Side effects of cervical cancer radiotherapy

You might have diarrhoea during your treatment. This is normal but can be unpleasant. Talk to the radiographers if you have diarrhoea. They will tell you how to manage it.

Feeling or being sick can start a few hours after treatment and last for a few days. Anti sickness injections and tablets can control it. Tell your doctor or nurse if you feel sick. You might need to try different anti sickness medicines to find one that works.

Tips

• Avoid eating or preparing food when you feel sick.

• Avoid foods that are fried, fatty, or have a strong smell.

• Drink plenty of liquid to stop you from getting dehydrated.

• Relaxation techniques help control sickness for some people.

• Ginger can help – try it as crystallised stem ginger, ginger tea or ginger ale.

• Fizzy drinks help some people when they’re feeling sick.

You might find that you have some stinging when passing water. You might also need to pass urine more often. This is normal but not very comfortable. Tell one of the radiographers if this happens. Make sure you are drinking plenty of water and other fluids.

Some people might have urine leakage or difficulty controlling their bladder. Learning pelvic floor exercises, re-training your bladder or following lifestyle changes can help. Speak to your doctor or specialist nurse. They can refer you to a physiotherapist.

After internal radiotherapy, you may have some bleeding from the vagina. This is usually when your doctor removes the applicators. Bleeding should clear up within 48 hours (2 days).

Tell your radiotherapy doctor or nurse if the bleeding becomes heavy or goes on for longer than this.

During your treatment the skin in the treatment area might become quite sore and red. This might include your vulva and the area around your back passage.

Use a moisturiser on the skin in the treatment area every day. This will help to keep the skin hydrated and more comfortable. Your radiographers will tell you which cream you should use. Don't use any other type of cream or lotion.

The skin reaction can look and feel like a burn, but it is inflammation due to the radiation. It usually starts about 5 to 7 days into treatment and continues for about 10 days after your last treatment. It then starts to improve.

Ask your radiographers for advice on how to manage the sore skin. There are things you can do to make yourself more comfortable.

Read more about radiotherapy and your skin

You might feel tired during your treatment. It tends to get worse as the treatment goes on. You might also feel weak and lack energy. Rest when you need to.

Tiredness can carry on for some weeks after the treatment has ended. But it usually improves gradually.

Various things can help you to reduce tiredness and cope with it, such as exercise. Some research has shown that taking gentle exercise can give you more energy. It's important to balance exercise with resting.

Get tips on coping with tiredness

Generally, radiotherapy can make body tissues tighter and less elastic. Doctors call this fibrosis. It can have some lasting effects, depending on the part of the body being treated. For example, it can cause skin thickening in the treatment area. 

Your skin might always be slightly darker in the area of treatment.

If you have not already had the menopause, your radiotherapy will cause an early menopause. The radiotherapy stops the production of sex hormones by the ovaries. The hormone levels start to fall from about 3 months after the start of treatment. It is still important to use effective contraception during this time. 

Your periods gradually stop, and you get symptoms of the menopause. The symptoms may be more severe than after a natural menopause. It may include:

• sweating – especially at night

• hot flushes

• mood swings

• irritability

• vaginal dryness

• lack of sex drive

• increased urgency to pass urine

You can take hormone replacement therapy (HRT) after treatment for most cervical cancers. There are gels and creams available that can help with vaginal dryness.

If you have already had your menopause, your ovaries will have stopped working before your treatment. So radiotherapy won't make as much difference to you.

Find out how to cope with menopausal symptoms

Radiotherapy will stop your ovaries from working. This means you will become infertile and will not be able to have children naturally. This can be very difficult to accept if you want to have children in future. Speak to your doctor before you start treatment if you are worried about this.

After your treatment, your vagina can become narrower and shorter. You might also have vaginal dryness. This can affect your sex life.

Your doctor will need to do a physical examination of your vagina during your follow up appointments. Using dilators can help to ensure you can still have sex and vaginal examinations comfortably. Dilators can help to prevent or minimise narrowing and stiffening of the vaginal tissues. So, it is important to start using them after your radiotherapy treatment. Your radiotherapy team will tell you how and when to start using dilators and suggest suitable lubricants.

Dilators

Dilators are tube shaped objects, made of plastic or metal. They come in different sizes. You gently put the dilator into your vagina for 5 to 10 minutes about 3 times a week. This stretches the vagina and helps to stop it from narrowing. It is important to be gentle and not force this. 

You could switch to a smaller size if you find it difficult to get the dilator in. You might find it easier with a water soluble lubricant such as Astroglide, Durex lube or KY jelly. Some people may find an oil based lubricant such as Yes OB better. Unfortunately, these are not available on prescription. You can buy them directly from the company or shops.

You can use the dilator in the bath if you prefer. You can also use a moisturiser such as Replens 2 or 3 times a week. 

If you find the dilator you have been using is getting a tighter fit, you may need to use it more often. You can talk to your doctor or nurse about this. You may have slight bleeding or spotting after using your dilator. This is normal.

However, it isn't normal to have heavy bleeding or pain. Contact your doctor or nurse If you have either of these.

You usually start using your dilator around 4 weeks after your radiotherapy ends. This varies depending on your radiotherapy centre. Your doctor might advise you to use the dilators for 2 years or more, even if you are sexually active.

This is not a common side effect, but sometimes one or both legs can swell if you have radiotherapy to the lymph nodes. Some people might have swelling of the genitals. This swelling is called lymphoedema. 

Tell your specialist straight away if you think either of your legs are getting swollen. You will need to see a lymphoedema specialist. The sooner they diagnose lymphoedema, the easier it is to treat.

Find out more about lymphoedema

You may have some permanent effects from your treatment. This doesn't happen to everyone. It's difficult to predict who is going to have a problem. 

After any type of radiotherapy for cancer of the cervix, you might find that you have to pass urine more often. The treatment can make the bladder less elastic. So it won't stretch as far and feels full sooner. You may also be more prone to urine infections.

You might have some permanent bowel effects from your treatment. This doesn't happen to everyone. It's difficult to predict whether you will be affected or not.

You may have loose or more frequent bowel motions. This is because the radiotherapy irritates the lining of the bowel. Tell your doctor if you are troubled by these side effects. You might be able to take medicine to firm up your bowel motions and make them less frequent.

In rare cases, radiotherapy can cause constipation, pain, sickness and bloating. Contact your doctor if you have these symptoms. Your doctor needs to check your bowel for a possible blockage.

Occasionally, radiotherapy to the pelvis can cause bleeding. This will show up in your bowel movements or urine, or from your vagina. It is usually caused by an increased growth of small blood vessels in that area after the treatment.

If you notice this, tell your doctor. Your doctor may call this problem telangiectasia (pronounced teel-an-gee-ek-tay-zee-a).

Some people with piles may find that their piles come back after radiotherapy.