The side effects of having radiotherapy for vaginal cancer can include diarrhoea, tiredness and skin soreness. There are immediate side effects and long term side effects.
Immediate side effects
You start to develop side effects during your treatment. When they start exactly depends on the type of radiotherapy you are having and your plan of treatment. Side effects tend to get worse as treatment progresses and can continue after your treatment ends. But they usually begin to improve after 1 or 2 weeks.
Everyone is different and the side effects vary from person to person. You might not have all of the effects mentioned.
Let your doctor know if you have diarrhoea. They might give you medicines to help control it. Drink plenty of fluids to replace the liquid you have lost.
Radiotherapy can make the lining of the bladder inflamed. This is called radiation cystitis.
It can make you very uncomfortable. You might have a lot of bladder pain and feel as though you need to pass urine all the time, even though you know you’ve only just been. Try to drink plenty of fluids because this will help.
Speak to your doctor or nurse if you have this.
During external radiotherapy, your vagina or skin in the treatment area is likely to become sore. Radiotherapy machines and techniques have improved significantly and side effects are less than they used to be. But this is a sensitive part of the body, so some soreness is difficult to avoid.
In mild cases, you might have some soreness and reddening, similar to mild sunburn. With a more severe reaction, the area might actually break down and weep.
Your nurse, radiographer or specialist will check the area and help you look after it. They might prescribe a steroid cream to put on. You can have painkillers if you need them.
Don't use any lotions, powders or creams on the treatment area without checking with your radiotherapy department first. Your radiotherapy team will give you advice at the start of your treatment about what creams to use to keep your skin moisturised. This helps to minimise the risk of side effects. This applies to both external radiotherapy or internal radiotherapy.
Ask the staff in the radiotherapy department if there is anything you can use to soothe the area if you need to. You can help to reduce any soreness by:
- not soaking in the bath for long periods of time
- patting skin dry with a towel rather than rubbing it
Your treatment might be stopped for a week or two if your skin reaction is very bad.
You might have some sickness if you have external radiotherapy to the lower part of the tummy. But this is not common.
Tell your radiographer, nurse or doctor if you feel sick. They can arrange for you to have anti sickness tablets before your treatment.
You might get tired during radiotherapy and this can last for some weeks after treatment.
Allow time during the day to rest.
When you have finished treatment, it might help to build up your activity levels slowly. You might have to wait for your vagina to heal properly following internal radiotherapy. Ask your doctor or nurse for advice.
Long term side effects
Most side effects gradually go away in the weeks or months after treatment. But some side effects can continue or might start some months or years later. Some changes can be particularly difficult to cope with.
Radiotherapy will stop your ovaries working if you have not had your menopause. So you will have 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. You can take hormone replacement therapy (HRT) to replace the hormones that the ovaries made.
You will no longer be able to become pregnant. This can be hard to come to terms with if you still hoped to have a family.
Radiotherapy can make scar tissue form. This is more fibrous than healthy tissue, so it’s stiffer and less stretchy. Scar tissue could form around the outside of your vagina and this might narrow the entrance. You may then find that penetrative sex can be painful.
To prevent narrowing, your specialist nurse will teach you to stretch the vaginal opening with dilators. You usually start using them between 2 to 8 weeks after your radiotherapy ends. This depends on the practice of your radiotherapy centre.
The dilators are smooth cone shaped objects that you put into your vagina to stretch it. They come in sets of different sizes. You use them daily or 3 times a week to start with, for 5 to 10 minutes each time. You use them with a water soluble gel, such as Astroglide or Durex lube. These gels can also help with vaginal dryness.
You start with one of a comfortable size and gradually use larger ones until your vagina is stretched enough for you to have sex comfortably.
Your doctor, nurse or radiographer can give you a set of dilators. Moisturisers such as Replens can also help, you use these 2 or 3 times a week.
If you are sexually active, you might like to involve your partner in using the dilators or have regular sexual intercourse.
It is normal not to feel like having sex for a while after treatment, so don't worry if you wait for a while. In this situation, it is important to keep your vagina open by using dilators.
The radiotherapy may cause tiny cracks in the bones over many years. This can cause pain in the pelvic area or stiff hip joints.
Let your doctor or specialist nurse know if you have pain in your pelvic bones. Very rarely, the pelvic bones might develop a break (fracture), which may need to be repaired with surgery.
Treatment can make the bladder less elastic. It won't stretch as far and feels full sooner. So you may find that you have to pass urine more often. This doesn't happen to everyone.
Radiotherapy can irritate the lining of the bowel. As a result, you might have loose bowel motions and they may be more frequent. Tell your doctor if this happens. You can take medicine to firm up your bowel motions and make them less frequent.
Some people could have the opposite effect and find it more difficult to have their bowels open. Talk to your doctor if you become constipated. They might need to check your bowel for a possible blockage.
You can take medicine to relieve constipation if a blockage is not the cause. A diet higher in fibre and drinking plenty of fluids might also help.
Sometimes, radiotherapy to the pelvis can cause bleeding. This will show up in your bowel movements or urine. This can be worrying, but it is not often serious.
Over a period of time, the radiotherapy causes an overgrowth of small blood vessels. As they are delicate and near the skin surface, they are more likely to bleed. Do tell your doctors so that they can check that the bleeding isn't caused by anything else.
Generally, radiotherapy tends to make body tissues in the treatment area less stretchy and more fibrous. You may have tightening or thickening of the skin.
One or both legs can swell (lymphoedema) if the radiotherapy affects the lymph nodes in the groin. It stops fluid from being able to drain out of the legs. In advanced vaginal cancer, this swelling is sometimes caused by the cancer, rather than treatment.
If you think you are developing swelling, tell your specialist or your nurse straight away. They can refer you to a lymphoedema specialist for assessment. The sooner it is diagnosed, the easier lymphoedema is to treat.
Severe side effects
Very rarely, where immediate side effects are particularly severe, your doctor may want to stop treatment to allow you to recover. If you’re troubled by short term or long term side effects, do speak to your radiographer, nurse or specialist. They will be able to help you.