Macmillan Virtual Multidisciplinary Team

Late effects of pelvic radiotherapy

 

Radiotherapy treats cancer by using high-energy x-rays to destroy cancer cells. Normal cells in the treatment area can also be damaged by radiotherapy, but usually they can repair themselves. Radiotherapy to the pelvic area may be given externally by a machine called a linear accelerator, or internally by implanting seeds of radioactive material into the tissues. This method of giving radiotherapy is known as brachytherapy.

 

Late effects are:

• Side effects that being during or shortly after treatment and don’t go away within six months (sometimes called long-term effects) – occasionally these effects become permanent.
• Side effects that don’t affect you during treatment but begin months or even years later, as a delayed response to treatment.
   
  The most common late effects after pelvic radiotherapy are changes to the way the bladder and bowel work. Both men and women may also notice changes in the physical and emotional feelings associated with sex.
   
  
  
  Bladder changes
  Pelvic radiotherapy can cause scarring and hardening (fibrosis) of the bladder wall, which shrinks the bladder. It can also weaken pelvic floor muscles and the valve that holds the bladder closed. This causes small amounts of urine to leak out (incontinence).
  
  
  Small blood vessels in the bladder lining may be more fragile and bleed easily, causing blood in the urine.
  
  
• Needing to pass urine more often than usual
• A burning sensation when you pass urine
• Being unable to wait to empty your bladder (urgency)
• Leaking urine (incontinence)
• Blood in your urine (haematuria)
• Difficulty passing urine
  
  
  Bowel changes
  Pelvic radiotherapy can cause scarring (fibrosis) in the large bowel lining, making it thicker and less flexible. This causes solid waste (stool) to pass through more quickly than before as the bowel is unable to hold as much. The muscles that help to hold stool in the rectum can also be affected, which may cause problems with bowel control and leakage (incontinence).
   
  The blood supply to the bowel can also be affected by radiotherapy, making the bowel tissue and the small blood vessels in it more fragile. When radiotherapy affects the small bowel, it can cause food intolerance, or conditions such as bile acid malabsorption or small bowel bacterial overgrowth.
   
• Diarrhoea or severe constipation
• Needing to rush to open your bowels (urgency)
• Leaking or soiling (incontinence)
• Passing a lot of wind
• Bleeding from the bottom
• Passing mucus
• Cramps or spasms in the bowel and/or feeling that you haven’t emptied your bowel completely (tenesmus).
  
  
  
  
  
  
  
  Lymphoedema
  If the lymph nodes (glands) in the pelvic area become damaged by pelvic radiotherapy or by surgery to remove them, fluid sometimes builds up in one or both legs (lymphoedema). You’re more at risk of lymphoedema is you’ve had an operation to remove the pelvic lymph nodes as well as pelvic radiotherapy.
   
  Lymphoedema can develop months or even years after treatment, causing one or occasionally both legs to become swollen. Rarely, both men and women can get swelling in the trunk or genital area.
  
  
  Bone changes
  Damage to the bones in the pelvic area is a very rare late effect of radiotherapy. If radiotherapy damages the pelvic bones, it may increase the risk of fine, hair-like cracks which can be painful. The pain is normally in the lower back and it can make walking difficult.
   
  Pelvic radiotherapy causes early menopause in younger women. This increases the risk of bone thinning (osteoporosis), but only if you can’t take hormone replacement therapy.
  
  
  Relationships
  Pelvic radiotherapy can affect your sex life and how you feel about yourself sexually. This can be more of a problem if you’ve had surgery to the pelvic area.
   
  Problems for women
• Low sex drive (libido)
• Vaginal narrowing
• Vaginal dryness
• Bleeding
• Problems with sexual sensations
• Infertility
   
  Problems for men
• Problems getting or keeping an erection (impotence)
• Changes in ejaculation
• Low sex drive (libido)
• Infertility
   
  If you would like more information about the effects of pelvic radiation disease, you can visit the Pelvic Radiation Disease Association website at www.prda.org.uk or visit the Macmillan website on www.macmillan.org.uk.

 Macmillan Cancer Support, "Managing the Late Effects of Pelvic Radiotherapy in Men", "Managing the Late Effects of Pelvic Radiotherapy in Women", 2012.