Radiotherapy
for gynaecological tumours - A guide for patients and their families
This information is currently under review
Radiotherapy for Gynaecological Tumours - booklet coverContents
Section 1
Section 2
Section 3
Section 4
Section 5
Section 6
Section 7
Section 8
Introduction
This booklet is to tell you about radiotherapy to
the pelvis for gynaecological tumours. The Christie is a specialised radiotherapy centre, and patients come here for treatments that are not available at general hospitals. If you are having
radiotherapy as an inpatient, please bring this booklet with you.
The doctor or nurse clinician will discuss your treatment with you and explain anything you do
not understand. Please share this booklet with your family and friends. They can have a role in helping you. It's important that they feel well-informed and
understand what is happening. If you would like more detailed information about your own treatment,
please ask the staff. There are also videos and DVDs on radiotherapy which you can take home to watch. Please ask your doctor, nurse or radiographer.
Please note:
mobile phones can interfere with the treatment equipment. Please look
out for signs letting you know if it is safe to use your mobile phone.
If you do have one with you, you may need to turn it off.
What
is radiotherapy?
Radiotherapy is the use of exact, carefully-measured doses of radiation to treat diseases. This booklet is written for women who are having radiotherapy to the pelvis for gynaecological tumours such as cancer of the womb, cervix, vulva or vagina. It describes
all possible treatments, and some may not apply to you. Your doctor will discuss your treatment with you.
Agreeing to treatment
Consent to treatment
The doctors, clinic nurses and specialist radiographers will
normally give you some written information to support what they have said about your treatment. At the time your treatment is being planned, you will have the opportunity to discuss anything you do not understand, or any worries or concerns you may have, before you actually start.
For radiotherapy treatments, we will ask you to sign a consent form agreeing to accept the treatment that you are being
offered. The key messages in the consent form for radiotherapy are included in this booklet for you to read and consider. It is important that you understand what the planned
treatment involves and that you have been given the opportunity to discuss any concerns before you sign the consent form.
Radiation can be harmful to the unborn child. It is important to
let the radiographers know if you have missed a period, or suspect that you might be pregnant before any radiation exposure is
given.
What treatments are available?
a course
of external beam radiotherapy treatment
(XRT )
or
internal treatment called
Selectron where radioactive sources are placed in the womb and/or vagina under
or a short general anaesthetic.
We will nurse you in bed until
this treatment is finished. Sometimes it is necessary to repeat this type of treatment
or
a combination
or of both
types of
treatment
Some women with cancer of the cervix or vagina may benefit
from having weekly chemotherapy (with a drug called cisplatin)
along with the external beam radiotherapy. The doctor or
nurse clinician will discuss this with you if it is recommended for your situation. We advise you to read the information on these treatments in the booklet 'Chemotherapy, a guide' and the leaflet on cisplatin.
When is radiotherapy offered and what are the benefits?
Each woman has her treatment planned individually, and your doctor at the Christie will discuss with you the type and length of treatment that is recommended for your condition. The
doctor will use the chart overleaf to explain the reasons for your treatment and the benefits of treatment you are being offered.
Chart to show your type of cancer and treatment
Cervix or vaginal cancer when surgery is
not possible.
- Radiotherapy: 20 treatments of
radiotherapy from the
outside followed by
Selectron (internal)
treatment.
- Chemotherapy: Cisplatin chemotherapy
with radiotherapy may
be offered. Patients need
to be generally fit and
well and have a good
kidney function.
- Aim: To reduce the tumour,
prevent it spreading,
with the aim of getting
rid of it altogether.
- Alternative: Normally there are not
because surgery has
already been ruled out.
Ask the treating team
and they will explain if
this is an option.
- Decline treatment: Your tumour will
continue to grow. It
may spread to other
areas of your body and
cause you increasing
symptoms.
Womb/uterus cancer after
a hysterectomy where
there is a risk of cancer cells
being left behind.
- Radiotherapy: 20 treatments of
radiotherapy from the
outside. If the tumour
involves the cervix then
Selectron (internal)
treatment is recommended.
- Chemotherapy: For certain types of cancer
a course of Carboplatin
chemotherapy may be
recommended before you
start radiotherapy.
- Aim: Treatment is being offered
as a follow-up (adjuvant)
treatment with the aim of
reducing the chance of your
cancer coming back.
- Alternative: No, not normally
- Decline treatment: You should be offered
regular follow-up
appointments with your
Gynaecologist who can refer
you back for radiotherapy in
the future if you require it.
Cervix cancer after a
hysterectomy where cancer was
found in lymph glands or tissues
beside the cervix.
- Radiotherapy: 20 treatments of radiotherapy
from the outside. Sometimes
followed by Selectron (internal)
treatment.
- Chemotherapy: Cisplatin chemotherapy with
radiotherapy may be offered.
Patients need to be generally fit
and well and have a good kidney
function.
- Aim: Treatment is being offered
as there is a risk that some
cancer cells may not have been
removed. With further treatment
the risk is reduced.
- Alternative: No, not normally.
- Decline treatment: You should be offered regular
follow-up appointments with
your Gynaecologist who can refer
you back for radiotherapy in the
future if you require it.
Womb/uterus cancer where
surgery is considered too high a
risk because of medical conditions ie.
heart disease or obesity.
- Radiotherapy: Treatment is tailored to each patient
and can involve 2 Selectron (internal)
treatments or radiotherapy from the
outside or both.
- Chemotherapy: Not normally.
- Aim: To control the tumour and in some
instances to get rid of it altogether.
- Alternative: Surgery has normally already been
ruled out. Hormone treatments can
be useful in controlling some cancers
but they do not get rid of the cancer.
- Decline treatment: Your tumour will continue to grow.
It may spread to other areas of your
body and cause you increasing
symptoms.
The areas being treated
These diagrams may be useful to help you understand where your cancer is and the area to be treated with radiotherapy. Your doctor may draw on them to help explain your treatment.
Your first visit to the radiotherapy
department
The specialist doctor who will look after you is a clinical oncologist. He or she will examine you and may arrange for tests such as
x-rays, scans and blood tests. These are to check your general health, and to help decide on the details of your treatment.
You will be cared for by a team of doctors including consultants, registrars and senior house officers, radiographers and nurses.
The team also has a nurse clinician who specialises in caring for women with gynaecological cancers. This team will not necessarily include the doctor who first saw you, but one consultant will be responsible for your treatment.
In choosing your treatment, your doctor at the Christie has carefully considered the nature of your illness, and your particular needs. Once treatment has been agreed with your clinical oncologist, we send you an appointment for treatment
preparation. The purpose of preparation is to design treatment that accurately targets x-rays to the tumour area.
The preparation for treatment takes some time - in some cases it may take up to two weeks or more. It is time well spent, as we are designing treatment to your particular needs.
Questions you may want to ask
about your treatment?
- What type and extent (stage) of disease do I have?
- Why are you recommending radiotherapy for me?
- What might be the benefits and side effects?
- Is there any alternative treatment, and, if not, why is this?
- Is there any treatment that will mean I can still have children?
- What will the radiotherapy involve and how many times will I
have to visit the hospital?
- Will there be any lasting effects from treatment?
What is external beam radiotherapy?
The type of radiotherapy that most patients have is x-ray therapy, where a controlled beam of high-energy x-rays is directed at the cancer. This kills the cancer cells while the normal tissue nearby is able to recover from the treatment.
While not all machines look alike, they all work in a similar way. These machines (see page 11) are just more powerful versions of the x-ray machines that are used to take pictures of chests and broken bones. Radiotherapy is usually given in small daily doses over a period of weeks.
The dose needed will depend on the exact type of cancer you have and how far it has spread. So you may find that you are having a different number of treatments from other women you meet at the hospital. If you are having more treatment, it does
not necessarily increase your risk of side effects. If you are having fewer treatments it does not mean the dose you are having will
be too small.
Preparation for treatment
Treatment preparation may be done on
a special x-ray machine called a simulator or on a C.T. Scanner. Often, purple marks are put on your skin with a special pen so that x-rays can be focused accurately. The
marks may rub off a little on to clothing. Do not worry too much if this happens - they will wash out - but it might be sensible
to wear older clothing. The radiographers will explain how you can keep the treated area clean, and will tell you when you can wash the marks off. At the end of your visit for treatment preparation, tiny permanent marks are made on your skin.
To plan treatment some women may need an internal
examination under an anaesthetic, which means you will be asleep. At the same time, we may take a biopsy (sample of tissue for examination) and place some small marker seeds in the
tumour. These help us to identify on x-ray where the tumour is so that the treatment can be planned accurately. The marker seeds
do not cause any harm and often remain in place long-term.
Do I have to stay in hospital?
Many women having external beam radiotherapy are able to have treatment as an outpatient, but if the side effects are severe and difficult to cope with, we may recommend that you come into
hospital.
If you are not able to travel to the hospital for daily treatment,
we may admit you to one of the wards. If you are well, you can
go home at weekends. When you are at home, if the side effects become severe such as uncontrollable diarrhoea, heavy bleeding, difficulty in passing urine, fever, severe tiredness
or pain, please return to the
Christie so that we can treat you. Phone your ward or the hospital first (0161 446 3000).
What happens when you have
your treatment?
On the day of your first treatment, you will come to the Radiotherapy department. If you are an inpatient, a therapy care assistant may bring you to the department.
You may have already visited this department as part of the
preparation for treatment and met some of the therapy radiographers.
Radiographers are highly trained men and women who operate the radiotherapy machines to give you the precise treatment prescribed
by the doctor. They will explain to you what is going to happen and take you into the treatment room. The radiographer will help you onto the treatment bed and will adjust both the bed and the machine to
the exact positions that are needed.
We will ask you to remove any clothing that covers the area being treated. We will also ask you to keep as still as possible.
The radiotherapy machines are quite big and if you have never seen them before, you might feel anxious. The treatment is
not painful, it is just like having an x-ray picture taken, but it takes longer. When all the adjustments have been made, the
radiographers will leave the room and will switch on the machine from outside. The treatment normally lasts only one to two minutes. However, the treatment session may take about 15
minutes, allowing time for changing and the machine to be set up.
During your treatment you will be alone in the room, but the
radiographers will be watching you carefully on a closed circuit television system. If for any reason you need them, just raise your hand and they will interrupt the treatment and come in to you immediately.
Some people are worried that they will be completely enclosed by the machine - this will not happen. The machine can move
around you, but nothing will press down on you. Most machines make a buzzing noise when they are operating. This is how you will know when the treatment is happening.
When you leave the room, you will have an appointment made for the next treatment day.
This routine will go on each day until your course of treatment is finished. The prescribed radiation dose and the number of days over which it is given varies between patients. There is usually
no radiotherapy treatment on Saturdays and Sundays, and we
take this into account when we plan your treatment. Sometimes treatment is given on Bank Holidays.
You will usually be treated on the same machine throughout your course of radiotherapy. However, the machines occasionally need to be serviced. Your radiographers will let you know about this.
You won't miss any treatment, although it may be on another machine.
Please discuss appointment times with the radiographers on the treatment machine.
If you have your treatment as an outpatient, the doctor and nurses will see you once a week in clinic. If you want to see the doctor or nurses at any other time, just ask the radiographers.
If you are an in-patient, you will see the consultant once a week on the ward round. In-between, other members of the medical team will review your progress.
What is internal treatment?
Internal treatment will be on the Selectron. Your doctor will
explain if you need this type of treatment when your radiotherapy treatment is first planned. Most internal treatments are carried out soon after patients finish their course of radiotherapy but this may depend on side effects. The treatment is described below.
Selectron treatment
The doctor will place applicators or tubes into your vagina or cervix under a general anaesthetic in the Radiotherapy Theatre. You will then go to the
Selectron room on Ward 1 where the applicators are attached to the Selectron machine. The Selectron machine puts radioactive pellets into the applicators which treat the tumour. You will not feel this but the machine will make some noises as it is doing this. You will have this treatment as an in-patient and you can normally expect to be
in hospital for about 3 days. The following information will help you understand what you can expect while you are in hospital.
The day before you go to theatre...
You will come into hospital and stay on a ward which may not
be the ward you return to after going to theatre. You may find it helpful to ask ward staff to arrange a visit to the Selectron room to see the equipment, and to meet some of the nurses who will be looking after you.
Preparation for theatre...
It is important to tell the staff if you are having any bowel
problems because, if you are having severe bowel problems, your treatment may need to be delayed. We will ask you not to have anything to eat or drink for about 6 hours before your anaesthetic. An anaesthetist may visit you the night before or the morning of theatre to discuss your anaesthetic and types of pain control. It is
a good idea to prepare a bag to take with you containing things you may need while having treatment, such as dentures, a watch, nightie and soap bag. You can leave your other clothes etc on the
ward to collect when you leave the Selectron room.
On the day you go to theatre ...
We will ask you to take a shower or bath before you go to theatre and put on a gown. This is a good time to go to the toilet. The nurse may also give you a pre-med to relax you before you go
to theatre. We will take you to theatre on a trolley where the anaesthetist will give you a general anaesthetic to put you to sleep.
While you are asleep, in the radiotherapy theatre, the doctor will place the applicators and insert a catheter to empty your
bladder while you are having treatment. As you wake up from the anaesthetic, we will take an x-ray to check on the position of the applicators. You may also have a short CT scan to ensure that the applicators are correctly placed before treatment is started.
A nurse will collect you from the theatre and take you to the
Selectron Room on Ward 1 where she will make you comfortable.
A staff member will then come and connect the tubes or applicators inserted into your vagina to the Selectron machine.
You will normally be on the machine for between 12 and 20 hours. During this time, if you wish to be on your side, a nurse will help
you.
Please remember to tell your relatives not to visit you on the theatre day, but they can ring the ward to find out how you are (0161-446-3708)
While you are having Selectron treatment ...
It is normal to have a feeling of pressure in the pelvis whilst having this treatment. This may be because of the gauze packing which holds the applicators in position. Or it may be that the catheter
in your bladder makes you feel as if you urgently need to pass water. If you try to relax and let go, the catheter will drain the
urine into a drainage bag. While the catheter is in, it is important to drink as much as you can (1-2 jugs of fluid). This helps with
drainage and prevents any urine infection. If you find the catheter uncomfortable, the nurses will give you medication to relieve this feeling. We can also give you something for nausea and to help
you to sleep, if needed.
"The treatment felt uncomfortable but tolerable"
The nurses will come in to see you every two hours. They will check whether you would like to change position, also if they
can get you anything to make you feel more comfortable. With the help of the nurses
you should be able to sit up sufficiently to read, drink, eat and watch TV. Alternatively,
you may want the nurses to help you to turn on to your side especially if you find this more comfortable for sleeping. At these two-hourly checks, the nurses will give you hot drinks and light meals such as sandwiches or toast. Please tell the staff about any discomfort so they can help you change position or
give you pain killers. If you need the nurse for something that cannot wait until the next visit, use your call bell and the nurse will come promptly. Do tell the nurses if the painkillers you are taking are not helping. They will be able to get you something stronger.
Once your tubes are connected to the machine, treatment will
not start until the radiographer or nurse has left the room, closing the door behind them. Treatment is then started by pushing the
start button on the control panel outside the room. When the Selectron machine is switched on and off on the outside control panel, you will hear a hissing and clicking noise. This just means that the machine is loading your applicators with radioactive pellets using air to push them along. Or by using suction, it is withdrawing the radioactive pellets back into the machine to make it safe for the nurse to come in.
To help pass the time ...
To help pass the time, it is a good idea to bring books or magazines in to read. If you have favourite music CDs, bring these with you and a CD player. There is a TV in the room for you to watch
Exercises
We encourage you to do exercises whilst you are having Selectron treatment. The nurses will explain these to you. It is important that you do not move your pelvis in a way that could change the position of the
treatment applicators. It is also Important that your joints do not get too stiff or that you develop complications from staying in one position for a long time.
It is a good idea to practice these exercises before you go to theatre and try and do them every hour while you are having treatment.
- Quad sets:
Tighten kneecap and the muscles along the front of the thigh by pushing down on the area behind the knee - hold 5 seconds - relax. Repeat
several times a day.
- Hamstring sets:
Tighten muscles along the back of the thigh by digging heels into bed
- hold 5 seconds - relax. Repeat several times a day.
- Glute sets:
Tighten buttock muscles by squeezing the muscles together inward
- hold 5 seconds - relax. Repeat several times a day.
We recommend that you take several deep breaths every hour while you are awake which will help keep your chest clear.
When Selectron treatment ends ...
The nurse will remove the catheter and applicators in the
Selectron room. She will explain the procedure to you as she removes them. This is a simple and quick procedure (usually a few minutes). It will help both you and the nurse if you try to remain
as relaxed as possible. Concentrating on deep breathing helps to make you less tense and reduces any discomfort. If you are
particularly worried about having the applicators removed, please tell the nursing staff and they can give you pain relief before the procedure. The nurse will then take you back to your own ward. Afterwards, you may have a bath or shower. Providing that you
are feeling OK, have passed urine and you are not bleeding, you should be able to go home later that day.
When selectron treatment is not possible
For technical reasons relating to the tumour, unexpected perforation of the uterus can occur during this procedure.
However, this is rare affecting about 3 in 100 women. Sometimes
it is not possible to carry out internal treatment because of technical reasons such as the tumour has blocked the opening to the uterus or because of a previous cone biopsy. In this situation, we suggest you have further external beam boost to the tumour over 8 to 10 treatments in place of the internal treatment.
Shrinking/closing of the vagina
This type of treatment produces a side effect which needs your personal care and attention. This side effect is called atrophy (shrinking) and is a result of scar tissue forming in the vagina
following this treatment. You will need to follow instructions carefully. If you do not, your vagina could shorten and become narrower and the upper part can close. So it is important that you keep your vagina open to prevent any problems when you come
for your check up, or when you start sexual intercourse again and for your general well-being and comfort. Your vagina can be kept open by vaginal dilation. Dilation means 'stretching and opening' and can be done by:
1. Use of a dilator
2. Sexual intercourse
3. A combination of intercourse and dilator use
Before you can go home, we will give you a vaginal dilator and some lubricating gel and we will explain to you how to use it. Obviously this is a personal area of care and some people have
reservations or strong feelings about using a dilator. Please discuss this with the nurse looking after you. Your feelings will always be respected.
Vaginal dilation
1. Connect dilator cone to the grey handle and apply lubricating gel.
2. Get into a comfortable position and slowly insert dilator into
the vagina as far as it will go.
3. Move the dilator from side to side for approximately 5 minutes.
4. Remove the dilator.
How to use your dilator
Start using your dilator on your first day at home after your Selectron treatment, and continue to use it once a day, every day, for six weeks. We would then advise you to continue the use of
the dilator 2-3 times a week.
Examine the dilator before each use to be sure that it is smooth.
If there are cracks or rough edges, do not use it - phone the ward staff for a replacement. You should not feel any pain or discomfort
if you are gentle and stay relaxed whilst using the dilator.
Starting with the smallest size dilator, attach the handle to the dilator and apply some gel to the fatter rounded end of the dilator or to the entrance of the vagina. Lie on your back in bed with
your knees bent and slightly apart. Some people prefer to insert the dilator standing with one leg raised on a chair, or squatting.
(You may find it is easier in the bath, or after a bath, when you are relaxed).
Insert the rounded end of the dilator into your vagina gently and as deeply as you can without discomfort, moving the dilator from
side to side (see diagrams). Continue this for five minutes. Now take it out and clean it with hot soapy water, rinsing it well. If you are able to do this easily, then next time try using the next size dilator and progress up the sizes.
Do not be alarmed if slight bleeding or spotting occurs following
dilator use. This is a normal reaction. Do not use force inserting the dilator. If you are unable to insert it easily, postpone it for
a few days or contact the ward or nurse clinician (0161-446-
8101). Most women should be able to progress to the middle- size dilator within a few days. If, after a week or two, this is easy and comfortable to use, then progress to the largest dilator. Remember it is important that you should use the dilator of the
right size that reaches the top of your vagina (you should be able to gauge this yourself ) and that you use the dilator regularly.
If you are not going to have intercourse or you are having it infrequently, we still recommend you to continue to use the dilator 2-3 times a week indefinitely.
Sexual intercourse after Selectron treatment
To allow the inflammation caused by your treatment to settle, we advise no sexual intercourse for at least two to three weeks afterwards to allow the area to heal. You may find your vagina
drier than usual and you may need a lubricant. There are many on the market, but the lubricating gel given to you on discharge with your dilator can be used during intercourse. If you find this is not sufficient or not to your liking, please let us know when you come back to clinic, as we can advise about other gels/creams that may help.
You may have some slight bleeding or spotting following intercourse and may feel some degree of discomfort. Do not be frightened by this. As the tissues begin to stretch,
the bleeding and discomfort should subside. Some women experience problems in resuming sexual intercourse after internal radiotherapy. Please tell us when you come back to clinic if you have any difficulty.
You are not a danger to your sexual partner. You cannot transmit cancer, and no radiation remains in your body once the treatment session is completed.
Side effects of external and internal treatment
Acute side effects are temporary and they don't happen to all women. They generally develop during the second half of the course of treatment usually after 7-14 days, and last for 4 to 6 weeks after the treatment ends. The time taken to recover does
vary from patient to patient. If you have any questions about side effects, please ask any member of the team treating you.
Bowel
Your bowels may become disturbed due to your treatment. For most women, this is in the form of diarrhoea but occasionally it can be constipation. Diarrhoea can start after about 2 weeks of treatment and last for several weeks after treatment ends. With
the diarrhoea, patients often get increased "wind", severe urgency, intermittent abdominal gripes/cramps, abdominal bloating and may pass mucus.
What you can do to help...
It is important that you continue to eat nourishing food during and after treatment. Ask the nursing or radiotherapy staff for
a copy of Eating Help Yourself which has information about coping with problems such as loss of appetite. If diarrhoea
becomes a persistent problem, you may need to follow a low fibre diet to ease your symptoms. Follow the diet for as long as your
side effects last, then gradually resume your normal diet.
If you have diabetes and you have developed diarrhoea, still follow the low fibre diet advice but make sure you eat meals and snacks containing low fibre starchy foods such as white bread, white rice and cereals etc from the 'Allowed list'. Once your symptoms have resolved, go back to your normal diabetic diet.
Fibre is the part of grains (flours and cereals), pulses, vegetables and fruit which is not digested and passes down the gut. To cut down the amount of fibre in your diet, try to follow the allowed food guide.
Avoid
- Beans, lentils, pulses, quorn
- Wholemeal or granary bread
High fibre white bread, brown chapatti
- Brown rice, whole-wheat pasta and whole-wheat noodles
- Biscuits and cakes made
with wholemeal flour, or dried fruit
e.g. flapjack, dried fruit biscuits, mince pies, fruitcake, digestive, plain or chocolate covered oat biscuits.
- High-fibre breakfast cereals
e.g. Weetabix, Shredded wheat, muesli, Fruit and Fibre, bran and oat cereals.)
- All vegetables except those listed in Allowed section, vegetable skins, potato skins, sweetcorn
- Soups - lentil, vegetable
- Fruit, fruit skins except those listed in allowed section, dried fruit
- Fruit juice: prune, tomato and juices 'with bits'
- Build Up drinks
Smoothies, fruit yoghurt with added fruit/cereal (check label)
- Wholemeal savoury snacks, nuts, popcorn
- Marmalade or jam with peel or pips
- Fruit and nut chocolate, coconut
Allowed
- Meat, fish (tinned, fresh, frozen), eggs, tofu.
- White bread, bread sticks, rusks, cream crackers, crumpets, plain scones, plain rolls, white chapatti.
- White rice, pasta, spaghetti and noodles.
- Biscuits or cakes made with white flour
e.g. Rich tea, custard creams, shortbread, chocolate- coated plain biscuits, plain or cheese scone, doughnuts.
- Rice Krispies, Cornflakes, Special K, Coco pops, Frosties.
- Potatoes, up to 2 tbsp per day of skinless courgette and cucumber, marrow, carrot, swede, turnip, passata, vegetable juice
- Soups - 'cream of ' tomato, chicken, mushroom or oxtail
- Small portions of melon, seedless grapes (no skins) tinned peaches, pears, mandarin oranges, fruit cocktail.
- Orange, apple, grapefruit, pineapple and grape juice with no bits.
- Milk, cheese, cheese spreads
All other yoghurt, fromage frais, ice cream, jelly, sorbet, ice-lollies, instant whips, crème caramel, milk puddings, custard and blancmange.
- Crisps.
- Shredless marmalade, jelly jam, honey and lemon curd.
Tomato sauce, yeast extract, 2 tsp of pickles and chutney.
- Plain or milk chocolate, boiled sweets, toffee, fudges, wine gums.
If you are following this diet for more than a week, a complete
multivitamin and mineral supplement is recommended daily such as Centrum, Boots A-Z, Lamberts A-Z Multi. For a more detailed
list please ask for a copy of the low-fibre diet booklet.
If you have followed a low fibre diet and are still having problems with diarrhoea, we can prescribe Isogel or Fybogel (also called Senokot High Fibre). These act by absorbing fluid and help to
form more solid, less frequent motions. These are often taken by people who have Irritable Bowel Syndrome and can help with both diarrhoea and constipation. Take these until your bowel
symptoms settle. Isogel is sometimes easier to take in a fizzy drink, while Fybogel needs to be drunk immediately once it is mixed
with water. If your bowel problems persist, then you may need additional medication such as Loperamide (imodium) or Codeine phosphate which the doctor can prescribe for you.
Bladder
Radiotherapy can irritate the bladder and give symptoms similar to cystitis such as increased frequency and burning or difficulty when passing urine. We recommend that you take plenty of fluids, at
least a litre a day. It is best to avoid drinking lots of tea and coffee. Some people find a glass of cranberry juice a day helpful.
Bladder and bowel problems gradually get better, and most people are back to normal at their follow-up clinic visit 6 weeks after treatment.
Fatigue
You may feel tired during treatment so rest is important. Tiredness often affects people after treatment ends, so you may need help with housework and shopping. Please ask any member of the
team treating you if you would like to see a social worker who
can advise on help available. Some women also have aching and stiffness in their joints and muscles. As your strength returns, as
it will do, you can gradually take up your normal daily activities.
Radiotherapy treatment can be a demanding treatment. If you
are feeling low or are not coping, let the nurses, doctors or radiographers treating you know so they can discuss with you what might help.
Sexual relations
During your treatment with radiotherapy, the top of your
vagina can become inflamed and women can find intercourse uncomfortable. We recommend that you do not have intercourse while you are having radiotherapy and for at least 2-3 weeks afterwards to allow the area to heal.
However, a course of radiotherapy is the equivalent of a major operation, and it may be some months before you feel interested
in the physical aspect of your relationship and your vagina is fully healed and comfortable. Many women find that their vagina is a little dry and at first, it is more comfortable to use a lubricant such as Aqua Gel, KY jelly or Replens.
If these problems last for months after treatment, please discuss this with your doctor at the follow-up visits as we would like to help you get back to your normal life-style. Sex is not harmful to you and will not make the cancer return.
Nausea
Very occasionally you may feel sick during your radiotherapy treatments, your taste changes or you go off your food. This is more likely to happen if you are having chemotherapy. Let the nurses or doctors looking after you know because they can help you.
Skin/pubic hair
Most radiotherapy treatments to the pelvis do not cause sore skin. We will advise you at the start of treatment if your treatment is
likely to do so, and what you can do to help yourself. The leaflet Skin care during and after your radiotherapy to the perineal area has helpful advice. Some women do find that their pubic hair falls out during or shortly after treatment, this usually grows
back but is often thinner.
Vaginal discharge or bleeding (after internal treatment):
You may find that you have a vaginal discharge. If you have had internal treatment you may have light bleeding. These are not unusual and may continue for a time after you get home. It is
not likely, but if the discharge or bleeding alters in any way (for example, becomes heavier or smells unpleasant or if there is bright red heavy bleeding), phone the ward.
Why do side effects happen?
The side effects happen because, as well as destroying cancer cells, radiotherapy can also damage healthy cells nearby. As
the diagrams on pages 6 show, the bladder and bowel are very close to the cervix and womb (uterus), so they can be affected by the radiotherapy too. When planning a woman's treatment,
the doctors choose the dose that will give the best chance of destroying the cancer cells and reducing the symptoms - with the smallest possible effect on healthy tissue.
It seems that some women are more sensitive to radiation than others, and are more likely to experience side effects. At present, it
is not possible to identify these women before treatment starts.
Late effects
There are some late side effects of radiotherapy that your doctor will discuss with you. These may occur months or years after your treatment and happen only in a very few cases. They can include long-lasting bowel, vaginal and bladder problems.
Cancers can damage the tissues that they are growing in. Cancer of the cervix can grow towards the bowel, and/or bladder and/or vagina and can weaken them before treatment. If the cancer
is fully destroyed by the radiation, the tumour damage to the bladder, bowel and vagina may mean that it is impossible for
this damage to be repaired, even after successful treatment. The extent to which this happens varies enormously, and depends on the size and extent of the tumour and its nature.
Your doctor will ask you to sign a consent form before treatment to say that you agree to the treatment and understand about the possible long term effects.
Bladder, bowel and vagina
One in three women may develop bladder, bowel or vaginal problems, but for most women these effects will be mild. These can include some lasting alteration in bowel habit which can be
controlled by altering diet, or needing to empty the bladder more frequently.
In a small minority of women (3 to 10 in 100) long-term effects
can be more serious and include such effects as narrowing of the bowel or bleeding from the bladder. If this happens, each woman
is assessed and referred to a specialist who has experience of dealing with these problems. Some women may need to have surgery to correct these problems ( 5 to 8 in 100). The risk of these serious effects for each patient is influenced by the combination
of cancer treatment, size and stage of the cancer and pre-existing problems in the pelvic area. ( These figures are based on treatment
outcomes from patients treated at The Christie.)
Lymphoedema
This is swelling of the leg(s) that occurs in a small number of women (less than 1 in 100) after a gynaecological cancer. When
it does occur, it is usually in women who have had both surgery and radiotherapy. There are things you can do to help prevent
it or minimise it, so ask the team looking after you for further information.
Infertility and early menopause
The treatment has a late effect on fertility which is permanent and will result in an early menopause
In younger women who are still having periods, radiotherapy to the pelvis causes the ovaries to stop working because they are very sensitive to radiation. This means unfortunately that
you will no longer be able to have children and will have an early menopause. If infertility is an issue for you and your partner please let the doctor who is planning your treatment know, he or she can arrange appropriate support.
Some women find that their periods stop while having radiotherapy, others can have 2 or 3 periods following
treatment before these stop altogether. At the same time, you may start to have menopausal symptoms such as hot flushes, night sweats, vaginal dryness, irritability and mood swings. Treatment and management of the menopause needs to be worked out for each woman because it depends on many factors including type of cancer, past medical history, age and
so on. This needs to be discussed on an individual basis with each woman. If you would like more information about this, please ask the team treating you.
The family planning association sex ware catalogue
A range of vaginal lubricants can be ordered by mail order.
Menopause Matters
For accurate, up to date information about menopause and treatment options
Research at the Christie
The Christie, along with the nearby Paterson Laboratory,
is a major centre for cancer research of all kinds. You may be
asked if you are willing to help with some of the clinical trials and audits that are going on. You are under no obligation to take part
in any of these. You will meet some of the research nurses who help to run the trials. They will also give you support and advice throughout your treatment, whether you are taking part in a trial or not.
Some questions about radiotherapy
Is radiotherapy safe?
Uncontrolled radiation can be dangerous. But radiation used in medical treatment is given in controlled, carefully measured doses. The aim is to treat the illness without harming the patient.
Will I be radioactive?
No. Patients treated by x-rays do not become radioactive. The radiation does not stay in your body after the treatment machine has been turned off, so you cannot do anyone else any harm. It is perfectly safe for you to mix with other people and to have visitors
if you are on the wards (apart from when you are actually having
Selectron treatment).
However, as some other people in the hospital are being treated with radioactive substances, there can be restrictions on visiting patients on the ward. Pregnant women should check with the nurse in charge before entering the ward. For the same reason, children are not encouraged to visit the ward, but they can meet their families in the Oak Road foyer or the conservatory.
I already have problems with my health. Will radiotherapy treatment make them worse?
Not usually, but some health problems such as diabetes, need to be monitored more closely during radiotherapy. Ask your Christie doctor if you are worried about any other health problems
Can I be treated as an outpatient?
Yes, if your doctor thinks you are well enough. Do not expect to be able to go out to work or run the home as well. After daily travel and treatment, you will almost certainly feel tired and need to rest. Space in the radiotherapy waiting area is limited. Please only bring one person with you.
You may be entitled to help with travel costs. Ask at the Post Office or local DSS for leaflet HC11 'Help with health costs'. Other financial help may be available through the Christie social work department.
As an inpatient, when will I have my treatment?
The radiographers will give you a leaflet at your
first appointment at the radiotherapy department, explaining how many treatments you will have and the date of your last treatment. Unfortunately, they cannot always give you an exact appointment time for the next day's treatment, but you will be told whether this will be in the morning or afternoon. They will give you an appointment time whenever possible.
If you have a morning appointment please stay on the ward until after your treatment, but if you have an afternoon appointment
you may leave the ward in the morning. You must check with the nurse in charge first.
If I have to stay in hospital, can I go home for the weekend?
Yes, if your doctor thinks that you are well enough. You must make your own transport arrangements to go home and come
back to hospital. At the present time on Oak House ward, you can go on weekend leave after your treatment on Friday, and return
in good time for your treatment on Monday - the ward re-opens at 7.30am on Monday. The time of weekend leave varies on other wards, so please check with the nurse in charge of the ward about
the time you need to return.
Can I be treated early on a Friday?
Unfortunately, we cannot guarantee an early treatment on Friday, as other patients would like an early appointment too. If this is going to cause you serious difficulty, please speak to the radiographers
After the treatment Follow-up after treatment for gynaecological cancer
What happens after my treatment at the Christie?
You will have regular follow-up appointments. You will normally alternate between seeing the oncologist who gave you the radiotherapy and seeing the gynaecologist who diagnosed your cancer. You will usually see the gynaecologist at the hospital
where you were first seen. Your appointments with the oncologist may be at the Christie, or at your local hospital depending on
where you live.
When will my first appointment be?
Your first appointment will be about 6 weeks after your treatment finishes. We will usually post this to you. The main aim of this is to check that the side effects of your treatment have settled. We will ask you some questions to check that your bowel and/or bladder symptoms are improving. We will also check whether any other symptoms you had relating to your cancer and treatment are getting better. The doctor will also examine you. This is to make sure that any tumour that could be felt before treatment started is responding satisfactorily.
Follow-up plan
Follow-up appointments are usually arranged:
- every 3 months in the first year,
- every 4 months in the second year
- every 6 months in the third, fourth and fifth year
Will I have a scan?
Most women will be followed-up with regular consultations and examinations. You may have scans of your abdomen and pelvis
if you have symptoms that we cannot explain, or if examination in clinic shows that everything has not returned to normal. In general, scans are not carried out before 3 months after your
treatment and ideally not before 6 months. This is because they can be very difficult to interpret as there may not have been
enough time for your body to have returned to normal following your treatment. It can also be difficult to distinguish between changes due to the treatment and those due to the tumour.
Why is a scan useful?
- to see if your cancer has responded to treatment.
- to identify any spread of the cancer
- to see if the cancer has come back (recurrence)
- to identify the cause of symptoms which may not be related to your cancer
If the scan is clear, it means that there is no visible sign of any remaining tumour. This is reassuring for you and the team treating you. But it doesn't rule out further problems in the future, so
you will need continued follow-up. If the scan shows that your cancer has returned in the pelvis, then further treatment including surgery may be an option. However, if the scan shows that your cancer has spread beyond the pelvis, then chemotherapy (drug treatment) or radiotherapy may be an option.
When will I know that the cancer is gone?
Women with cervical cancer who are going to develop a recurrence of their cancer are most likely to do this within two years following treatment. The highest chance of recurrence is
in the first year following treatment. This is why patients are seen frequently in the first two years after treatment. For women with the common types of cancer of the cervix, uterus, vagina or vulva
it is unusual for them to have further problems from their cancer if they are free of any problems at five years.
Do I need further smear tests?
We do not recommend that women who have had radiotherapy to the pelvis have further smear tests taken from the cervix or
vagina. These are not helpful because radiotherapy makes it very difficult to interpret the smear tests. If you only had surgery for treatment for cancer of the cervix or uterus then smear tests may
be carried out at follow-up visits.
What symptoms should I report or be worried by?
If you have the following symptoms you should contact the Christie or your gynaecologist or your GP to ask for an earlier appointment:
- Pain lasting for 2 to 3 weeks, particularly if it keeps you awake
- New swelling in one or both legs
- Bleeding or discharge from the vagina or bowel, or from the bladder when passing urine
- A serious change in bladder or bowel habit
Treatment effects:
A few women will develop symptoms that could be due to treatment effects. These can be similar to the symptoms caused by tumour recurring or an entirely different condition. Tests
will help us to identify the cause of these symptoms to suggest appropriate treatment. These effects may occur some time after treatment finishes, even after several years.
If you have further tests or surgery at another hospital, it
is important that you tell your doctors that you have had radiotherapy treatment before.
After you have had treatment for cancer it can be a worrying time. Please remember that you will have the same aches and pains that you have always had. If you develop a new health problem, this may not be related to your cancer and its treatment
Appointments
Once you are having treatment, if you have a problem with your appointment time, please contact the Radiotherapy Department at the Christie on 0161 446 3485 as soon as possible. It is helpful
if you can quote your hospital number - it will be on your appointment card or letter. If your follow-up appointment is inconvenient, please contact
the Health Records Department on 0161 446 3346 or 3347. Or you could write to The Health Records Officer, The Christie NHS Foundation Trust, Withington, Manchester M20 4BX. If you do write, please make sure that your letter arrives well in advance of
your appointment, as this will make it easier to arrange another appointment for you.
If you change your address, please let the Health Records Department staff know your new address, and the address of your new family doctor.
Travel and holidays
Most people do not feel like travelling for the first few weeks after their treatment. Every woman is different but it may take 4 to 6 weeks before your side effects settle and it may be some time
after this before you feel like going on holiday. Once you feel like going on holiday there should be no problem travelling within
the UK. However, if you are thinking about going abroad, make sure you have adequate health insurance which includes your cancer diagnosis. Even in Europe, you should have insurance
as well as the European Health Insurance Card. This may mean that the cost of your insurance policy is higher than it has been previously. Some people have found it useful to get a quote for
their insurance before booking a holiday, as this could affect your choice of destination. More information about this and other things to consider are in the Cancerbackup booklet 'Travel and Cancer'.
Benefits and finance
You may be entitled to Disability Living Allowance (for under 65s)
or Attendance Allowance (65+) or other benefits
- Find out more today, freephone 0800 882200
Pick up a leaflet or ask to see a social worker
Consent for gynaecological
radiotherapy
The doctor is here to help you. He or she will explain the proposed treatment and what the alternatives are. You can ask any questions and seek further information. You can refuse the treatment.
You may ask for a relative, or friend, or a nurse to be present.
Your treatment may involve:
- External beam radiotherapy to the pelvis
- Insertion of radioactive sources into the uterus and / or vagina under general anaesthetic.
The doctor will ask you to sign a consent form, here are the key messages:
Early side-effects:
- This treatment will cause some degree of diarrhoea and / or cystitis. It may cause some tiredness. These side effects are temporary.
Long-term effects:
- This treatment will cause sterility and the early onset of the menopause in pre-menopausal women.
- This treatment carries a small long-term risk of damage to the bladder area or bowel which may need subsequent surgery.
- This treatment may cause some narrowing of the vagina which
is usually preventable.
These reactions are explained in the booklet ' Radiotherapy for gynaecological tumours' which you must have been given an opportunity to read and discuss with staff before being asked to sign the consent form.
Before you sign the consent form…
the doctor will ask you...
- To agree that to the best of your knowledge you are not pregnant
- To agree to what is proposed which will have been explained to you by the doctor named on the form
- To agree to the use of an anaesthetic as required for the treatment. That you understand that you will receive a full explanation about the anaesthetic from a member of the medical staff of the Anaesthetic Department before any treatment needing an anaesthetic.
The doctor will ask you if you understand:
- that any procedure in addition to those described on the form will only be carried out if it is necessary to save your life or to prevent serious harm to your health.
- that there is no guarantee that a particular person will perform the procedure. The person will, however, have appropriate experience.
The doctor will explain:
- about additional procedures which may become necessary during your treatment. You have listed any procedures which you do not wish to be carried out without further discussion.
You will need to check that all the information on the consent form is correct, and if you understand and are satisfied with the
explanation. You will have time to consider the information before being asked to sign the consent form.
Training health professionals is essential to the continuation of the health service and improving the quality of care. Your treatment may provide an important opportunity for such training, where necessary under the careful supervision of a senior doctor. You
may refuse any involvement in a formal training programme without this adversely affecting your care and treatment.
Further information
Cancerbackup
Cancerbackup is a national cancer information charity which runs a cancer information service for patients and carers. The
Freephone is 0808 800 1234 (or 020 7613 2121 for charged calls). Calls are answered by specially trained cancer nurses who can give you information on all aspects of cancer and its treatment.
Cancerbackup also publish booklets which are free to patients, their families and carers. You can get a copy by ringing or writing to
Cancerbackup
3 Bath Place,
Rivington Street,
London EC2A
3JR.
Cancerbackup booklets include:
- Booklets on specific cancers, for example, cervix, uterus and vulva.
- Understanding radiotherapy and Understanding chemotherapy
- Booklets on living with cancer - some of these are listed below:
- Sexuality and cancer
- Who can ever understand? - talking about your cancer
- Lost for words: how to talk to someone with cancer
- What do I tell the children?
- Travel and cancer
- Cancer and Complementary therapies
The Cancer Information Centre on the glass link corridor has the full range of Cancerbackup booklets available available free to patients and their relatives/carers.
The Christie information
The Christie produces a range of information booklets and videos, some of these are listed below:
- Where to get help: services for people with cancer
Discusses sources of help when you have cancer, including financial help, also lists the cancer support groups.
- Eating help yourself
This booklet gives advice on coping with eating problems when you don't feel well and you are having treatment.
- Video or DVD on Radiotherapy
You can borrow a video or DVD to watch at home. Please ask on the ward of the staff in clinic. These are available in English, Urdu, Cantonese and Mandarin.
These booklets and videos are free to patients and their families.
If you would like a copy please ask the ward staff. If you are an outpatient, please ask your nurse or radiographer.
Large print version are available, please contact
Patient Information on 0161 446 3576.
Useful contacts
- Nurse clinician -0161 446 8101
or ring 0161 446 3000 and bleep her
- Dietitian - 0161 446 3729
- Social worker - 0161 446 3730
- Occupational Therapist - 0161 446 8024
- Physiotherapist - 0161 446 3795
- Counsellor - 0161 446 8038
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Information produced by The Christie Patient Information Service - June 2006
CHR/XRT/103/12.03.03