Radiotherapy for womb cancer

You may have radiotherapy:

• after surgery, to reduce the risk of the cancer coming back (called adjuvant radiotherapy)
• instead of surgery, if a general anaesthetic or an operation is not suitable for you
• to try to cure a cancer that has come back after surgery (recurrent cancer)
• to treat cancer that was not completely removed with surgery.

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

We have more information about what happens before and after radiotherapy, and questions you may want to ask.

Your cancer specialist may talk to you about having radiotherapy after surgery. This is to reduce the risk of the cancer coming back in the pelvic area. Your specialist team will look at the stage, grade and type of womb cancer you have before discussing this with you.

Some people with early stage cancer may not need radiotherapy. But your doctor may suggest having radiotherapy if you have a slightly higher risk of the cancer coming back. This can help to reduce your risk. Most people with stage 2 or 3 womb cancer are advised to have radiotherapy after surgery.

Your specialist will explain the benefits and disadvantages of radiotherapy in your situation. They will explain the side effects you are likely to get and the possible long-term effects.

If the cancer has spread, you may have external beam radiotherapy to shrink the cancer or to control the symptoms. For example, you may have this treatment if the cancer has spread in the pelvic area, or to other parts of your body such as the bones. This is called palliative radiotherapy. It is planned carefully so that you have as few side effects as possible.

Macmillan is here to support you. If you would like to talk, you can:

• call the Macmillan Support Line on 0808 808 00 00.
• chat to our specialists online.
• visit our womb cancer forum to talk with people who have been affected by womb cancer, share your experience, and ask an expert your questions.

External radiotherapy uses a machine like a big x-ray machine, which produces high-energy rays. A radiographer gives you the treatment in the radiotherapy department at the hospital. You have it as an outpatient once a day from Monday to Friday, with a rest at the weekend. Each session of treatment usually takes just a few minutes. A full course may last up to 5 to 6 weeks.

External radiotherapy is painless. It will not make you radioactive. It is safe for you to be around other people, including children and pregnant women.

Your radiotherapy is planned by your clinical oncologist and a technical team. They will plan your treatment, so it does as little harm as possible to normal cells.

Your radiographer will explain what you will see and hear. The radiotherapy machine will move around you, but it does not touch you. The treatment is painless. Once you are comfortable in the correct position, they will ask you to keep as still as possible. They will leave the room for a few minutes while you have your treatment. There will be a camera so they can see you and hear you if you need to talk to them.

Radiotherapy to the pelvic area can sometimes cause problems months or years after treatment. These are called late effects. Some of these may be permanent, but there are lots of ways to manage or treat them.

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, as they may not be caused by radiotherapy.

Radiotherapy can make the 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 prevent narrowing. Dilators are tampon-shaped plastic tubes of different sizes, which you use with a lubricant.

Your specialist nurse or doctor will explain the best way to use them.

Radiotherapy can also cause vaginal dryness. This can feel uncomfortable, particularly during sex. Creams, gels or lubricants can help.

There are lots of products you can try. You can buy them at a pharmacy 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 more comfortable and pleasurable. Lubricants can be water-based, silicone-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. Tell your doctor if you have symptoms such as itching or soreness.

After pelvic radiotherapy, the blood vessels in the lining of the vagina can become fragile. This means they can bleed more easily after sex or after using the vaginal dilators. Bleeding may be caused by:

• vaginal tissue sticking together
• scar tissue causing the vagina to narrow.

If you have any bleeding, always tell your cancer doctor or nurse. 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 when you know the cause.

After radiotherapy, you 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 your bladder is affected, you may need to pass urine 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 stools. If you have bleeding, always tell your cancer doctor or GP so it can be checked.

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.

If you develop lymphoedema, you can be referred to a lymphoedema specialist to help manage it. We have more information about how you can reduce the risk of lymphoedema.

Radiotherapy can cause thinning of the bones in the pelvis. Often this does not have any symptoms, but is seen on scans. Sometimes it may cause fractures in the pelvis called insufficiency fractures. These can cause pain in the lower back or pelvis. If this happens, your doctor can give you painkillers to help. You may also be referred to a physiotherapist.