Having Radiotherapy treatment for Gynaecological cancer

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Why have I been given this information?

Your oncologist (specialist cancer doctor) has recommended that you would benefit from a course of radiotherapy treatment. Radiotherapy can be given on its own or together with other treatments, such as chemotherapy. This leaflet explains what radiotherapy involves, the possible side effects and support available.

What is radiotherapy?

Radiotherapy is a type of radiation treatment which uses high energy x-rays to kill cancer cells. It is given using a machine called Linear accelerator or Tomotherapy. 

Planning your radiotherapy treatment 

What pre-treatment preparation do I need to do?

For radiotherapy, we need to ensure that your internal organs are in the same position for every treatment. To do this we will need you to have a full bladder and empty bowels – please see daily  preparation for radiotherapy treatment leaflet provided.

You will need to lie down on your back for this scan. Using this scan, we will design the radiotherapy according to your individual anatomy and cancer.  

After the CT scan the radiographers will place some small permanent tattoo dots on your skin. These ’dots’ will be used to make sure you are in the same position each day for your upcoming radiotherapy treatment. 

How long will the CT scan take?

The CT scan will usually take about 30 minutes. However, you will be in the department for up to 2 hours. 

When will I start my treatment?

You treatment will start a few weeks after your planning CT scan. We will give you these dates after your scan. 

How often will I receive radiotherapy treatment?

Your consultant will tell you how many treatments you need. You will receive your radiotherapy treatment every day, Monday to Friday however your treatment may not start on a Monday. If your treatment is during a bank holiday you may need to be treated on a weekend or need 2 treatments in one day —we will let you know if this is the case.  

We make every effort to ensure your radiotherapy treatment continues as planned. However, on occasion, the radiotherapy machines may require essential maintenance or unexpected repairs. If this happens during your course of treatment, we may need to cancel your appointment for that day. If this is necessary, we will arrange an additional treatment session. 

What happens when I arrive at the department to start my radiotherapy treatment?

For each treatment session, you will need to arrive with a comfortably full bladder and an empty bowel, as you did for you planning CT scan.  

At each radiotherapy appointment you will need to check in at the radiotherapy desk and a member of the team will book you in.  

At each visit, the radiographers will take you into the treatment room and position you on the treatment couch as you were for the planning scan. The radiographers will explain what they need to do and may ask you to make small movements so that the marks that were put on your skin during the planning stage line up with laser lights in the treatment room. When they are happy with the position, the staff will leave the room to deliver the treatment. 

You will be alone in the room for a 5-10minutes while the radiotherapy machine is switched on. The radiographers can always see you when you are in the treatment room. If you have any problems, they will advise you to raise your hand for attention and they will come in to help you.

The machine will make mechanical noises when on, but it will not touch you or cause any pain.   

Who will support me during my treatment?

During your treatment, you will have weekly review appointments booked with a specialist radiographer who can answer your questions or give you advice if you have any concerns or problems. You can also speak to the radiographers who you see each for treatment. 

What are the side effects of radiotherapy?

Not everyone will experience the same side effects, or the same intensity. If you notice any changes please tell the radiographers and they will give you appropriate advice.

Early side effects start during radiotherapy or shortly after completing radiotherapy and usually resolve within two to six months of finishing radiotherapy

• Bladder symptoms – You may find you are emptying your bladder more often then usual and this may be accompanied by a burning sensation (cystitis). Drinking the recommended amount of fluid each day will help, however if you notice you are getting up more frequently at night then avoid drinking too much during the evening.  
•  Diarrhoea – Radiotherapy to the pelvis can irritate the bowel and cause diarrhoea, wind or stomach cramps. If this occurs during treatment the radiographers will give you advice on what medication you can take and may ask you to stop using your enemas. Increasing the amount of fluid you drink will ensure you do not become dehydrated. 
• Vagina – Your vagina may become irritated and cause discomfort such as inflammation and soreness. You may notice an increase in vaginal discharge or spotting. Pease let the radiographers know if the bleeding is heavy and/or  has an offensive odour. Do not use tampons, douches or talc, as they can could cause discomfort and · irritation.  If you wish to, it is ok to continue with sexual intercourse during treatment however, if it becomes uncomfortable or sore then discontinue. You will need to use contraception if you wish to continue sexual intercourse e.g. condoms.
• Piles/ Haemorrhoids – Patients who have a history of piles may experience a flare up. If this becomes painful please inform the radiographers.
•  Skin reaction – Your skin in the treatment area may become pink or, if you have more pigmented skin, it may become darker. You may develop dry and itchy skin. If a skin crease is included in the treatment, the skin may become very sore and broken. You can use a sodium lauryl sulphate (SLS) free moisturiser on the skin in the treatment area e.g. E45, Epaderm or Aveeno. But discontinue if skin breaks. The radiographer will give you advice on products to use if this occurs.
• Pubic hair loss – Pubic hair loss can occur about two to three weeks into treatment. This loss may be temporary or permanent. Your doctor will advise you if the lost hair is likely to re-grow or not.
•  Tiredness – (fatigue) is common. The tiredness will slowly improve after your treatment has finished. Research shows that gentle exercise is beneficial to help relieve fatigue, but take care and rest when you feel you need to. Speak to the radiographers if this is becoming a problem.
• Nausea – Radiotherapy to the abdomen and para-aortic nodes will cause you to feel sick (nausea) If you are having treatment in these areas  you will be prescribed anti-sickness medication.

Long Term Side effects

These side effects can occur many months or years after completing treatment and may be permanent.

•  Bladder/bowel symptoms – Some patients may have diarrhoea, loose stools, feeling of urgency, cramping and increased wind.  These side effects can usually be managed by simple measures such as low fibre diet and loperamide. In some cases you may find that you need to pass urine more often or become slightly incontinent (leaking urine). Rarely you may develop more severe side-effects such as bowel narrowing or fistula  (a hole forming between a loop of bowel or bladder and the vagina) Please report any changes to your team, so that you can be assessed and referred for specialist advice.
•  Vagina – When the vaginal tissue heals after radiotherapy, small scars and adhesions can form. The muscles supporting the vagina can also loose their flexibility and harden. This may result in the vagina becoming tighter and shorted, therefore making vaginal examinations and sexual intercourse difficult and uncomfortable. To help with this you will be given vaginal dilators at the end/follow up appointment. This helps in preventing scar tissue and adhesions forming thereby keeping your vagina as supple as possible. Your vagina may also feel dry due to the radiotherapy affecting cells that produce the natural lubricant, this can make sexual intercourse feel uncomfortable. You may use vaginal moisturiser and/or lubricants to help.
• Infertility – Radiotherapy will cause infertility, which means you can no longer become pregnant and your body will go in to menopause. If you are still having periods, they are likely to stop during or shortly after radiotherapy. However, it is advisable to use contraception e.g. condoms when resuming sexual activity in case you remain fertile.  
• Lymphoedma – If radiotherapy has been given to your lymph glands this can cause swelling of the legs. It is important to let your doctor know if you notice and swelling of you feet, legs or pelvic area after  you have completed radiotherapy.  
• Pelvic fracture – Radiotherapy can affect the density of the bones in the treatment area. It can cause fine, hair—line fractures with the pelvis which would normally heal up on their own with out any specific medication. A diet rich in calcium and vitamin D can be helpful.
• Second malignancy – The use of radiotherapy does carry a small risk of causing a new different cancer in the treated area. This is something that may happen many years later, but it is a small risk for most patients.  

It is important that you feel comfortable with what you have been told. If you have any further questions or concerns about your treatment, please contact your key worker or radiographers for further discussion/support. 

For emergencies out of hours contact your GP or call NHS 111.