What is radiotherapy?

Radiotherapy treats cancer by using high-energy x-rays. These destroy cancer cells, while doing as little harm as possible to normal cells.

Radiotherapy for womb cancer can be given in different ways:

  • External-beam radiotherapy – radiotherapy is given from outside the body (externally) from a radiotherapy machine.
  • Internal radiotherapy – radiotherapy is given from inside the body.

Some women may have radiotherapy with chemotherapy. This is called chemoradiation. Your cancer doctor can discuss these treatments in detail with you.

When radiotherapy is used for womb cancer

You may have radiotherapy:

  • after surgery, to reduce the risk of the cancer coming back (called adjuvant radiotherapy)
  • instead of surgery, if a general anaesthetic or an operation is not suitable for you
  • to try to cure cancer that has come back after surgery (recurrent cancer)
  • to treat cancer that was not completely removed with surgery.

Before your radiotherapy, your radiotherapy team will explain what your treatment involves and how it may affect you.

We have more information about what happens before and after radiotherapy, and questions you may want to ask.

Radiotherapy after surgery

Your cancer doctor may talk to you about having radiotherapy after surgery. This is to reduce the risk of the cancer coming back in the pelvic area. Your specialist team will look at the stage, grade and type of womb cancer you have before discussing this with you.

Many women with stage 1 cancer will not need radiotherapy. But some women have a higher risk of the cancer coming back. In this situation, your doctors may suggest you have radiotherapy to reduce your risk. Most women with stage 2 or 3 womb cancer are recommended to have radiotherapy after surgery.

Your specialist will talk to you about the benefits and disadvantages of radiotherapy in your situation. They will explain the side effects you are likely to get and the possible long-term effects.

Radiotherapy to control symptoms

If the cancer has spread in the pelvic area or to other parts of your body, such as the bones, you may have radiotherapy to shrink the cancer or to control the symptoms. This is called palliative radiotherapy. It will be planned to ensure that you have as few side effects as possible.

Possible side effects of radiotherapy for womb cancer

You may develop side effects over the course of your treatment. These usually improve 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. There are often things that can 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 side effects of radiotherapy are made worse by smoking. If you smoke, stopping smoking will help.

Skin changes

The skin in the area being treated sometimes gets dry and irritated. Avoid using perfumed soaps or body wash during treatment, as they could irritate the skin. You will 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 it may be thinner than it was before.

Tiredness

Tiredness is a common side effect and may continue for months after treatment is over. During treatment, you will need to rest more than usual, especially if you have to travel a long way for treatment each day.

We have more information about tiredness.

Bowel changes

Radiotherapy to the pelvis may irritate the bowel and cause diarrhoea and soreness around the back passage. Your doctor can prescribe medicine to help. Eating a low-fibre diet may help reduce diarrhoea. You should also drink plenty of fluids.

Bladder changes

Radiotherapy can irritate the bladder. You may feel like you need to pass urine (pee) more often. You may also have a burning feeling when you pass urine. Your doctor can prescribe medicines to make passing urine more comfortable.

Vaginal discharge

You may have a slight vaginal discharge after treatment has finished. If you are worried about this, or if it continues or becomes heavy, talk to your specialist nurse or cancer doctor.

Possible late effects of radiotherapy for womb cancer

Radiotherapy to the pelvic area can sometimes cause problems months or years after treatment. These are called late effects. These may be permanent. If they happen, there are lots of ways to manage or treat them.

It is always important to tell your GP or cancer doctor about any new symptoms that develop a long time after treatment. They need to be investigated, as they may not be caused by radiotherapy.

Effects on the vagina

Radiotherapy can make your vagina narrower and less stretchy. The vaginal walls may be dry and thin, and can stick together. This can make penetrative sex and internal examinations uncomfortable.

Your hospital team may recommend you use vaginal dilators to help. Dilators are tampon-shaped plastic tubes of different sizes, which you use with a lubricant.

Although dilators are commonly used, there is not strong evidence about how effective they are. Your specialist nurse or doctor will explain the best way to use them.

If your vagina is dry, moisturising creams or lubricants designed to be used in the vagina can help. There are lots of products you can try. You can buy them in chemists or online. Or your doctor can prescribe them.

Vaginal moisturisers work by drawing moisture into the vaginal tissue. You apply them regularly. You can also use lubricants when you have sex to make it feel more comfortable and pleasurable. Lubricants can be water-based, silicone-based or oil-based. You can buy them from chemists, some supermarkets or online.

Vaginal dryness can make you more likely to get infections, such as thrush. Let your doctor know if you have symptoms such as itching or soreness.

Vaginal bleeding

After pelvic radiotherapy, the blood vessels in the lining of the vagina can become fragile. This means they can bleed more easily, especially after sex. Bleeding may also be caused by the vaginal tissue sticking together, or scar tissue causing the vagina to narrow.

If you have any bleeding, always let your cancer doctor or nurse know. They will examine you and explain whether it is likely to be caused by the radiotherapy. If the bleeding is minor, once you know the cause you may find that it does not trouble you much.

Bowel or bladder late effects

After radiotherapy, some women may develop changes to the bowel or bladder. It is common to have some mild changes, but much less common to have severe side effects that affect your quality of life. If this happens, symptoms may develop months or sometimes years after radiotherapy treatment.

If your bowel is affected, you may have to go to the toilet more often or more urgently than usual, or you may have diarrhoea.

If the bladder is affected, you may need to go to the toilet more often or more urgently.

The blood vessels in the bowel and bladder can become more fragile. This can cause blood in your urine (pee) or bowel movements (poo). If you have bleeding, always tell your cancer doctor or GP so that it can be checked.

Lymphoedema

Pelvic radiotherapy may increase the risk of swelling in one or both legs. This is called lymphoedema. It is not common, but the risk is higher if you have surgery to remove the lymph nodes as well as radiotherapy. We have more information about how you can reduce the risk of lymphoedema.

Late changes to the pelvic bones

Radiotherapy can cause thinning of the bone in the pelvis. This often does not have any symptoms, but is seen on scans. In some women it may cause fractures in the pelvis called insufficiency fractures. These can cause pain in the lower back or pelvis. If this happens, it can be treated with painkillers and physiotherapy.