Pelvis

Radiotherapy to the pelvis is a common treatment approach for cancers involving pelvic organs.

Radiotherapy To The Pelvis

Is often used to treat cancers in areas such as the bladder, rectum, anus, prostate, cervix, uterus (womb) and vagina. It can also be used to treat lymph nodes in the pelvis region.

Some radiotherapy treatments are also given together with chemotherapy and/or brachytherapy (internal radiation). Please see the individual sections below.

Meeting your Doctor

Before treatment starts, you’ll have a chat with your doctor. They will explain the treatment, possible side effects, and ask you to sign a consent form. This meeting can be in person or over the phone.

Planning Scan

Before treatment starts, you’ll have a planning scan, usually a few weeks before. During this visit, you’ll meet with a radiographer to discuss things like the use of micro-enemas for your treatment. You will also be asked to follow a drinking protocol for your scan and treatment.

To ensure that your bladder and bowels resemble the planning scan, it’s important to follow to the proper bladder and bowel guidelines. This prevents delays from getting on and off the bed to manage your bowels or bladder and helps ensure that your radiotherapy is accurate.

During this planning CT session, you will be laid down in the treatment position and will have a CT scan to precisely locate the tumour and the area to be treated.

Small tattoos will be placed on the skin around the area that will receive radiation. These markings help ensure that radiation is delivered to the same spot each time.

Please note: Depending on the dose and schedule that the consultant has prescribed, some prostate patients may have a planning scan on an MRI scanner instead of a CT scanner.

If you have been referred for internal radiation therapy (brachytherapy) to the prostate, please see the Brachytherapy section for more information.

Radiotherapy

Radiotherapy for prostate cancer is usually given 5 days a week (Monday to Friday). The number of treatments will depend on the doctor’s recommendation. You must follow the same bowel and bladder preparation which you were given at your planning scan. Once you are ready for treatment, the therapeutic radiographers will accurately position you on the treatment couch. This will be the same position which you laid down in for your planning CT scan.

The linear accelerator will rotate around you and deliver the radiotherapy treatment. You won’t feel the radiation, but you might hear some noises as the machine operates. Each session typically takes around 10 to 15 minutes. However, the actual radiation exposure lasts only a few minutes. You’ll need to stay still during the treatment, but you won’t feel pain or discomfort during the process.

Links to Useful Resources:

Meeting your Doctor

Before treatment starts, you’ll have a chat with your doctor. They will explain the treatment, possible side effects, and ask you to sign a consent form. This meeting can be in person or over the phone.

Planning Scan

Before treatment starts, you’ll have a planning scan, usually a few weeks before. During this visit, you’ll meet with a radiographer to discuss things like the use of micro-enemas for your treatment. For your planning scan and treatments, your bladder will need to be empty. During the planning scan, you’ll be positioned for treatment, and the scan will help the doctors find the tumour and the area that needs treatment.

During this planning CT session, you will be laid down in the treatment position and will have a CT scan to precisely locate the tumour and the area to be treated.

Small tattoos will be placed on the skin around the area that will receive radiation. These markings help ensure that radiation is delivered to the same spot each time.

Radiotherapy

Radiotherapy for bladder cancer is usually given 5 days a week (Monday to Friday). The number of treatments will depend on the doctor’s recommendation. You must follow the same bowel and bladder preparation which you were given at your planning scan. Once you are ready for treatment, the therapeutic radiographers will accurately position you on the treatment couch. This will be the same position which you laid down in for your planning CT scan. The linear accelerator will rotate around you and deliver the radiotherapy treatment. You won’t feel the radiation, but you might hear some noises as the machine operates. Each session typically takes around 10 to 15 minutes. However, the actual radiation exposure lasts only a few minutes. You’ll need to stay still during the treatment, but you won’t feel pain or discomfort during the process.

Links to Useful Resources:

Meeting your Doctor

Before treatment starts, you’ll have a chat with your doctor. They will explain the treatment, possible side effects, and ask you to sign a consent form. This meeting can be in person or over the phone.

Planning Scan

A few weeks before treatment starts, you will have CT and MRI planning scans. These scans help the consultant and the Planning team to outline the area that needs to be treated. A radiographer will explain to you how to prepare your bladder for the scans and treatment.

During these planning scans, you will be laid down in the treatment position. Small tattoo dots will be placed on the skin around the treatment area. These markings help the radiographers to set you up to the same spot every day.

Radiotherapy

Radiotherapy for rectum and anus cancer is usually given 5 days a week (Monday to Friday). The number of treatments will depend on the doctor’s recommendation. You must follow the same bladder preparation which you were given at your planning scan. Once you are ready for treatment, the therapeutic radiographers will accurately position you on the treatment couch. This will be the same position which you laid down in for your planning CT scan.

The linear accelerator will rotate around you and deliver the radiotherapy treatment. You won’t feel the radiation, but you might hear some noises as the machine operates. Each session typically takes around 10 to 15 minutes. However, the actual radiation exposure lasts only a few minutes. You’ll need to stay still during the treatment, but you won’t feel pain or discomfort during the process.

Links to Useful Resources:

Meeting your Doctor

Before treatment starts, you’ll have a chat with your doctor. They will explain the treatment, possible side effects, and ask you to sign a consent form. This meeting can be in person or over the phone.

Planning Scan

A few weeks before treatment starts, you will have CT and MRI planning scans. These scans help the consultant and the Planning team to outline the area that needs to be treated. A radiographer will explain to you how to prepare your bowels and bladder for the scans and treatment. This involves drinking a certain amount before each scan and treatment, and the use of micro-enemas to prepare your bowels.

During these planning scans, you will be laid down in the treatment position. Small tattoo dots will be placed on the skin around the treatment area. These markings help the radiographers to set you up to the same spot every day.

Radiotherapy

Radiotherapy for gynaecological cancer is usually given 5 days a week (Monday to Friday). The number of treatments will depend on the doctor’s recommendation. You must follow the same bowel and bladder preparation which you were given at your planning scan. Once you are ready for treatment, the therapeutic radiographers will accurately position you on the treatment couch. This will be the same position which you laid down in for your planning CT scan.

The linear accelerator will rotate around you and deliver the radiotherapy treatment. You won’t feel the radiation, but you might hear some noises as the machine operates. Each session typically takes around 10 to 15 minutes. However, the actual radiation exposure lasts only a few minutes. You’ll need to stay still during the treatment, but you won’t feel pain or discomfort during the process.

If you have been referred for internal radiation therapy (brachytherapy) to the gynaecological region, please see the Brachytherapy section for more information.

Links to Useful Resources:

Using dilators after pelvic radiotherapy for patients with a female pelvis

Guidance on using dilators after pelvic radiotherapy for patients with a female pelvis.

Using dilators after pelvic radiotherapy

Using dilators after pelvic radiotherapy for patients with a female pelvis.

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Hello, my name is Vash and I’m a specialist therapy radiographer in brachiotherapy.
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Brachotherapy is a type of internal radiotherapy used to treat some cancers.
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And my name is Megan and I’m a therapeutic radiographer in radiotherapy.
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One of the possible late side effects of radiotherapy or brackchotherapy to the pelvis is vaginal stenosis. This is when
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the vagina can become narrower, shorter, and tighter due to the scar tissue forming after treatment. You may notice
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this as discomfort during sexual intercourse or during an internal examination. You might also experience dryness, reduced stretch, or tenderness.
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The good news is that there are ways to help prevent and reduce these effects.
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One of the most effective methods is regularly and gently stretching the vaginal tissue using vaginal trainers,
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also called dilators. Vaginal trainers are smooth tubes that come in different sizes. The hospital provides a set of
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four sizes. We recommend starting with a smaller size and gradually increasing when it feels comfortable. You don’t need to use the largest size. A
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comfortable size is enough. We usually advise starting once any treatment side effects like soreness or spotting have
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settled. This is typically around 2 to four weeks after treatment. You should aim to use the trainers three to four
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times per week for about 10 minutes each time. We recommend continuing for around 2 years after treatment. If you have
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regular penetrative sexual intercourse, you may not need to use them as often.
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Using vaginal trainers is not mandatory, but we do strongly recommend it. Many patients seen later in clinic feel that
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using them earlier could have helped to prevent long-term problems. Before you begin, wash the trainer with warm soapy
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water and rinse it well. Find a comfortable position. This could be lying on your bed with your knees
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relaxed apart or standing with one leg raised. Apply lubricant to the trainer.
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This can be prescribed by your GP. Avoid oil based products like Vaseline or baby oil as these can cause irritation.
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Gently insert the trainer into the vagina as far as is comfortable. Take your time and try to stay relaxed. Once
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the trainer is inserted, there are two important movements to follow. First, a gentle in andout motion. Slowly move the trainer in and out for about 5 minutes.
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Second, a gentle rotating motion. Keep the trainer in place and rotate it in circular movements for another 5 minutes. These movements help stretch the tissue and keep the vagina flexible.
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When you finished, gently remove the trainer, then wash it again with warm soapy water. Rinse well and allow it to
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dry. Using the trainer shouldn’t be painful, but you may feel some discomfort at first. You might also notice light spotting or light bleeding
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when you begin. This is usually normal and should improve over time. If it becomes very painful or bleeding is heavy, please contact your healthare
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team. As the trainer becomes easier to use, you may consider moving up to the next size. The standard hospital set is
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made of plastic, but there are other options available. Some people find silicone trainers more comfortable or
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gentler to use. You can explore these options yourself or speak to your specialist nurse for advice. Sexual
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intercourse using your fingers or a vibrator can also stretch the vaginal tissue. However, we still recommend continuing to use the trainers
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regularly. Lubricants can also help with dryness during both trainer use and sexual activity. Regular use of vaginal
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trainers can help prevent long-term tightening and maintain vaginal health.
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This can make future examinations and sexual activity more comfortable. If you have any concerns or questions, please
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speak to your doctor, nurse, or specialist team. Thank you for watching.
 

Side Effects

Even though radiation targets the tumour, it can also affect healthy tissue nearby. Side effects usually start after a few treatments and can be different depending on the area being treated.

Common side effects of pelvis radiotherapy include:

  • Tiredness (Fatigue): Tiredness is one of the most common side effects, and it tends to build up over time during treatment.
  • Skin Changes: The skin in the treated area may become red, dry, or irritated, like sunburn. You might also experience itching or peeling. See the link below advising you on how to look after your skin during and after radiotherapy treatment.
Skin care during and after your radiotherapy treatment leaflet
  • Nausea: Some patients may feel nauseous, especially if the radiation is directed near the stomach or bowels.
  • Pelvic Discomfort: Some patients experience pelvic pain and cramping.

Radiotherapy to the pelvis can irritate the bowel or bladder, leading to symptoms like:

  • Diarrhoea or more frequent bowel movements.
  • A feeling of urgency to urinate or burning sensation when urinating.
  • Blood in the stool or urine, though this is less common.
Important:

Please Note

Most side effects improve 10-14 days after treatment ends. Your healthcare team will be there to manage any side effects and provide support during and after your treatment.

Please inform your radiotherapist if you are experiencing any side effects.

Useful Resources:

Radiotherapy to your whole pelvis – For prostate, bladder and penile cancers leaflet
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