Our patient information leaflets provide guidance and advice to patients, carers and visitors on a number of services that we deliver.
Each leaflet is reviewed every three years so that readers have up to date information.
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Patient information leaflets
Important: Please tell us if you have a cardiac device as we will need to monitor your heart during your treatment.
Please let us know if you are pregnant or think you might be pregnant.
It is important to remember that you need to use contraception whilst receiving treatment for cancer in order to prevent pregnancy – please see our leaflet ‘Avoiding pregnancy during radiotherapy and chemotherapy’.
Introduction
You will have been provided with this booklet following a discussion with your Clinical Oncologist about receiving radiotherapy to the pelvis for gynaecological cancers such as cancer of the womb, cervix or vagina.
This booklet describes:
Depending on the type and stage of the cancer, radiation therapy (external beam and/or brachytherapy) may be used alone or in combination with other treatments such as surgery and/or chemotherapy. Although there will be some side effects, the advantages will outweigh the disadvantages for you.
The doctor or gynae specialist radiographer will discuss your treatment with you and explain anything you do not understand. Please share this booklet with your family and friends.We understand that this can be an anxious time for patients. You may feel overwhelmed with lots of information in a short period of time. We hope that this booklet answers some of your questions about the radiotherapy and your care during this time.
This booklet deals with the physical aspects of your treatment, but your emotional wellbeing is just as important. Having treatment can be distressing for some patients. If you require further medical or emotional support, you can be referred to a variety of health professionals specialising in different areas. All the staff are here to make sure your treatment goes as smoothly as possible and to support you. We will try to help you with any questions or problems you may have.
The diagrams below show the normal anatomy of the female pelvis and may be useful to help you understand where your cancer is and the area to be treated with radiotherapy. Your doctor may draw on these diagrams to help explain your treatment. If you have had surgery your anatomy will be different depending on what procedure you have had.
Normal Female anatomy
What is Radiotherapy?
Radiotherapy is the use of radiation to treat cancer and is a very common form of treatment for gynaecological cancers. It is often used in combination with surgery and chemotherapy. Your clinical oncologist (specialist cancer doctor) will discuss the best treatment plan for you and your type of cancer. Radiotherapy may be given in different ways: externally, internally (called brachytherapy) or a combination of both.
Radiotherapy uses radiation (high energy x-rays) to treat cancer. The radiation only damages the cells within the treatment area, killing the cancer cells but allowing normal healthy cells to recover. Any side effects of radiotherapy are usually confined to the area being treated. In the long term you will be cared for by your oncology team. This is to assess both your recovery and treatment and your response to treatment. Treatment is given over a prescribed number of days/weeks so that only small doses (fractions) of radiation are given at a time.
Radiotherapy is a quick and painless procedure. It does not leave you radioactive-therefore you are safe to be around children and pregnant women and carry out your daily routine without worry.
Radiotherapy is given daily, Monday to Friday, with breaks at the weekend. The treatment will take around 15-30 minutes each day. Your radiotherapy course can vary in length. The duration is decided by your consultant and will have been explained at your initial consultation.
It is very important that you attend all your treatment appointments daily.
Please also note that the radiotherapy team work in pairs and is comprised of both male and female staff, therefore we cannot guarantee that a ‘female or male staff only’ request can be met. Unfortunately we do not have chaperones available. If you feel you need gender specific staff it is likely that you will have to wait until after your scheduled appointment time for us to accommodate your request.
St Bartholomew’s Hospital is a teaching centre, and we often have radiotherapy students within the department who may be present during your treatment. They will always be supervised by the qualified radiographers who are delivering your treatment.
During your treatment you will be seen by a Gynae advanced practitioner radiographer. They will provide information and advice on any practical, financial, or emotional concerns you may have during your treatment. You can speak to them at any point during your treatment; their number is at the end of this leaflet.
You will have been given a leaflet called preparation for radiotherapy treatment at the initial appointment / time of consent by the Gynae advanced practitioner radiographer. You must follow the advice in this leaflet to help prepare your bladder and bowels for the planning CT scan appointment.
Radiotherapy planning appointment
The radiotherapy department can be found in the basement of the King George V Wing (KGV) at St Bartholomew’s Hospital.
On your arrival for radiotherapy please check in at the radiotherapy reception desk. You will be given a questionnaire to fill in while you wait (it should take 5-10 minutes to complete. Please complete this as it provides staff with important information about you. A radiographer will come and collect you from the waiting room, when they are ready for you, and will go through the questionnaire with you.
At this planning appointment the radiographers will explain to you in more detail what is going to happen. They will ask you to confirm your name, address and date of birth. You will be asked for this information before every procedure or treatment undertaken in the department.
They will also discuss with you;
It is very important that you are NOT and DO NOT become pregnant while undergoing radiotherapy planning and treatment as the treatment would be harmful to the unborn child.
You must let the radiographers know immediately if you think you may be pregnant at any time during your course of treatment.
Contrast dye
It may be necessary to have a contrast injection for your CT scan. The contrast agent is a type of dye that helps us get a better understanding of the internal structures of your body.
A liquid dye called Omnipaque will be injected into a vein in your arm via a canular. This allows us to see your blood vessels during the CT scan and will provide clearer pictures for your doctor to plan your radiotherapy treatment.
Your doctor will discuss this with you and may send you to have a blood test before your planning appointment.
Using the dye does not usually cause any problems for patients. However, some people can experience side effects. The most common side effects are a general sensation of warmth in your body and/or a metallic taste in your mouth during the contrast injection. The planning radiographer will monitor you after your CT scan to make sure you feel well after the contrast injection, and they will also remove the canular.
It is sometimes not possible to use the contrast injection for medical reasons, or if access to your veins is not successful. In this situation the CT scan will be performed without the contrast injection.
During the planning scan
Your treatment must be carefully planned. To plan your radiotherapy treatment, we carry out a radiotherapy planning CT (computerised tomography) scan of your pelvis. This scan locates the exact site of the area to be treated in relation to surrounding normal tissues. This planning CT scan is taken with you in the same position required for treatment, which is different from the position used for standard CT scans.
CT Scanner- Siemens – healthineers.com
Your planning scan will take place in the CT (computerised tomography) scanner.
For this appointment you will be asked to use an enema and drink some water to ensure your internal organs are in the correct place to plan your radiotherapy treatment. Your radiographer will explain this to you on the day of your scan. You will then be asked to change into a gown and remove all of your clothes from the waist down. We do provide the gown but please be aware that it will have to be removed for the scan and treatments, but we will keep you covered as much as possible.
You will be positioned on the scanner couch, lying on your back with supports under your head, knees and ankles, with your arms across your chest or above your head. The radiographers will ensure your body is straight. The radiographers will make you as comfortable as possible, as it is important that you are able to lie very still.
Once you are lying on the couch the radiographers will take some measurements and draw some pen marks on your skin. The pen marks will wash off when having a bath or shower but please do not scrub at them.
The radiographers will leave the room and the scan will then take place. The bed will move in and out of the machine a few times during the scan. You will hear a buzzing noise, but the scan is not painful at all.
The scan will take about five minutes. During this time, you can breathe normally.
Once the scan has been completed the radiographers will, with your permission, make three or more very small, permanent marks on your skin (tattoo); one in the centre of the pelvis and one on either side of the pelvis. You may also need one in the middle of your abdomen. These marks are permanent and are done by placing ink on the skin and then gently scratching the surface of the skin with a fine needle. These marks are necessary to ensure that you are positioned correctly when you attend for your treatment appointments.
The radiographers will then provide you with an appointment card with the time and date of your first radiotherapy treatment. This is usually about 1-2 weeks after your planning scan as we need to allow time for your individual treatment plan to be created and checked.
What will happen on my first day of radiotherapy treatment?
Please make your way to the radiotherapy reception and check in at the desk. When the radiographers are ready one of them will discuss your treatment with you and how to minimise and manage the associated side effects. It is also an opportunity for you to ask any questions that you might have. The radiographer will provide you with a list of all your further appointment dates and times.
What preparation will I need to do for my treatment?
You will need to have an empty bowel and a full bladder for every treatment just like you did for your planning scan. The radiographers will provide you with a preparation card which states the times when you will need to prepare your bowels and bladder.
To prepare your bowel you will need to use an enema even though you may have already opened your bowels at home. If you are experiencing diarrhoea, then please inform the radiographers and they can advise on the enema usage.
To prepare your bladder you will need to drink several cups of water (available in the waiting room) before you are called for treatment.
It is important you have an empty bowel and comfortably full bladder as this reduces the radiation dose to the bowel and bladder and ensures your anatomy is the same as it was when your treatment was planned, which is important for accuracy.
When the radiographers are ready to treat you they will ask you to get changed in one of the changing cubicles. Please remove all of your clothing, except underwear, from the waist down and put on the gown provided. You can store your belongings in the changing room (this room can be locked). The radiographers will then take you into the treatment room where you will meet other members of the treatment team who will introduce themselves to you.
Radiotherapy treatment is given on a machine called a linear accelerator - often known as a Linac
Linear accelerator (Linac) - image supplied Courtesy of Varian.
The couch will be set up for you as it was at your planning scan. The radiographers will ask you to lie down on the couch and the lights will be dimmed. They will then position you in the correct position for treatment by aligning your permanent marks with special laser lights. During this time try your best to just relax, breathe normally and let the radiographers move you without helping them.
Once you are in the right position the Linac will then move around you. It can come close to you, but it will not touch you.
The radiographers will leave the room at this point; you will hear an alarm noise as they leave. Although you are in the treatment room on your own there is CCTV in the room so that the radiographers can see you and the machine at all times. If you need the radiographers at any point during your treatment we ask that you remain lying but raise your hand clearly and the radiographers will stop the treatment and come to check that you are alright.
You will not feel anything from the treatment, and you can breathe normally throughout. However, it is extremely important that you remain very still throughout the whole procedure.
A series of images are taken before your treatment to ensure that the treatment is being delivered accurately. There will be a short delay while these images are assessed, and you may feel the bed moving as the radiographers are adjusting the treatment couch from outside the room. If the images show that your bladder is too small or your rectum too full, then we may ask you to drink more water or empty your rectum before we set you up again. When the images show us that everything is as it should be we will proceed with your treatment.
The radiographers may also need to come in and out of the treatment room a couple of times during your treatment session. This whole process will take approximately 15-20 minutes. Please stay lying in the same position until they let you know that treatment has been completed.
You are then free to get changed and leave the department. The radiographers will confirm with you the time of your next appointment.
It is quite normal to feel anxious on your first day of treatment but, as you get to know the staff and the daily routine, it should become easier. Please talk to us if you have any worries.
What side effects can I expect?
Below are the details of some of the possible side effects that the treatment may cause you. The side effects and their intensity vary from patient to patient, therefore we provide you with all of the information to allow you to make an informed decision. Side effects are usually split into early and long-term effects.
You do not normally experience side effects straight away, but everyone’s reaction is different. Any effects that you experience normally start after about 2 weeks of treatment. Side effects only affect the area of the body that we are treating. Radiotherapy continues to work inside your body for up to 14 days after you have finished your treatment. Any side affects you experience will also continue for this time. After 14 days you should start to feel better, but everybody’s recovery time is different.
Tell the radiographers treating you if you start to experience any side effects of the treatment. They will give you advice on how to manage the side effects or refer you to the Gynae advanced practitioner radiographer.
Tiredness (fatigue)
Radiotherapy can make you feel more tired than usual. You should listen to your body and rest if you need to but continue your normal activities if you feel able. Some people find a little exercise can help their tiredness. Walking can be very helpful to deal with fatigue.
Diarrhoea
Radiotherapy to your pelvis may cause diarrhoea. To help you to manage diarrhoea the radiographers can give you diet advice. If the diarrhoea persists then we can prescribe you anti-diarrhoea tablets. Having diarrhoea can cause abdominal discomfort and pain.
Urinary Incontinence
You may notice some urine leakage or difficulty controlling your bladder. This can happen during the radiotherapy or after the radiotherapy has finished. Physiotherapy can sometimes help to manage this. This can include doing pelvic floor exercises, which a specialist radiographer will speak to you about early in your treatment. You may find it helpful to wear pant liners if you do experience leaking during your radiotherapy. If you do use these, please ensure they are removed before you get changed for treatment.
Cystitis (burning sensation when passing water)
Radiotherapy may irritate the lining of your bladder. This can make you feel you need to pass urine more often and it can burn. We will ask you to drink more water than usual to help keep your urine diluted. If the burning persists, please let the radiographers know. They will send you to the nurses for a urine test to see if you need antibiotics.
Skin reactions
Your skin within the treatment area may turn pink/red or a darker pigmentation, feel warm and tender or become dry and itchy. We encourage you to continue your normal skin care routine during treatment. We will discuss skincare with you on your first treatment.
Long-term or permanent side effects
Any long-term side effects can develop months or even years after the treatment has finished. Your doctor will discuss these with you. Although radiotherapy is accurately planned a small part of normal tissue will be treated. Although this is uncommon it may cause long term symptoms such as:
Change in bowel habit
There may be a need to open your bowels more urgently, especially in the morning. Bowel movements may become more frequent, two or three times a day instead of once.
Changes to the bladder
There is a small risk of long-term changes to the bladder. Your bladder function may be different after treatment and possibly not return to normal.
You may:
a) Need to empty your bladder more frequently especially at night
b) Be unable to hold as much urine for as long due to the loss of elasticity (ability to stretch) of the bladder wall and subsequent reduced bladder size
Vaginal dryness, narrowing and shortening
This may happen due to scar tissue developing in your vagina. Your vagina may also become less stretchy, making having sex uncomfortable. Your gynecological specialist radiographers will offer advice on using dilators to help with this. This information is available on a separate leaflet please ask your radiographer for a copy.
Noticing blood
Radiotherapy can affect the tissues in the pelvis causing small amounts of blood in the urine, bowel motions or after sex. If you notice you are passing more than a small amount, see your GP as it needs to be investigated further.
Risk of Lymphoedema
Pelvic radiotherapy can affect the lymph glands in the pelvis causing permanent swelling of the legs. This is called lymphoedema and is more likely if you have had surgery to the pelvic nodes, though pelvic radiotherapy can increase the risk.
It is rare but can start many months or years later. To reduce the risk, it is important to avoid infection or inflammation of the legs and pelvis, so avoid cuts/grazes, nicks from shaving, insect bites/stings and sunburn. Do regular gentle exercise; swimming or walking. The use of a moisturising lotion on your legs is recommended.
Some early signs include persistent tightness of your shoes, the ankles being swollen or heaviness of the legs.
If you develop these signs, or are concerned, talk to your oncology doctor/ gynaecological CNS (cancer nurse specialist at your follow-up appointments. Referral to a specialist practitioner in lymphoedema may be appropriate.
Menopausal symptoms
Pelvic radiotherapy can lead to a radiation-induced menopause. The symptoms may not occur immediately but a few months after the completion of your treatment. A radiation-induced menopause may lead to hot flushes, feeling low, and tiredness, lack of energy, anxiety, irritability, night sweats, vaginal dryness and loss of libido. There are a variety of treatments for menopausal symptoms, including hormone replacement therapy (HRT) and many complementary therapies. You can discuss this with your oncologist doctor or your GP who can advise you.
Changes to bones
The pelvic bones may develop changes due to the late effects of radiotherapy. These can present as a pelvic insufficiency fracture, which is a hair-line fracture of one of the pelvic bones. It may cause dull pain which can be helped by rest or may require pain killers. This may be investigated by a scan if necessary. If the pain continues or gets worse then you should mention this to the Oncologist doctors or your GP who can then advise you.
Infertility
Pelvic radiotherapy (+/- chemotherapy) can cause infertility. If you are of childbearing age there are some options that you can discuss with the doctor which may help you conceive in the future. Please ask your doctor or advanced practitioner for more information and advice.
Please do not become pregnant during your radiotherapy treatment as this will harm the unborn child. It is very important you use contraception. If you think you may be pregnant, please tell a member of staff immediately.
Uncommon late side effects:
Severe narrowing of the bowel: This may cause a blockage which may require surgical correction and a colostomy.
Severe ulceration of the bladder or vagina: This may lead to the formation of a fistula or false passage between the vagina and bladder or the vagina and rectum. It may require surgery and a colostomy.
Late malignancy: There is a very small chance of developing another cancer in the treatment area after radiotherapy to the pelvis. This may occur 15-20 years after treatment.
This list may seem daunting, but please bear in mind that, despite these potential risks, the indication is still that the benefits provided for you with this treatment far outweigh the disadvantages. We will support you and help you to manage these side effects if they arise.
Review during treatment
During your first week of treatment, you will see the Gynae advanced practitioner radiographer to discuss how to manage any short term side effects, in particular diarrhoea. You will be given a diet sheet of lists of food that you are able to eat if you get diarrhoea and lists of food that you should avoid. The radiographer will also explain pelvic floor exercises in detail to help you manage to maintain the full bladder that is needed for treatment. You will also be given lifestyle advice and help to set up any other additional support that you may need. The next appointment with the Gynae radiographer will appear as ‘Gynae clinic’ on the appointment list the radiographer gave you. The Gynae advanced practitioner will give you information regarding the internal treatment (brachytherapy) if you have been told that you will have this treatment at the end of your external beam treatment. The last appointment with the Gynae advanced practitioner is to discuss the long term side effects of radiotherapy where you will be shown some exercises using a dilator to help prevent some of the late side effects.
The treatment team of radiographers will look after you on a daily basis and are there to support you through your treatment, help you manage your side effects and answer any questions that you may have about your treatment.
Once a week you will be reviewed by medical team which may include a doctor or a Gynae advanced practitioner radiographer. This appointment is to check how you are managing with the treatment and side effects, provide any additional support and information you may need and plan with you when you will be seen again after your treatment has finished.
When radiotherapy has finished
Towards the end of your treatment, we will give you an appointment for a follow up at a clinic with your oncology doctor. This will usually be between 4-6 weeks after finishing your treatment. At this appointment, your doctor will give you a gentle vaginal examination. You may also have a blood test and an appointment will be made for a scan.
It is important to attend the follow-up appointments with your oncology doctor.
Radiotherapy side effects can continue and may get worse for up to 10 days after your treatment has finished. This is normal, but if you do need further support or advice please contact the department by phone between 9am-5pm (Monday-Friday).
Contact Us
Radiotherapy
Radiotherapy Basement
King George V Wing (KGV)
St Bartholomew’s Hospital
West Smithfield London EC1A 7BE
Radiotherapy Reception (Mon-Fri 8.30am-5pm): 020 3465 5222
Emergency Hotline (when the department is closed): 07917 093 738
Specialist Gynae Radiographer Sita Mahto: 020 346 56219
Macmillan Cancer Information Centre
West Wing, Ground Floor
King George V Wing (KGV)
St Bartholomew’s Hospital
West Smithfield London EC1A 7BE
Just drop in Mon-Fri 10am-12noon and 2-4.30pm. Or call on 020 346 56611. If calling outside working hours, ring Macmillan free on 0800 808 00 00 or visit the Macmillan website.
Maggie’s Centre @ St Barts
St Bartholomew’s Hospital
West Smithfield
London EC1A 7BE
Tel: 0203 904 3448
Drop in Mon-Fri: 9am-4pm
https://www.maggiescentres.org/our-centres/maggies-barts
References & Further information
https://www.cancerresearchuk.org/about-cancer/breast-cancer
If you need general information or advice about Trust services, please contact the Patient Advice and Liaison Service (PALS) on 020 3594 2040 or visit www.bartshealth.nhs.uk/pals. Alternatively, please contact staff who are providing your care if you require clinical advice.
For help interpreting this leaflet in other languages, please ring 020 8223 8934.
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Reference: BH/PIN/1008
Publication date: August 2020
All our patient information leaflets are reviewed every three years.
| Version number | Date | Notes |
|---|---|---|
| 1 | 07 Sep, 2022 | Updated by Traci Hughes |