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Patient information - Cervical cancer - External Beam Radiation Therapy (EBRT) - post-operative with chemotherapy

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What is Radiation Therapy (Radiotherapy)?

Radiotherapy is the use of high energy x-rays to treat cancer. Radiotherapy is sometimes called external beam radiotherapy (EBRT) and is delivered by a linear accelerator (radiotherapy treatment machine). Your treatment is individualised and carefully planned by your doctor and radiation therapists.

What happens during radiation therapy?

When you are having radiotherapy, you will be on your own in the treatment room. The radiation therapists can see and hear you at all times via cameras in the treatment room. The machine will not touch you during treatment and you won’t feel anything. The machine will move around you and make a buzzing sound.
If you become concerned or feel unwell in any way, raise your hand or call out. The radiation therapists will interrupt the treatment and attend to you.

What is the aim of treatment?

Radiotherapy is given to destroy any remaining cancer cells after your surgery.

How long will this treatment take?

The treatment is usually given Monday to Friday as an outpatient in the radiotherapy department. It takes about 20 minutes each time. A course of radiotherapy will take approximately 5 to 6 weeks to complete. Some people may have chemotherapy as well as radiotherapy. Your doctor will talk to you about the number and type of treatment that is best for you. 

Emergency

IMMEDIATELY go to your nearest hospital Emergency Department, or contact your doctor or nurse if you: 

Emergency contact details

Ask your doctor or nurse from your treating team who to contact if you have a problem
  • develop a temperature of 38ºC or higher
  • develop chills, sweats, shivers or shakes 
  • develop uncontrolled vomiting or diarrhoea
  • develop uncontrolled bleeding.
Daytime:
Night/weekend:
Other instructions:
Before radiotherapy begins and during treatment, if you are pregnant or feel that there is any chance that you may be pregnant it is important to discuss this with your doctor.
Do not try to get pregnant during this treatment. Ask your doctor or nurse about what type of contraception you should use.

Some cancer treatments can reduce your fertility. This can make it difficult or impossible to get pregnant.

Talk to your doctor or nurse before you start any treatment. Depending on your situation there may be fertility sparing options available to you.

Tell your doctor, nurse or radiation therapist if you:

  • develop changes to your bowel or bladder habits
  • develop any changes to your skin
  • feel unwell in any way.

Note: you may experience continued vaginal bleeding during the first few weeks of starting your radiotherapy

At home it is important to:

  • take your medications as prescribed by your doctor.

Smoking

  • You are strongly advised to stop smoking.
  • Smoking during and after treatment can impact on the success of treatment.
  • For some people, smoking can increase the risk of side effects.

Quitting smoking

  • It is never too late to quit smoking. Quitting smoking is one of the best things you can do to help your treatment work better.
  • There are many effective tools to improve your chances of quitting.
  • Talk to your treating team for more information and referral to a smoking cessation support service.

Staying active

  • Research shows that exercise, no matter how small, has many benefits for people during and after cancer treatment.
  • Talk to your doctor before starting an exercise program. Your doctor can advise whether you need a modified exercise program.

Cancer treatments can cause damage to normal cells in your body, which can cause side effects. Everyone gets different side effects, and some people will have more problems than others.

The table below shows some of the side effects you may get with this treatment. You are unlikely to get all of those listed and you may also get some side effects that have not been listed.

Tell your doctor or nurse about any side effects that worry you. Follow the instructions below and those given to you by your doctor or nurse.

Short term side effects: May occur during treatment or within a few weeks of finishing radiotherapy and usually settle within 4 weeks

Bowel irritation

  • During the last few weeks of treatment, you may have:
    • bowel motions (stools, poo) that are more urgent or frequent
    • a small amount of bleeding or clear discharge when passing a motion
    • a sore or irritated rectum
    • bloating, cramping or pain.
  • Take anti-diarrhoea medication as directed by your doctor.
  • Drink plenty of fluids (unless you are fluid restricted).
  • Avoid spicy foods, dairy products, high fibre foods, and coffee.
  • Ask your doctor or nurse for eviQ patient information - Diarrhoea during cancer treatment. 
  • Contact your doctor or nurse as soon as possible if your diarrhoea continues despite taking medication, or if you feel dizzy, light-headed or unwell.

Tiredness and lack of energy (fatigue)

  • You may feel very tired, have no energy, sleep a lot, and not be able to do normal activities or things you enjoy.
  • Do not drive or operate machinery if you are feeling tired.
  • Nap for short periods (only 1 hour at a time).
  • Prioritise your tasks to ensure the best use of your energy.
  • Eat a well balanced diet and drink plenty of fluids (unless you are fluid restricted).
  • Try some gentle exercise daily. Rest when you feel you need to.
  • Allow your friends and family to help.
  • Tell your doctor or nurse if you have problems managing any of the symptoms listed above.

Bladder problems

  • You may have
    • discomfort and burning when you urinate
    • blood in your urine.
  • You may also notice that you urinate more often.
  • Some people have less control over their bladder (incontinence) which may be temporary or ongoing.
  • Increasing your fluid intake (unless fluid restricted) and taking Ural® may provide some relief from the burning sensation when passing urine.
  • Contact your doctor or nurse immediately, or go to the nearest hospital Emergency Department if you are unable or having difficulty to pass urine, or severe discomfort.

Skin changes

  • The skin on your pelvis may become
    • red
    • warm
    • dry
    • itchy
    • more sensitive
    • darker than normal.
  • Skin changes usually start to develop 2 to 3 weeks after the start of treatment. They usually begin to settle down about 2 to 4 weeks after treatment has finished.
  • It is important to care for your skin during treatment and for 4 weeks after treatment as directed by your treating team.
  • Do not scratch the affected area and avoid tight fitting clothing that rubs the skin.
  • Sitting in a salt water bath can help to clean and soothe the skin.
  • Ask your doctor or nurse for eviQ patient information - Skin changes and skin care during radiotherapy. 
  • Tell your doctor or nurse if you get any skin changes, they can help you to manage them.

Hair loss

  • In the area of treatment your hair may fall out.
  • This can happen 2 to 3 weeks after starting treatment.
  • This is usually temporary, but for some people it can be permanent. 

Sexual function and vaginal changes - female

  • You may get dryness, itching or a burning sensation in the vagina.
  • This may cause pain or discomfort during sex.
  • Using a water-based lubricant may ease some discomfort.
  • To overcome vaginal dryness, you may need to use an internal moisturiser such As Replens®, Aquagel®, Vielle® or Sylk® which can be bought from your chemist.
  • Tell your doctor or nurse if you get any of these symptoms, they can help you to manage them.

Nausea and vomiting

  • You may feel sick (nausea) or be sick (vomit) from this treatment.
  • Tell your doctor or nurse if you feel sick and they can help you with management.
  • Ask your doctor or nurse for eviQ patient information - Nausea and vomiting during cancer treatment.

Increased risk of bleeding or infection

  • Your cancer treatment may cause your blood count to decrease.
  • This may increase your risk of bleeding, bruising and infections
  • Wash your hands often.
  • Keep a thermometer at home and take your temperature regularly, and if you feel unwell.
  • Learn how to recognise the signs of infection.
  • Limit contact with people who are sick.
  • Ask your doctor or nurse for the eviQ information - Infection during cancer treatment. 
  • Contact your doctor or nurse immediately, or go to the nearest hospital Emergency Department if you get any of the following signs or symptoms:
    • a temperature of 38°C or higher
    • chills, shivers, sweats or shakes
    • a headache or stiff neck
    • a sore throat or cough
    • uncontrolled diarrhoea
    • severe pain in your abdomen
    • shortness of breath
    • a fast heartbeat
    • feeling unwell even without a temperature.

Long term side effects: May develop months after radiotherapy has finished and may be permanent

Bladder changes

  • Radiotherapy can cause changes to the lining of your bladder in the long term which can be temporary or ongoing.
  • You may have:
    • discomfort and burning when you urinate
    • urgency or pass urine more often
    • leakage or less control over your bladder (incontinence).
  • Tell your doctor or nurse if you get any of the symptoms listed above, they can help you to manage them.
  • Contact your doctor or nurse immediately, or go to the nearest hospital Emergency Department if you are unable or having difficulty to pass urine, or severe discomfort.

Bowel changes

  • For some people, their bowel habits do not return completely back to normal after treatment has finished.
  • You may get:
    • an urgent need to open your bowels
    • pain when opening your bowels
    • a small amount of bleeding or clear discharge when passing a motion
    • diarrhoea
    • constipation
    • leakage or less control over your bowel motions (incontinence).
  • Tell your doctor or nurse if you get any of the symptoms listed above, they can help you to manage them.
  • Contact your doctor or nurse as soon as possible if you have any bleeding from your rectum.

Sexual function and vaginal changes - female

  • Treatment to the pelvis may cause vaginal changes including dryness and narrowing or shortening of the vagina (called vaginal stenosis). These changes may be temporary or ongoing.
  • It is important to keep the vagina lining as supple as possible to reduce this.
  • You can manage vaginal narrowing by having regular intercourse or using a vaginal dilator.
  • Ask your doctor or nurse for eviQ patient information - How to manage vaginal stenosis using a vaginal dilator 
  • Tell your doctor or nurse if you get any of these symptoms, they can help you to manage them or refer you to someone who can help.

Tiredness and lack of energy (fatigue)

  • Feeling tired or fatigue may continue for some time after the radiotherapy has finished.
  • Tell your doctor if you have ongoing tiredness and lack of energy.

Early menopause

  • You may get:
    • hot flushes and night sweats
    • mood changes
    • vaginal dryness
    • irregular or no periods.
  • You may also:
    • have trouble sleeping
    • find sex painful or lose interest in sex.
  • Talk to your doctor or nurse about ways to manage these symptoms.

Swelling (lymphoedema)

  • You may get swelling in your legs.
  • Your legs may feel heavy or tight and you may have aches and pains.
  • This is caused by a build up of fluid in body tissues.
  • Tell your doctor or nurse if you notice any swelling in your limbs, they can help you to manage it.
  • Early treatment can reduce the risk and severity of swelling.

Bowel blockage (bowel obstruction)

  • This treatment can affect the movement of faeces through the bowel, causing a blockage.
  • You may get:
    • abdominal pain
    • loss of appetite
    • nausea or vomiting        
    • constipation
    • watery diarrhoea.
  • Tell your doctor or nurse if you have any of the symptoms listed above.
  • Contact your doctor or nurse immediately, or go to the nearest hospital emergency department if you have uncontrolled pain, vomiting or diarrhoea.

Pelvic fracture

  • You may be at risk of breaking a bone in your pelvis.
  • The risk can depend on the type of treatment you have.
  • Tell your doctor or nurse if you have ongoing sharp pains or soreness in your joints.

Developing a second cancer

  • There is a very small risk that you may develop a second cancer as a result of having radiotherapy.
  • This is uncommon and may not happen until at least 10 years after treatment.
  • Talk to your doctor if you have any concerns about the benefits and risks of radiotherapy.

Will I be radioactive? 

You will NOT be radioactive during or after external beam radiotherapy treatment. You can safely mix with other people, including children and pregnant women, at any time during and after your treatment.

Will I lose my hair? 

You may lose some hair on your head or body if it is in the area of treatment. This usually occurs 2-3 weeks into your treatment. In most patients this is temporary, but for some this may be permanent.

Will treatment affect my sex life?

While it is still safe for you to have sexual intercourse during your radiotherapy, the desire to have sex may decrease because you may become tired, anxious or unwell. It may help to discuss your worries with your partner and/or your radiation oncologist or nurse. A referral to a sexual counsellor may also assist.

What can you do if intercourse is painful?

Many women find they are in too much discomfort to have sex until the tissues in your vagina have healed. This may take 4-6 weeks after your radiotherapy has finished. It may help to discuss this with your partner, radiation oncologist and/or nurse. A referral to a sexual counsellor may assist in managing this side effect. The regular use of a vaginal dilator will help with keeping the tissues in your vagina flexible and elastic. Ask for eviQ patient information - How to manage vaginal stenosis using a vaginal dilator

Do I still need to use contraception? 

Yes, you should use contraception during and after radiotherapy. Ask your doctor or nurse about what type of contraception you should use and for how long.

Will this treatment affect my fertility? 

Some cancer treatments can reduce your fertility. This can make it difficult or impossible to get pregnant. Talk to your doctor or nurse before you start any treatment. Depending on your situation there may be fertility sparing options available to you, discuss these with your doctor or nurse. See our patient information sheets – Fertility for women during cancer treatment.

There is a possibility that radiotherapy treatments to the pelvis may make you infertile. Radiotherapy can damage your eggs, which can lead to birth abnormalities. Please ask your radiation oncologist for information on egg preservation and ovary sparing procedures before you start your treatment.

Should I be on a special diet while having treatment? 

It is recommended that you enjoy a balanced diet (including grains, fruit, vegetables and dairy products) and drink plenty of fluids while you are on treatment. Some foods and drinks may irritate your bladder, causing increased frequency of urination and discomfort. If you have any concerns or questions about your diet, have difficulty eating or are experiencing weight loss, ask to see a dietitian who can help you.

What does the X-ray taken during treatment tell me? 

The X-rays or other images that the radiation therapists take during your treatments are used to confirm your position. These x-rays cannot be used to tell if your tumour is responding to the radiotherapy treatment.

Can I drive during treatment? 

In general, most patients will be well enough to drive whilst they are receiving radiotherapy treatment. If you are unwell or on strong pain killers discuss this with your radiation oncologist prior to driving a motor vehicle.

Can I have a flu or tetanus vaccination?

It is usually safe to have vaccinations such as flu and tetanus while you are having treatment. If you are due for vaccinations talk to your radiation oncologist about the best time to have them.

Is it safe to take vitamin tablets and herbal medicines? 

Before starting any medications, including prescription, over-the-counter medicines, vitamins and alternative or natural or herbal medicines tell your doctor, radiation therapist or nurse. Some medications may interact with your treatment.

Who can I talk to if I am not coping? 

You may feel anxious or depressed during and after the treatment process. Let your treating team know and they will arrange for you to talk to someone. You can also call the Cancer Council 13 11 20 for more cancer information and support.

How do you know if the treatment is successful? 

It is not possible to know if your treatment has been successful immediately after you finish treatment. Your doctor will see you during and after your treatment and will discuss your progress.

What is the follow­ up? 

Once your treatment has finished, you will be advised by your doctor as to what follow up appointments are needed.

Telephone support

  • Call Cancer Council on 13 11 20 for cancer information and support

Gynaecological cancer information

General cancer information and support

Quit smoking information and support

Quitting smoking is helpful even after you have been diagnosed with cancer. The following resources provide useful information and support to help you quit smoking. Talk to your treating team about any other questions you may have.

This document is a guide only and cannot cover every possible situation. The health professionals caring for you should always consider your individual situation when making decisions about your care. Contact your cancer clinic staff or doctor if you have any questions or concerns about your treatment, or you are having problems coping with side effects. Use of this document is subject to eviQ’s disclaimer available at www.eviQ.org.au

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The currency of this information is guaranteed only up until the date of printing, for any updates please check:

https://www.eviq.org.au/pi/3026

18 Feb 2020