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.

Before pelvic radiotherapy

A team of specialists plan and give you radiotherapy. They also give you information, practical care and support throughout your treatment. Your team includes:

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

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

  • Stopping smoking

    Research shows that stopping smoking during and after radiotherapy may help it work better. It can also reduce the side effects of treatment. Your radiotherapy team, GP or a pharmacist can help.

  • Preventing pregnancy if you are female

    It is important that you do not get pregnant during your treatment. This is because radiotherapy can harm an unborn baby. You should use contraception to prevent pregnancy during your treatment and for a time after. This is important even if you have been told that radiotherapy will stop your periods or make you unable to get pregnant. It is difficult to know exactly when your fertility will be affected. Even if your periods stop, you may still be able to get pregnant.

    We have more information about contraception and having sex during treatment in our information about cancer and your sex life.

  • Preventing pregnancy if you are male

    Your radiotherapy team may tell you to use contraception to prevent a pregnancy during your treatment and for a time after. Some treatments can be harmful to an unborn baby.

    Preventing pregnancy may be important even if you have been told that radiotherapy might affect your fertility. It is difficult to know exactly when this will happen. You may still be able make someone pregnant.

    After radioactive seed brachytherapy for prostate cancer, you should use condoms during sex for the first few weeks. This is to protect your partner in case a radioactive seed moves from the prostate into the semen. 

    We have more about having sex during treatment in our information about cancer and your sex life.

  • Fertility if you are female

    Having pelvic radiotherapy often means you will not be able to get pregnant, or carry a pregnancy after treatment. Your team will give you information about this before you start treatment. We have more information about cancer treatment and fertility in women.

    Sometimes it is possible to have surgery called ovarian transposition before radiotherapy starts. This is an operation to move the ovaries away from the area having treatment. After radiotherapy it may be possible to use eggs from the ovaries to start a pregnancy.

  • Fertility if you are male

    Pelvic radiotherapy may make you unable to make someone pregnant (infertile). For some people, radiotherapy causes changes that may get better with time. For others, the treatment they have to the pelvic area causes permanent infertility. 

    Before treatment, your team will explain any risks to your fertility. They will also give you information about persevering your fertility, if this is possible for you. This usually means collecting and storing sperm. We have more information about cancer treatment and fertility in men

How will I have pelvic radiotherapy?

You may have pelvic radiotherapy from outside the body, called external beam radiotherapy. Or you can have it from inside the body, 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.

Side effects of pelvic radiotherapy

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 have finished radiotherapy, side effects may get worse for a time before they get better. Usually, they gradually improve over a few weeks or months after treatment has ended.

Some possible side effects of pelvic radiotherapy are:

  • tiredness
  • effects on the skin in the area being treated
  • changes passing urine
  • bowel changes.

We have more information about side effects during pelvic radiotherapy.

Late effects of pelvic radiotherapy

Late effects are side effects that either:

  • start during or shortly after treatment and last for longer than 3 months – these are sometimes called long-term effects
  • do not affect you during treatment but begin months or even years later, as a delayed response to treatment.

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 changes in our information about the late effects of pelvic radiotherapy.

Many people who have pelvic radiotherapy never develop late effects. Or if they do, the late affects are mild and do not interfere with their daily lives. Newer ways of giving radiotherapy are designed to reduce the chance of developing late effects as much as possible.

If late effects develop, you can often have effective treatment. Or you can manage the effects to make them easier to deal with. Some late effects improve over time, and may eventually go away on their own.

Follow-up after pelvic radiotherapy

After radiotherapy has finished, your oncologist or radiographer will tell you about your follow-up care. It will depend on the type of cancer and the type of radiotherapy you had. Your follow-up care may involve one of the following:

  • No follow-up appointments 

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

  • Regular follow-up appointments

    You have regular appointments at the radiotherapy department, or your original hospital. The first appointment is usually 4 to 8 weeks after treatment finishes.

  • Follow-up by telephone 

    A nurse or radiographer will call to check how you are. If they are worried about anything, they will arrange an appointment for you at the clinic.

  • Patient led follow-up 

    You do not have set appointments, but can contact the team and 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.

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. You should do this at any time, even between appointments. Do not wait until your next scheduled appointment. You can just ask for an earlier one.

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 accept what you have experienced.

It may also take time to recover from treatment. You may feel tired for a while, and you may have lots of emotions to deal with. It is important to give yourself time to recover and adjust.

Getting support

Macmillan is here to support you. If you would like to talk, you can do the following:

Lifestyle changes

Even if you already have a healthy lifestyle, you may choose to make some positive changes after treatment. We have more information about a healthy lifestyle after treatment.

Your radiotherapy team can also give you advice about:

Looking after your pelvic floor muscles

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

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

Reducing the risk of lymphoedema

Lymphoedema is swelling that happens because of a build-up of fluid in the body’s tissues.

Surgery to remove lymph nodes, or radiotherapy to the lymph nodes can cause lymphoedema. If you have both treatments, the risk is higher.

We have more information about lymphoedema and reducing your risk.

Having sex after treatment

Your team may advise you to wait a few weeks after radiotherapy before having sex. This is to allow any irritation in the area and side effects to improve. Ask your doctor or nurse for advice about this, as 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 feelings about your body. If you are ready to have sex, take your time and make sure you are relaxed. Lubricants or creams may help to make penetrative sex feel more comfortable. If you have any problems that do not improve, talk to your cancer doctor or nurse.

We have more information about cancer and your sex life.