Radiotherapy for womb cancer
Radiotherapy treats cancer by using high-energy x-rays. It destroys cancer cells in the area where the radiotherapy is given.
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
- A combination of both.
Sometimes you have radiotherapy with chemotherapy. This is called chemoradiation. Your cancer specialist will discuss your treatments with you.
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 a 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 specialist 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.
Some people with early stage cancer may not need radiotherapy. But your doctor may suggest having radiotherapy if you have a slightly higher risk of the cancer coming back. This can help to reduce your risk. Most people with stage 2 or 3 womb cancer are advised to have radiotherapy after surgery.
Your specialist will explain 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, you may have external beam radiotherapy to shrink the cancer or to control the symptoms. For example, you may have this treatment if the cancer has spread in the pelvic area, or to other parts of your body such as the bones. This is called palliative radiotherapy. It is planned carefully so that you have as few side effects as possible.
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Internal radiotherapy is also called brachytherapy. It gives a high dose of radiotherapy directly to the top of the vagina (where the womb was before surgery to remove it). It also gives a high dose to the area close by. You may have internal radiotherapy on its own. Or you may have it at the end of your external radiotherapy treatment. You usually have it as an outpatient.
The treatment is given by placing hollow tubes (applicators) into the vagina. The radiotherapy is given through these tubes.
After the applicators are in place, they are connected to the brachytherapy machine. The machine is operated by a radiographer or physics technician. It places a radioactive capsule (source) into the applicators. The machine then gives the planned dose of radiation. When the treatment is finished, the radioactive source goes back into the machine. The nurses will then take out the applicators and you can go home.
If you still have a womb, you may have a slightly different type of internal treatment. It involves putting an applicator into the womb as well as the vagina. This is done under a general anaesthetic or sometimes a spinal anaesthetic. Your doctor or nurse can explain more about how it is given.
There are different ways of giving internal radiotherapy. It can be given over several sessions or one longer session. Your cancer doctor and nurse specialist will explain about your treatment, and what to expect.
External radiotherapy uses a machine like a big x-ray machine, which produces high-energy rays. A radiographer gives you the treatment in the radiotherapy department at the hospital. You have it as an outpatient once a day from Monday to Friday, with a rest at the weekend. Each session of treatment usually takes just a few minutes. A full course may last up to 5 to 6 weeks.
External radiotherapy is painless. It will not make you radioactive. It is safe for you to be around other people, including children and pregnant women.
Your radiotherapy is planned by your clinical oncologist and a technical team. They will plan your treatment, so it does as little harm as possible to normal cells.
Your radiographer will explain what you will see and hear. The radiotherapy machine will move around you, but it does not touch you. The treatment is painless. Once you are comfortable in the correct position, they will ask you to keep as still as possible. They will leave the room for a few minutes while you have your treatment. There will be a camera so they can see you and hear you if you need to talk to them.
You may develop side effects over the course of your treatment. These usually improve over a few weeks or months after treatment finishes. Sometimes you may notice the side effects get a little worse for a short time after finishing treatment, before they start to get better.
If you are having only internal radiotherapy, it is not common to get side effects. You may feel some discomfort when the tube is placed into the vagina. But your doctor or nurse will use some gel to numb the area. The treatment only affects a very small area in the top of the vagina. This means it is not likely to cause any long-term side effects, for example to your bladder or bowel. But you may notice some effects to the vagina and your sex life after treatment.
External radiotherapy causes more side effects than internal radiotherapy.
Your doctor, nurse or radiographer will explain what to expect. Tell them about any side effects you have during or after treatment. There are often things that can help.
The side effects of radiotherapy are made worse by smoking. If you smoke, stopping smoking will help. If you want help or advice on how to give up, talk to your clinical oncologist, GP or a specialist nurse.
The skin in the area that is treated may:
- feel sore or itchy.
Your radiographer or specialist nurse will give you advice on taking care of your skin. If your skin becomes sore or itchy or changes colour, tell them straight away. They can give you advice and treatments if needed.
Skin reactions should get better within 4 weeks of treatment finishing.
During your treatment, you are usually advised to:
- wear loose-fitting clothes made from natural fibres, such as cotton
- wash your skin gently with mild, unperfumed soap and water and gently pat it dry
- avoid rubbing the skin
- avoid wet shaving
- avoid hair-removing creams or products, including wax
- follow your radiotherapy team’s advice about using moisturisers
- protect the treated area from the sun.
Effect on pubic hair
You may lose some of your pubic hair. After treatment, it usually grows back, but may be thinner than it was before.
Radiotherapy often makes people feel tired. Tiredness may get worse as treatment goes on. If you are having radiotherapy alongside other treatments, such as surgery or chemotherapy, you may feel more tired. But there are things you can do to help, such as:
- get plenty of rest
- do some gentle exercise, such as short walks
- eat a healthy diet and drink plenty of fluids
- ask others for help with everyday jobs.
After treatment finishes, you may continue to feel tired for weeks or months. If it does not get better, tell your cancer doctor or specialist nurse.
We have more information about coping with tiredness (fatigue).
Radiotherapy to the pelvis may irritate the bowel. It can cause diarrhoea and soreness around the back passage.
Your doctor can prescribe medicine to help. Eating a low-fibre diet during treatment and for a few weeks afterwards may help reduce diarrhoea. You should also drink plenty of fluids.
Radiotherapy can irritate the bladder. This can make you want to pass urine (pee) more often and causes a burning feeling when you pass urine. Your doctor can give you medicines to help. Drinking at least 2 litres (3 ½) of fluid a day will also help.
Your doctor may ask you to give a urine sample. This is to check you do not have a urine infection.
You may have a small amount of 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.
Radiotherapy to the pelvic area can sometimes cause problems months or years after treatment. These are called late effects. Some of these may be permanent, but 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 checked, as they may not be caused by radiotherapy.
Effects on the vagina
Radiotherapy can make the 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 prevent narrowing. Dilators are tampon-shaped plastic tubes of different sizes, which you use with a lubricant.
Your specialist nurse or doctor will explain the best way to use them.
Radiotherapy can also cause vaginal dryness. This can feel uncomfortable, particularly during sex. Creams, gels or lubricants can help.
There are lots of products you can try. You can buy them at a pharmacy or online, or your doctor can prescribe them.
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 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. Tell your doctor if you have symptoms such as itching or soreness.
After pelvic radiotherapy, the blood vessels in the lining of the vagina can become fragile. This means they can bleed more easily after sex or after using the vaginal dilators. Bleeding may be caused by:
- vaginal tissue sticking together
- scar tissue causing the vagina to narrow.
If you have any bleeding, always tell your cancer doctor or nurse. They will examine you and explain whether it is likely to be caused by the radiotherapy. If the bleeding is minor, you may find that it does not trouble you much when you know the cause.
Bowel or bladder changes
After radiotherapy, you 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 your bladder is affected, you may need to pass urine more often or more urgently.
The blood vessels in the bowel and bladder can become more fragile. This can cause blood in your urine or stools. If you have bleeding, always tell your cancer doctor or GP so it can be checked.
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.
If you develop lymphoedema, you can be referred to a lymphoedema specialist to help manage it. We have more information about how you can reduce the risk of lymphoedema.
Changes to the pelvic bones
Radiotherapy can cause thinning of the bones in the pelvis. Often this does not have any symptoms, but is seen on scans. Sometimes it may cause fractures in the pelvis called insufficiency fractures. These can cause pain in the lower back or pelvis. If this happens, your doctor can give you painkillers to help. You may also be referred to a physiotherapist.
Below is a sample of the sources used in our womb cancer information. If you would like more information about the sources we use, please contact us at email@example.com
Concin et al. ESGO/ESTRO/ESP guidelines for the management of patients with endometrial carcinoma. International Journal of Clinical Oncology. 2021. Available from www.pubmed.ncbi.nlm.nih.gov/33397713/
Royal College of Radiotherapy: Clinical Oncology. Radiotherapy dose fractionation, third edition. 2019. Available from www.rcr.ac.uk/publication/radiotherapy-dose-fractionation-third-edition
Sundar et al. BGCS uterine cancer guidelines: Recommendations for practice. European Journal of Obstetrics & Gynecology and Reproductive Biology. 2017. Available from www.bgcs.org.uk/wp-content/uploads/2019/05/BGCSEndometrial-Guidelines-2017.pdf
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 Senior Medical Editor, Professor Nick Reed, Consultant Clinical Oncologist.
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