Cervical cancer: Understanding late effects of radiotherapy
Late side effects may happen a few months or years after treatment. They might happen once, carry on over the long term or come and go. Sometimes they cannot be cured, but it might be possible to manage them.
You might have late effects not listed here, because everyone is different. They may also be caused by a different part of your cancer treatment. It is not possible to predict if you will get them and when they might happen, which can be difficult to come to terms with. Research and support for late effects of radiotherapy is growing.
Joining a support group can be a positive way to share your experiences, feel less alone, and come to terms with the physical and emotional impact of treatment. Ask your clinical team if you need more support or have any late effects at all.
This page looks at late side effects.
How likely am I to get late side effects?
Before treatment you will discuss and sign a consent form with your clinical oncologist or therapeutic radiographer. They will tell you what to expect, and you can ask questions and discuss any concerns you have about late effects.
You can read different radiotherapy consent forms (HERE) based on the specific area being treated. These consent forms are packed with useful information about early and late side effects.(1)
When you consent to treatment, you are saying you understand that you have a chance of getting late side effects. Your team will use words like Expected, Common, Less Common and Rare.
This table shows what these words mean.
| Wording on the consent form | % chance of side or late effect | How many patients will get this? |
|---|---|---|
| Expected | 50 to 100% | Between half and all patients |
| Common | 10 to 50% | Up to half of all patients |
| Less common | Less than 10% | Fewer than one in ten patients |
| Rare | Less than 1% | Fewer than one in 100 patients |
Possible late side effects
- Effects on the bladder: Sometimes, the bladder can become smaller after radiotherapy. This means you might need to wee more often in the long term.
If your bladder works well before treatment, this is less likely to be a problem.
- Early menopause: Your period might stop earlier than usual, and you might go through an early menopause.
- Fertility: Your reproductive organs (listed below) may be in, or near the treatment area. Be sure to ask if this affects you. If it does, it’s important to discuss any plans or thoughts you have about having children from the outset. Your consultant can provide advice tailored to your situation. This can be a sensitive topic, and you may not have all the answers, but having the conversation early allows you to explore your options and make informed decisions. Reproductive organs include: ovaries, uterus, fallopian tubes, cervix and vagina.
- Sexual problems: You might experience narrowing of the vagina and dryness that can make penetrative sex uncomfortable.
- Urinary frequency: This means needing to wee more often (frequency) than normal or suddenly needing to wee (urgency).
- Urinary incontinence: You might have some wee leaking out if you cough or strain.
- Bowel changes: You might need to poo more often (frequency) and more suddenly (urgency). Your poo might become more watery.
- Cancer-related fatigue: You might find you still have fatigue after your treatment has finished. For some people this can go on for months or years
- Lymphoedema: You might have swelling in the legs or lower body due to fluid building up.
- Pelvic bone fractures: Bones in the treatment area can be weaker, which means they can break more easily.
- Skin changes: Your skin can become thicker or thinner in the treatment area and change colour.
Rare or less common late effects
- Cystitis and bladder changes: You might have pain when you wee and find you need to wee more often.
- Rectal pain and discomfort: This may worsen when going to the toilet. This may also affect your sex life if you receive anal sex.
- Bleeding: This can be from your bladder, bowel or vagina.
- Bowel and bladder damage: You might need surgery if your bowel or bladder narrow (known as stricture). Sometimes a fistula can form. This is an abnormal connection between two parts of your body and may need further treatment.
- Ulceration: Bowels in the treatment area can form sores that are difficult to heal.
- Kidney impairment: Your kidneys may not work as well after treatment.
- Malabsorption: You may have problems absorbing nutrients in your food.
- Bowel blockage: There’s a small chance your bowel might get blocked, which can cause stomach pain and trouble with bowel movements.
- Pelvic Fracture: Radiation can weaken the bones in your pelvis and make them more likely to break.
- Second Cancer: There is a very small chance that you could develop another type of cancer. This is rare, and depends on lots of different factors like age, area treated and radiation dose.
- Ureteric strictures: This is a narrowing of the tubes that go from your kidneys down to your bladder and from your bladder out of your body.
- Nerve damage: Radiation can damage the nerves in your lower back.
What can help with these late effects?
- Keeping active: Gentle movement can help you feel better, both during and after treatment. Your treatment team can tell you what is safe for you to do.
- Bladder care: Keep drinking water and talk to your doctor if you have trouble with weeing. Pads can help with any leaks.
- Bowel health: Professional advice on what food and drink to have can help. So can medication. Speak to your treatment team about any bowel changes and watch for any signs of blockage.
- Sexual health: Use lubricants for dryness, talk to your treatment or clinical team about what products are recommended and any discomfort you may have. You may be able to use dilators to help make penetrative sex more comfortable.
- Menopause and infertility: Your medical team can help with symptoms of early menopause. Please let your Consultant know at the earliest time point about your plans for having children and they can advise accordingly.
- Managing lymphoedema: Special exercises and treatments can help reduce swelling. Ask to speak to a lymphoedema specialist if this is happening to you.
- Monitoring rare side effects: Talk to your treatment team as soon as you notice any changes, this can help catch and treat any serious problems early.
- Managing cancer-related fatigue: Food and drink, keeping active, keeping a fatigue diary, medicine like steroids and physiotherapy may all be options for managing fatigue. Speak to your doctor or medical team for advice; and learn more about managing cancer-related fatigue.
- Drinking fluids: Drinking plenty of fluids such as water and squash can help with fatigue and tiredness caused by your treatment. It can also help flush out toxins in your body caused by treatment. You can try diluted juice if you don’t like water.
- Skin care: The skin in the treatment area will always be more sensitive to the sun. Always protect it by covering up and use a high factor sunblock.
- Alcohol use: Please follow the NHS guidelines on safe drinking levels and any instructions you get from your team on what is right for you, your diagnosis and your treatment. If in doubt, please ask your team.
- Stop smoking: If you are looking to stop or reduce smoking, there are services available to help you.
Always talk to your doctor or medical team about any late effects you have. Even if they are not mentioned here. Everyone is different and experiences treatment differently. There may be ways they can help you reduce or manage symptoms.
Further information
Learn more about sex and cancer here:
Pelvic radiotherapy for women | Sexuality and cancer | Cancer Research UK
Sex and cancer | Impact on your sex life and relationships | Macmillan Cancer Support
The Pelvic People – We’re on a mission to end painful sex
Learn more about side effects and support here:
Pelvic Radiation Disease Association
Learn more about radiotherapy consent forms here:
https://www.rcr.ac.uk/our-services/management-service-delivery/national-radiotherapy-consent-forms/
Learn more about radiation skin reactions here:
