Possible side effects of radiotherapy for cervical cancer

You may develop side effects during radiotherapy. These usually improve in the weeks and months after treatment finishes. Your team will discuss this with you. Tell them about any side effects. There are often things that can help.

Side effects may include:

  • skin changes
  • tiredness
  • stomach cramps or diarrhoea
  • low numbers of red and white blood cells – you will have regular blood tests if needed
  • a burning feeling when you pass urine or feeling like you want to pass urine more often
  • vaginal discharge.

Radiotherapy can sometimes cause side effects months or years after radiotherapy treatment. These may include:

  • changes to the vagina, bowel or bladder
  • lymphoedema (swelling) in one or sometimes both legs
  • thinning of the bone in the pelvis.

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, and there are lots of ways to manage them.

Side effects of radiotherapy

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. 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. Organisations such as QUIT can also offer advice and support.


Skin changes

Your skin in the area being treated may get dry and irritated. Avoid perfumed soaps or body washes during your treatment. They could irritate your skin. You will be given advice on looking after your skin. Your doctor, radiographer or nurse can give you 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 before.


Tiredness

This is a common side effect. It may continue for some months after treatment is over. During treatment, you may need to rest more than usual. But it is good to do gentle exercise, such as walking, when you feel able. Once your treatment is over, gradually increase your activity. Try to balance rest periods with exercise such as walking. This will help build up your energy levels.

You are just lying there during radiotherapy and almost feel like nothing is happening, but it really drains your energy.

Nisha


Bowel changes

Radiotherapy to the pelvis may irritate your bowel and cause tummy (abdominal) cramps. If you have cramps, tell your doctor, nurse or radiographer. They can give you medication to help.

You may need to open your bowels more often and you may have diarrhoea. Drink plenty of fluids if you have diarrhoea. Your doctor may also prescribe medication to help manage it. Your doctor, nurse or radiographer may suggest you follow a low-fibre diet. This means avoiding:

  • wholemeal bread and pasta
  • raw fruit
  • cereals
  • vegetables

during treatment and for a few weeks after it.


Changes in your blood

External radiotherapy can reduce the number of blood cells made by your bone marrow. This is more likely to happen if you are having chemoradiation. If your white blood cells are low, you are more prone to infection and may need antibiotics. If your red blood cell count is low, you may feel tired and you may need a blood transfusion. Your hospital team will arrange for you to have regular blood tests if needed.


Bladder changes

Radiotherapy can irritate the bladder. You may feel like you need to pass urine more often. You may also have a burning feeling when you pass urine. Your doctor can prescribe medicines to make passing urine more comfortable. Try drinking at least 2 litres (3½ pints) of water or other fluids each day to help with the symptoms.


Vaginal discharge

You may have a light vaginal discharge after treatment has finished. If it continues or becomes heavy, tell your clinical oncologist or specialist nurse.


Possible late effects

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

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.


Late 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 no strong evidence about how effective they are. Rarely, they may cause damage to the vagina, especially if they are not used correctly. Your specialist nurse or doctor will explain the best way to use them.

Vaginal dryness

This can feel uncomfortable, particularly during sex. Creams, gels, lubricants or pessaries (small pellets that are put inside 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.

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 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, so 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, you may find that it does not trouble you much once you know the cause.


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 or bowel movements. 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. You can reduce the risk of lymphoedema by:

  • taking care of the skin on your feet and legs
  • avoiding cuts and insect bites on your feet and legs
  • treating any cuts, bites or grazes promptly
  • seeing your GP without delay if you have any signs of infection in your feet or legs
  • doing regular, gentle exercise such as walking
  • keeping to a healthy weight.


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.

Back to Radiotherapy for cervical cancer explained

Before your radiotherapy

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

Your radiotherapy team

You will meet many different specialists from your radiotherapy team. You may see them before, during and after radiotherapy treatment.

After treatment

It can take time for your body to recover after finishing treatment. Advice and support is always available.