Radiation Therapy to the Pelvis

You will receive 4 to 6 weeks of radiation to the pelvis (the area between your hips). Some common side effects include diarrhea and fatigue. Rectal and bladder irritation can also occur. Side effects can begin about 2-3 weeks after the start of treatment and can last for 2 to 4 weeks after the treatments end. Side effects may occur at different times. It also depends on the area of the rectum in the treatment field. For tumors high in the rectum, more diarrhea is seen and less skin irritation. For low lying tumors, more skin irritation is seen. Not everyone has side effects.

Position for Your Treatment

Each day, right before your treatment, you will be asked to get into position on a treatment table. Some patients are put into “molds.” These molds are made during the treatment planning period.

You may have tiny dots or marks that were put on your skin. These marks relate to your treatment field. They look like tiny freckles and will not be easy to see.

If these marks fade, we will remark them. After your treatment is finished, you can let the marks fade. You can also gently remove them using soap and water or baby oil. These marks may rub off on your clothes. If this happens, spray the stains with hair spray or Spray'N'Wash® before you wash your clothes.

Radiation Skin Reaction

Most radiation goes through the skin into body tissues. Even so, the skin in treatment sites can become red and irritated. It can also become dry and itchy. Sometimes, the skin will peel and become moist. This happens most often in skin folds and curves. We will tell you which sites to watch.

Watch your skin closely and report any changes. Use the skin care products as directed. We will watch your skin reaction closely. We may tell you to change the way you care for your skin as it may be painful. Tylenol® or ibuprofen should help. If you need something stronger or help with skin care, let us know.

Skin Care During Treatment

Follow the guidelines in this handout during and after your treatment, until your skin is fully healed.

1. You may bathe or shower using lukewarm water. If you need soap, use one that is meant for dry or sensitive skin such as. Aveeno®, Dove®, Basis®, Neutrogena®, Cetaphil® or Ivory®. Rinse skin well and gently pat it dry. Do not rub the skin in treatment fields.

2. Avoid heat. Do not use heating pads, very hot water in the bath or shower, or hot water bottles.

3. Avoid cold. Do not allow the skin to become chilled from ice or very cold water or air.

4. Avoid sunlight or sunlamps on the treatment site. When you are outside, keep the area covered with clothing. If clothing does not cover the entire area, use a sunscreen with SPF of 30 or higher.

5. Avoid rubbing or scrubbing the skin in the treatment site. Wear loose, cotton-based clothing that will allow good air flow. Avoid clothing made of nylon or synthetics. These fabrics tend to hold moisture next to the skin. Clothes that bind can irritate the treated skin.

6. Avoid tape on the treated skin.

7. Do not apply anything to the treated skin unless approved by your doctor or nurse. This includes bath oils, perfumes, talcum powders, and lotions. If we expect a skin reaction, we will suggest a skin moisturizer. Use it each day as instructed.
   

Diarrhea

Diarrhea can occur with radiation to the abdomen. This is because the lining of the bowel is very sensitive to radiation. How severe diarrhea becomes depends on the amount of bowel in the radiation field. It also depends on the total dose of radiation. Diarrhea most often begins during the 3rd or 4th week of treatment.

If you do not have diarrhea, you may keep eating your normal diet. Try to eat foods high in protein such as meat, fish, milk, cheese, eggs, and peanut butter.

If you do get diarrhea, let us know. You may need to take some medicine. Decrease the amount of fiber and fat in your diet. See Health Facts for You #323 Eating Hints to Help with Diarrhea. Drink at least 8-12 glasses of liquids per day.

Food Supplements

Liquid or powdered food supplements add protein and calories to your diet. These can be found in grocery, drug, and health food stores. Some brand names include Carnation Instant Breakfast, Boost, Ensure, Sustacal, Osmolyte, Skandi-Shake. If you have diabetes, choose Glucerna or Choice products.

Many stores carry generic brands of these supplements. Canned liquid supplements are easy to use. Just pop the can and drink. Powders can be mixed into fluids or foods.

Rectal Irritation

If your pelvis is in the treatment field, you may have a sore rectum. This is a short-term side effect. You may get a sore rectum because the lining of the rectum is very sensitive to radiation. Diarrhea may also make it worse. If you have a history of hemorrhoids, they may worsen or flare up during treatment. Rectal symptoms include burning, itching, and small amounts of bleeding. These symptoms can occur both inside and outside of the rectum.

Rectal symptoms may be mild. They may also be severe and require treatment. Hemorrhoid medicines with hydrocortisone (Preparation H, Anusol HC, or generic) may relieve rectal symptoms. Discuss rectal symptoms with your doctor or nurse.

Bladder Irritation

You may also have swelling or soreness of the bladder lining. It is a short-term side effect.

Symptoms may include feeling as if you need to urinate suddenly and often. It can be signaled by burning or pain when you urinate. Tell your doctor or nurse if you have any bladder symptoms. Drink plenty of liquids. Bladder symptoms may also be a sign of an infection. You may be asked to provide a urine sample. Sometimes, medicine is prescribed for bladder irritation.

Feeling Tired

Feeling tired (fatigue) during radiation treatment is a common side effect. Fatigue does not mean that your tumor is getting worse. Some people feel no fatigue and can keep up with their normal routines. Others need to take an extra nap each day. Some change their routines, working only part time. Others don’t do anything that requires a large amount of energy. Fatigue can begin right away, or it can occur after 1 – 2 weeks of treatment. It can go on for a few weeks to months after treatment has ended. Rarely, it can last for up to a year.

Low blood counts may also cause you to feel tired. Your bone marrow makes blood cells. If a lot of bone is in your radiation field, your body may produce less blood cells. This is a short-term side effect. Your doctor may order a blood test from time to time to check your blood cell counts.

Tips for Dealing with Fatigue

1. Listen to your body and rest when you need to. A short nap during the day or sleeping a little longer may help.

2. Make time for hobbies you enjoy. Take a walk in the fresh air, visit with a friend, or pursue a hobby during the times that you have the most energy. Do things that help you feel good.

3. Stop smoking and do not drink alcohol to excess. Do something healthy for yourself. If you need help, talk with your doctor or nurse. There are ways we can help you.

4. If you work, you may want to keep working. Some people can maintain a full-time job. Others find it helpful to work fewer hours. Many employers will agree to part time work. We can schedule your treatment times to fit in with your work schedule.

5. Plan regular active exercise – daily walks, riding an exercise bike, or any mild exercise. Go at your own pace. Never exercise to the point of
   fatigue. You should feel less tired after the exercise than you did before the exercise.

6. Find ways to deal with your emotions. Pent-up emotions can add to fatigue. Talk with family or friends. Having a good cry or laugh can be helpful.

7. Eat well. Keep foods around that need little effort to prepare – cheese, yogurt, or slices of meat. When you feel well, prepare and freeze meals to eat later when you are tired. You need extra calories and protein to maintain energy and repair normal skin cells while getting treatments. Speak with a clinic nurse if you have problems eating.

8. Drink at least 8 to 12 glasses of fluid per day. The water will help to flush some of the by-products of your treatment out of your body.

9. If you need help with your basic daily needs, ask your nurse or the social worker to help you contact your local resources. You may be able to receive help with meals, housekeeping, personal care, transportation, support groups, and respite care.

10. Accept help from family and friends. If friends ask if they can help, accept it! If they ask you to call if you “need anything,” they may need ideas from you. Often people want to help but don’t know what things you need help with. Things like mowing the lawn, making meals or watching the kids, can help both you and your friends to feel good.

11. Visits from family and friends can be pleasant, but also tiring. You do not need to be the perfect host or hostess. Let friends and family fix dinner and get the drinks and snacks for you!

12. Some people may have pain from cancer or other causes. Pain can be very tiring. Your doctor and nurse can work with you to achieve good pain control. Let them know about any pain you have during treatment.

Fertility

Radiation to the pelvis can affect your fertility.

Radiation in the pelvic area may stop menstruation. It may also cause symptoms of menopause. Treatment can also result in vaginal itching, burning, and dryness. If you have these symptoms, contact your nurse or doctor.

Radiation to the pelvis can also reduce the number of sperm and their ability to fertilize. This does not mean that you cannot conceive a child.

Talk to your doctor about birth control. You should not become pregnant or conceive a child during treatments. If you are pregnant before starting treatments or suspect you may be, please tell your nurse or doctor right away.

Sex

Sometimes, when you have cancer and are going through treatment your sex drive will decrease. This side effect will likely go away when the treatment ends. It helps to tell your partner your needs and feelings.

You may have sex unless your doctor tells you not to. Sex may become painful due to the shrinking and the drying of vaginal tissues. Using vaginal lubricants and changing position during sex may help. Your doctor may suggest using a vaginal dilator during and after treatment to prevent vaginal tightness. Your nurse will tell you how to use it.

Radiation to the pelvis causes ovaries to stop working. If you have not gone through menopause, you will do so at this time. You may or may not have symptoms of menopause.

Symptoms of menopause may include hot flashes, mood changes, vaginal dryness, tingling, and insomnia. Your doctor will talk with you about ways to manage these symptoms. This may or may not include hormone replacement therapy.

Treatment may affect your ability to get or maintain an erection. Most of the time, this is a short-term side effect. Rarely, it can be a permanent side effect.

Radiation can cause pubic hair to thin. It begins about 2-3 weeks after treatment has started. Your pubic hair may or may not come back. How long this side effect lasts depends on the total dose of radiation given.

Other Concerns

Cancer can affect many areas of your life. It can affect your emotions, marriage, family, jobs, finances. You may also feel concerned about your future. The nurses and social workers can help you cope.

Cancer Resource Services

Gilda’s Club offers support and education. It is free support for everyone living with cancer. Call 608-828-8880 or email program@gildasclubmadison.org

Cancer Information Service has information about cancer care around the country as well as locally. The toll-free number is 1-800-422-6237.

Who to Call

Radiation Oncology

8 am–5 pm
(608) 263-8500

Ask to speak to a nurse. If the clinic is closed, your call will be sent to the paging operator. Give your name and phone number with the area code. The doctor will call you back.