. If you are not sure where to start or just want to talk, you can contact our cancer support specialists.

Smoking

If you smoke, try to stop. Research shows that stopping smoking during and after radiotherapy may help it work better. It may also help to reduce the risk of some types of cancer coming back.

Stopping smoking can also help to reduce many of the side effects of pelvic radiotherapy. Your radiotherapy team, GP or a pharmacist can help.

If you are LGBTQ+

Our information about pelvic radiotherapy is written for everyone having this treatment. If you are LGBTQ+, you may have additional questions about the care and support you need. Your healthcare team are there to support you and treat you in a way you feel comfortable with.

Sometimes it may help if your healthcare team know your sexual orientation or gender. It may help you feel better supported. And it may help your healthcare team give the right information and support to you and the people closest to you.

If you are trans or non-binary, talking to a health professional about your body may be especially difficult and complicated. Pelvic radiotherapy may involve parts of the body that do not reflect your gender identity. You may find this uncomfortable or upsetting to talk about. You may also have specific questions if you take hormones or have had gender-affirming surgeries.

You may find it helps to have someone you trust with you at appointments. They can listen and help you cope with what is happening. It may also help to talk to others in a similar situation.

Live Through This runs a peer support group for LGBTQ+ people affected by cancer. This can be a good way to meet and share with others, hear how others have coped, and talk about what you are going through.

Side effects of pelvic radiotherapy

Radiotherapy destroys cancer cells in the area where it is given. It can also damage some normal cells. This may cause side effects.

Side effects do not usually happen straight away. They may develop during your course of treatment or in the days or weeks after treatment finishes. After you finish radiotherapy, the effects may get worse for a time before they get better.

Some of the side effects of pelvic radiotherapy include:

  • tiredness
  • effects on the skin
  • changes passing urine (pee)
  • bowel problems
  • changes to your sex life 

We have more information about side effects during pelvic radiotherapy.

Late effects of pelvic radiotherapy

Late effects are side effects that either:

  • begin during or shortly after treatment and last longer than 3 months – these are sometimes called long-term effects
  • begin months, or even years, after treatment.

Your radiotherapy team can tell you more about your risk of getting late effects. Your risk depends on:

  • the type of cancer
  • the type and amount of radiotherapy you had
  • whether you had other cancer treatments, such as surgery or chemotherapy.

The most common late effects after pelvic radiotherapy are changes to how the bowel and bladder work. We have more information about these and other possible late effects of pelvic radiotherapy.

Always tell your cancer doctor, nurse or GP if you have side effects that do not go away. You should also tell them if you develop any new symptoms or problems after you finish treatment. They can give you advice and treatments to help.

Follow-up after radiotherapy

After your radiotherapy has finished, your cancer doctor or radiographers will tell you about your follow-up care. This will depend on the type of cancer and the type of radiotherapy you have had. There are different types of follow-up:

  • You may not need follow-up appointments

    Instead you may get advice about problems to watch for and the details of someone to contact if needed.

  • Regular follow-up appointments by phone or at a clinic

    Your appointment may be with the specialist who recommended the radiotherapy, or with a nurse or radiographer. The first appointment is usually 4 to 8 weeks after treatment finishes.

  • Patient-led follow-up

    This means you do not have regular appointments, but you can contact your team to arrange one if you are worried. This may not be suitable for everyone. You still have any tests or scans that you need as normal.

Follow-up appointments are a good chance to discuss any problems or worries you have. It may help to make a list of questions before so you do not forget anything important. If you feel anxious, it can help to have a friend or family member with you.

If you have any ongoing side effects or new symptoms, contact your specialist nurse, cancer doctor or the person you have been told to contact. Do not wait until your next scheduled appointment. You can do this at any time, even between appointments.

Well-being and recovery

You may have mixed emotions when you come to the end of your radiotherapy treatment. You will probably feel relieved, but you may also feel anxious and uncertain. Some people find they feel low after finishing the treatment. It can take time to get your confidence back, and to accept what has happened.

It may also take time to recover from treatment. You may feel tired or have other side effects for a while. If cancer or the treatment has changed how you feel about your body, our information about body image may help. It is important to give yourself time to recover and adjust. You can call the Macmillan Support Line on 0808 808 00 00 and talk to one of our cancer support specialists. You can also ask your healthcare team for details of local support groups that may be able to help.

Your radiotherapy team may give you advice about:

  • Lifestyle changes

    When your treatment has finished, you may want to make some positive changes to your lifestyle. You may have already followed a healthy lifestyle before your treatment. But you may now want to focus more on being as healthy as you can. There are things you can do to help your body recover. These can also help improve your well-being and lower your risk of getting other illnesses and other cancers.

    We have more information about healthy eating, physical activity and other ways to have a healthy lifestyle.

  • Look after your pelvic floor muscles

    Pelvic floor muscles support the organs in the pelvis. They are important for bladder and bowel control and are used in sex. Radiotherapy to the pelvis can weaken these muscles. They also get weaker naturally as you get older.

    You may be advised to do regular pelvic floor exercises after pelvic radiotherapy. It is important to do these exercises correctly. You will usually be referred to a physiotherapist or specialist nurse. They will teach you how to do them.

    To look after your pelvic floor muscles, try to:

    • maintain a healthy weight
    • avoid getting constipated
    • avoid heavy lifting.
  • Reduce the risk of lymphoedema

    If you have had radiotherapy to the lymph nodes or surgery to remove lymph nodes, you may develop lymphoedema. This means fluid collects and causes swelling in one or both legs or the area between the legs. If you have had both radiotherapy and surgery, the risk is higher.

    We have more information about lymphoedema and how to lower your risk..

  • Having sex after treatment

    Your radiotherapy team may advise you to wait a few weeks after radiotherapy before having sex. This is to allow any side effects or irritation in the area to improve. Ask your cancer doctor or nurse for advice about this. It can depend on the treatment you are having.

    It is normal to feel nervous about having sex after pelvic radiotherapy. You may have ongoing side effects. Or you may be coping with changes that affect your body image. If you are ready to have sex, take your time and make sure you are relaxed. Use a lubricant to help make penetrative sex feel more comfortable. If you have any problems that do not improve, talk to your cancer doctor or nurse.

About our information

  • References

    Below is a sample of the sources used in our pelvic radiotherapy information. If you would like more information about the sources we use, please contact us at cancerinformationteam@macmillan.org.uk

    Andreyev HJN, Muls AC, Norton C, et al. Guidance: The practical management of the gastrointestinal symptoms of pelvic radiation disease. Frontline Gastroenterology, 2015; 6, 53-72.

    Dilalla V, Chaput G, Williams T and Sultanem K. Radiotherapy side effects: integrating a survivorship clinical lens to better serve patients. Current Oncology, 2020; 27, 2, 107-112.

    The Royal College of Radiologists. Radiotherapy dose fractionation. Third edition. 2019. Available from: www.rcr.ac.uk/system/files/publication/field_publication_files/brfo193_radiotherapy_dose_fractionation_third-edition.pdf [accessed March 2021]. 


  • Reviewers

    This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical and health professionals and people living with cancer. It has been approved by Chief Medical Editor, Professor Tim Iveson, Consultant Medical Oncologist.

    Our cancer information has been awarded the PIF TICK. Created by the Patient Information Forum, this quality mark shows we meet PIF’s 10 criteria for trustworthy health information.