Radiotherapy to the Anus: Side Effect Information

Radiotherapy to the Anus: Side Effect Information

Introduction
This leaflet will explain possible side effects which may develop when receiving Radiotherapy to the anus and pelvic area.

These effects are individual and will depend on the dose of radiotherapy you receive and the length of your treatment. Everyone reacts to Radiotherapy differently and many people have minimal side effects. Most side effects are temporary and are rarely severe. Acute (early) side effects may start at varying times during treatment and disappear in the weeks after treatment finishes. Late side effects may not occur for a long time after the treatment has finished. 

The Radiographers will explain your possible side effects in more detail and answer any questions you may have before you start treatment.

You may also be having chemotherapy treatment at the same time as your radiotherapy. Chemotherapy is the treatment of cancer with drugs. You will be given specific written information and consented separately for this.

You will have weekly blood counts while you are having radiotherapy treatment.

During treatment you are not radioactive. Once the treatment machine is switched off there is no radiation present so you are safe to be around children and pregnant people.

Possible early or short-term side effects
These can start during radiotherapy or shortly after completing radiotherapy treatment and usually resolve within two to six months of finishing radiotherapy.

Expected side effects of treatment include:

• Tiredness – It is not uncommon to feel tired as you go through Radiotherapy treatment. It can be a combination of travelling to and from hospital and coping with the side effects of treatment. Research suggests that gentle exercise and keeping active can help with the symptoms of tiredness and fatigue. Macmillan Cancer Support have a lot of information available. Please ask your Radiographers for the appropriate booklets.
• Skin soreness, itching, blistering and colour changes – redness in white skin tones and subtle darkness, yellow/purple/grey appearance in brown and black skin tones. Patients receiving treatment to the lower rectum / anus may get a more severe skin reaction in the treatment area; moist patches may develop and dressings may need to be applied. You may also need to take painkillers for a while towards the end of treatment and for three to four weeks after. Your radiographers will be able to give you appropriate skin care advice. 
• Hair loss in the treatment area – You may find that you will lose your pubic hair in the treatment area. It will grow back but may be thinner.
• Bowel frequency (opening your bowels more often than normal) and urgency (a sudden urge to open your bowels).  You will probably find that your bowel motions become more frequent over time with looser stools and possibly diarrhoea. It is not uncommon to have increased wind and pass some mucous or blood in your stools. You may also experience a bloated and tender feeling in your stomach. You can help yourself by trying to eat your usual diet and avoid missing meals. If necessary, we will advise you on medications to help control diarrhoea. If you are having chemotherapy as well, these side effects may be more severe.
• Pain around the anus

Other common side effects that you may experience include:

• Mild bowel incontinence
• Urinary frequency – passing urine more often than normal and a sudden urge to pass urine.
• Cystitis/pain when urinating.  This is caused by bladder inflammation.  You can help yourself by:
  • Drinking plenty of fluids and keeping well hydrated. This will depend on weight and body size but the average amount is 1.5-2 litres (3-4 pints) per day.
  • Avoid drinks that can irritate the bladder such as tea, coffee, green tea, alcohol, fizzy drinks such as cola or fresh juices. Herb/fruit or caffeine free drinks are fine.

 Please tell the radiographers if you think you may be developing urinary problems.

• Nausea and/or vomiting Sometimes people can lose weight during treatment. This can be due to the side effects of sickness, diarrhoea and tiredness which can upset appetite. Eating frequent small meals and drinking plenty of fluids can help. Let the radiographers know if you are struggling as it is possible to get a prescription for anti-sickness tablets. A referral to a dietitian can be made if necessary. 

Possible late or long term side effects
These may or may not happen months or even years after radiotherapy and may be permanent.  Many of these late side effects, taken in combination, are often referred to as pelvic radiation disease.

Expected and common possible late or long term side effects can include:

• Skin thickening or discolouration – lighter or darker for any skin tone, or visible blood vessels.
• Bowel changes – this may include opening your bowels more often than normal and/or a sudden urge to open your bowels.  It can also include mild/moderate bowel incontinence and bleeding from the back passage.  You may also experience mucus, discharge or wind from the back passage and pain around the anus.
• Bladder changes; may include urinary frequency and passing urine more frequently.
• Early menopause – this can result in changes in bone density.  Weight bearing exercises and a calcium enriched diet may help to prevent this.
• Infertility – unable to produce a viable sperm or egg and/or for the uterus to be able to carry a foetus. Your consultant should have discussed with you the effects of your radiotherapy treatment on fertility. In young people with functioning ovaries, radiation treatment to the pelvis can result in infertility. This is because the treatment brings about a premature menopause. Infertility can also occur following treatment for anal cancer as the scrotum may be affected by the treatment. When infertility does occur it is often not immediate and you will need to use contraception during and after treatment (your consultant or one of the team will give you advice about this).
• Vaginal narrowing, shortness or dryness – this may make sexual intercourse uncomfortable or difficult.  To help prevent this happening you may be recommended to use a vaginal dilator with some lubricant jelly. These will be given to you during your radiotherapy. They are used to maintain the opening of the vagina, and can help to make future clinical examinations more comfortable for you. 
• Change in ejaculate and inability to achieve an erection – The ability to get an erection may be affected due to the effect of radiotherapy on the nerves and blood vessels that supply the penis. You may also experience a loss of libido. Your consultant or one of the team will be able to advise you about treatments that can help with these side effects.

Your consultant will make you aware of any less common side effects that you may experience and identify these on your consent form.

There is a booklet giving detailed information about potential late side effects entitled “Managing the Late Effects of Bowel Cancer Treatment” which is produced by Macmillan Cancer Support. Please speak to your consultant or one of the team if you are concerned about long term side effects.  

After treatment:
The early side effects from the treatment will continue for several weeks after the treatment course has been completed. 

If you develop new symptoms after your treatment is over, or you are concerned that the immediate side effects are not clearing up, you can contact the Macmillan Radiotherapy Specialist Radiographer 01905 761420 or the Acute Oncology Service 01905 760158

There is often a simple explanation for these symptoms and they do not necessarily mean you will develop the late effects of treatment.

CT Planning

In order to plan your radiotherapy treatment, you will need to have a radiotherapy CT planning scan.  Further information on the CT planning scan and radiotherapy can be found in the booklet, Radiotherapy Treatment at the Worcestershire Oncology Centre, this will be given to you by your consultant when discussing radiotherapy treatment.

Prior to your CT scan, every patient will have an individual chat with a scanning radiographer.  In order to minimise treatment side effects and to ensure treatment accuracy, you will be required to have a comfortably full bladder and an empty bowel for you CT planning scan and daily radiotherapy treatment.

Bladder preparation: 1 hour before your CT scan you will be required to empty your bladder and then drink 400mls of water over 10 minutes and then wait 40-50 minutes in order to have a comfortably full bladder.  You will then be required to hold this until after your CT scan or radiotherapy treatment, if you have difficulty holding your water then please speak to our receptionist or a radiographer.

Bowel/Rectum preparation: You should aim to have an empty bowel/rectum (back passage) for your CT planning scan & radiotherapy treatment. You will be required to empty your rectum before you start your bladder preparation (outlined above);

Hydration – It is very important to be hydrated when attending for your CT scan appointment and your radiotherapy treatment. Please make every effort to increase your hydration in the days/weeks before your CT scan and your radiotherapy.

A good indication if you are drinking enough is to check the colour of your urine – Your urine should be pale and straw coloured.

The radiotherapy team at the Worcestershire Oncology Centre have worked with Worcestershire Acute Hospitals Charity to fund the use of reusable water bottles for patients undergoing pelvic radiotherapy treatment and are following a drinking protocol.  As well as supporting patients in drinking the right amount of fluid for their radiotherapy treatment, the use of the water bottles will also reduce the use of single use plastic in the department.

If your symptoms or condition worsens, or if you are concerned about anything, please call your GP, 111, or 999.

Patient Experience
We know that being admitted to hospital can be a difficult and unsettling time for you and your loved ones. If you have any questions or concerns, please do speak with a member of staff on the ward or in the relevant department who will do their best to answer your questions and reassure you. 

Feedback
Feedback is really important and useful to us – it can tell us where we are working well and where improvements can be made. There are lots of ways you can share your experience with us including completing our Friends and Family Test – cards are available and can be posted on all wards, departments and clinics at our hospitals. We value your comments and feedback and thank you for taking the time to share this with us.

Patient Advice and Liaison Service (PALS)
If you have any concerns or questions about your care, we advise you to talk with the nurse in charge or the department manager in the first instance as they are best placed to answer any questions or resolve concerns quickly. If the relevant member of staff is unable to help resolve your concern, you can contact the PALS Team. We offer informal help, advice or support about any aspect of hospital services & experiences.

Our PALS team will liaise with the various departments in our hospitals on your behalf, if you feel unable to do so, to resolve your problems and where appropriate refer to outside help.

If you are still unhappy you can contact the Complaints Department, who can investigate your concerns. You can make a complaint orally, electronically or in writing and we can advise and guide you through the complaints procedure.

How to contact PALS:
Telephone Patient Services: 0300 123 1732 or via email at: [email protected]

Opening times:
The PALS telephone lines are open Monday to Friday from 8.30am to 4.00pm. Please be aware that you may need to leave a voicemail message, but we aim to return your call within one working day.

If you are unable to understand this leaflet, please communicate with a member of staff.  

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