Possible late or long-term side effects may happen months or years after radiotherapy treatment, and in some cases may be permanent. They may happen once, continue for a long time, or come and go. While some late effects cannot be cured, they may be managed
You might experience late effects not listed here since everyone’s experience is different. They could also be caused by other parts of your cancer treatment. It can be hard to predict if and when these effects will occur, which can be challenging to accept. However, research and support for managing late effects from radiotherapy are improving.
Support Groups: Joining a support group can be helpful for sharing your experiences and feeling less alone. It’s a way to cope with the physical and emotional impacts of treatment.
If you have concerns or experience any late effects, please reach out to your clinical team for more support.
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’ll explain what to expect, and you can ask questions or share any concerns about late side effects.
By signing the consent form, you are saying you understand that you might get early and 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 |
Key information: It’s important to let your consultant know as soon as possible if you plan to have children, especially if your uterus or ovaries are in the treatment area. They can guide you on the best options.
Early menopause is a guaranteed side effect of treatment, often starting during or soon after radiotherapy. Your body will stop producing eggs and hormones.
Infertility is a guaranteed side effect of this treatment, meaning you won’t be able to carry a pregnancy after radiotherapy. It’s very important to use contraception during vaginal sex while undergoing treatment.
Possible late side effects
- Bladder Effects: Sometimes, the bladder can become smaller after radiotherapy. This means you might need to wee more often in the long term and it might be painful. Urine leakage, especially when coughing or straining, is also common.
- Bowel Effects: Your bowels might change after treatment. You might feel the need to use the toilet more often (frequency) and a sudden urge to open your bowels (urgency). You might also experience rectal discomfort or pain, especially when using the toilet. This discomfort could also impact your sex life if you engage in anal sex.
- Bowel/bladder damage: Bowel or bladder damage may sometimes require surgery due to issues like narrowing (stricture) or an abnormal connection between two areas (fistula).
- Bleeding from your bladder or bowel or vagina.
- 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.
- Sexual problems: You may experience narrowing and dryness of the vagina, which can affect vaginal intercourse and comfort during pelvic examinations. Your team might recommend using vaginal dilators after treatment to help reduce these issues.
- Pelvic bone fractures: After menopause, radiation can weaken your pelvic bones, making them more prone to breaking.
- Lymphoedema: You may experience swelling in your legs or lower body due to fluid buildup.
- Radiotherapy effects: You might have hair loss in the treatment area, skin thickening or discoloration (lighter or darker), and visible blood vessels.
- Other effects: You could also experience kidney issues and problems with nutrient absorption.
Rare late effects
- Bowel blockage: There’s a small chance your bowel could get blocked, leading to stomach pain and difficulties with bowel movements. Seek help straight away if you think your bowel is blocked.
- 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. Learn more about this here.
- Ureteric strictures: This refers to narrowing of the tubes that connect your kidneys to your bladder.
- Nerve damage: Radiation can cause nerve damage in the lower back area.
What can help with these late effects?
- Keeping active: Gentle exercise can improve your well-being during and after treatment. Your treatment team can guide you on safe activities.
- Bladder care: Drink plenty of water, and let your doctor know if you have difficulty urinating (weeing).
- Bowel health: Get professional advice on diet and medications for bowel health. Talk to your treatment team about any changes and watch for 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 team can help with symptoms of early menopause. Talk to your consultant as early as possible about your options if you want to have children.
- 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 clinical team for advice.
- 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: Follow NHS guidelines on safe drinking and any advice from your clinical team regarding alcohol use. If you have questions, don’t hesitate to ask. - Stop smoking: If you are looking to stop or reduce smoking, there are services available to help you. Please see the links at the bottom of this page for more information.
Always talk to your doctor or treatment team about any late effects you have: even if they are not mentioned here. Everyone is different and experiences treatment and late effects differently. There may be ways they can help you reduce or manage symptoms.
Further information
Learn more about sexuality and cancer here:
Pelvic radiotherapy for women | Sexuality and cancer | Cancer Research UK
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:
Learn more about managing cancer fatigue:
Managing and treating cancer fatigue | Cancer Research UK
Cancer-related fatigue | NHS inform
Advice on reducing alcohol use:
Drink less – Better Health – NHS (www.nhs.uk)
NHS stop smoking services:
NHS stop smoking services help you quit – NHS
