Series No 29 - Gynaecology Radiotherapy

We want to involve you in all the decisions about your care and treatment. If you decide to go ahead with treatment, by law, we must ask for your consent and will ask you to sign a consent form. This confirms that you agree to having the procedure and understand what it involves.

Staff will explain all the risks, benefits and possible alternatives before they ask you to sign a consent form. If you are unsure about any aspect of your proposed treatment, please do not hesitate to speak to the team looking after you.

During your time with us we aim to provide the highest standards of care and support you in your decisions regarding your treatment. We will respect your dignity, individuality and personal preferences.

Your care will be managed and given by therapeutic radiographers, doctors and nurses. You will meet both male and female healthcare professionals during the course of your treatment. If you have any concerns about this, please talk to the radiographers about it. We try to be sensitive to your needs, so please do not hesitate to discuss things with the team caring for you.

If you are of an age where you can get pregnant (12 to 55 years old) and capable of becoming pregnant (you have a womb), you will be asked to confirm that you are not pregnant.

You must tell the staff immediately if there is any chance of you being pregnant at any time during your treatment. You should not become pregnant for at least four months after radiotherapy.

All patients should use reliable contraception throughout this period. If you have any further questions or concerns, please talk to your radiotherapy doctor, specialist nurse or specialist radiographer involved in your care.

1. You will see a Clinical Oncologist who will explain your diagnosis and discuss treatment options with you.
2. You will be consented for radiotherapy and/or brachytherapy.
3. Radiotherapy treatment planning appointment. You will have a planning CT scan using intravenous contrast dye if required.
4. First treatment. You will start treatment about three weeks after the planning scan.Each appointment will take approximately 30-40 minutes.

5. Review clinics. You will be reviewed once a week during treatment by your clinical team or the radiotherapy review team. This will either be face-to-face or via phone.

6. Treatment complete. You will be reviewed by your clinical team, as an outpatient, four to six weeks after your treatment course has completed. This may be a telephone consultation, or if face-to-face, will be held in the UCLH Macmillan Cancer Centre

Radiotherapy appointments: All take place in the Radiotherapy Department, basement floor, main UCH hospital building.

A female reproductive system consists of two ovaries, two fallopian tubes, the vagina and the cervix, which is the neck of the womb. All of these organs lie close to the bladder and bowel. Most gynaecological tumours arise in the cervix or uterus.

Radiotherapy is a very common form of treatment for gynaecological cancers. It is often used in combination with surgery and chemotherapy. Radiotherapy may be given in different ways: externally, internally (also called brachytherapy), or a combination of both. Each patient’s treatment is individual. Together, you and your doctor will consider the risks and benefits of the different treatment options and decide which treatment(s) are best for you.

Radiotherapy is the specialised treatment of cancer (and some other diseases) using high energy radiation beams.

Radiotherapy works by damaging cancer or tumour cells in the part of the body being treated. The radiation stops the cells from dividing and growing. Radiotherapy can also damage nearby normal cells. The normal cells are more likely to recover from the effects of the radiation than the cancer or tumour cells. Doctors take great care to reduce the radiation dose to a person’s healthy cells.

Radiotherapy does not hurt, and it will not make you radioactive. You will be completely safe to be around family, friends and pregnant women. You will feel nothing from the treatment and the machine will not touch you. It is rather like having an ordinary x-ray. The most important thing is for you to lie very still for treatment.

Treatment is given daily Monday to Friday, including Bank Holidays. A course of treatment will last four to eight weeks. Your treatment schedule will be decided by your doctor or consultant urology radiographer and confirmed on your first treatment visit to the radiotherapy department.

Before beginning radiotherapy, your treatment must be carefully planned. Before starting radiotherapy planning and treatment you will need to follow special instructions on preparing your bladder and bowels. Daily bowel and bladder preparation during your treatment is important because:

• It will improve the accuracy of your treatment.
• It will reduce the risk of any long-term bladder and bowel side effects.

You will be given a booklet called “Radiotherapy for gynaecological cancers: preparation for planning and treatment”. This information contains special advice on bladder and bowel preparation. It is important that you understand and follow the instructions for planning and treatment preparation given to you.

You will need to come to a radiotherapy planning appointment before your radiotherapy starts. A radiotherapy radiographer will fully explain the process to you and complete any paperwork needed. To plan your treatment, you will have a radiotherapy planning CT scan of your pelvis. This scan locates the exact site of the area to be treated in relation to surrounding normal tissues.
Before your CT scan you will:

• Be asked to go to the toilet to use the enema and empty your bladder.
• Be asked to drink approximately 500ml of water. This will be 3 - 4 cups of water, which will be available in the waiting area. Do not do this until instructed by a radiographer.
• Be asked to wait for 30-40 minutes, to allow for your bladder to fill (comfortably), before you have your radiotherapy planning scan. If you do not feel your bladder is full after 30-40 minutes, please tell the radiographers.
• You will be asked by the radiographers about how well your bowel preparation is working.

When it is time for your scan the radiographers will take you in to the CT scanner room. You will be asked to change into a hospital gown and remove all clothing from the waist down apart from your underwear. The radiographers will place specialised pillows under your head and legs to support them and to ensure you are in the correct position. They will then place a modesty cover over your pelvic area and lower your underwear.

Using a felt-tip pen, the radiographers will place some temporary marks on your skin and take some measurements. These are for reference only and can be removed when you go home. The radiographers will then leave the room to perform the CT scan.

You will feel the bed move in and out of the scanner. You will pass through the scanner a number of times. The radiographers will be watching you the entire time. When the scan is done, and the radiographers have checked the images they will re-enter the room. The radiographers will then mark several specific points (also called tattoos) on your skin. These are alignment marks to ensure each treatment is accurate. The marks are permanent and are done by placing ink on the skin and then gently scratching the surface of your skin with a fine needle.

You won’t feel anything during the scan. All we ask is that you lie still and breathe normally. After the scan is completed, you will be free to leave. Before you go, you will be given an appointment card with the date and time for your next visit, which will be your first treatment.

During the scan you may be given an injection of a contrast agent that will help us see your organs and vessels more clearly. The doctor will use these images alongside other scans you will have had to decide on the exact area for treatment.

In some cases, this CT scan process will be repeated after emptying your bladder. In this situation the radiographers will ask you to go to the toilet to empty your bladder again and will then set you up on the couch as previous and perform a second CT scan.

Patients will normally receive their treatment as an outpatient. Treatment is every day, Monday to Friday, including Bank Holidays. Your clinical oncologist will have already told you how many treatments you will be having. The treatment radiographers will explain the procedure to you and answer any questions you may have.

You will need to follow the same bladder and bowel preparation as you did when you came for your treatment planning.

Please arrive at least one hour before your given treatment appointment. At each treatment appointment you will:

• Be asked to go to the toilet to use the enema and empty your bladder.
• Be asked to drink approximately 500ml of water. The number of cups you drink for treatment will be the same as the number of cups you drank for your planning CT scan (3 – 4 cups).
• Be asked to wait for 30 - 40 minutes, (depending how long you waited before having your planning CT scan) to allow for your bladder to fill (comfortably), before the radiographers can deliver your radiotherapy treatment. Please let the radiographers know if you do not feel full at this point.

For each radiotherapy appointment, you should allow up to 2 hours in the department to do your treatment preparation and to allow for any delays. You should aim to arrive at least one hour before your given treatment appointment time, to allow for your bowel and bladder preparation. It is important that you understand and follow the instructions for treatment preparation given to you.
 
You will be collected from the waiting room and taken to the treatment room by a member of staff.

You will be asked to change into a hospital gown and remove all clothing from the waist down.

You will be asked to lie on your back on the treatment couch and the radiographers will place specialised pillows under your head and legs and ensure you are in the correct position.

The radiographers will place a modesty cover over your pelvis and thighs and move the gown to see the tattoo dots on your pelvis.
The room lights will be dimmed, and the radiographers will move you, the couch and the treatment machine (Linac) so that you are in the correct position for treatment.

Once final verbal checks have been made the radiographers will leave the room. You will hear a buzzing noise as they leave.

You will not feel anything from the treatment, but you will need to lie still and breathe normally throughout the whole procedure.

The radiographers will be watching you at all times on a closed-circuit camera. If you need them to come back in, just raise your hand.

Each treatment will last about 10 minutes. The Linac will move around you but will never touch you. You may hear a buzzing noise when it switches on. You will not feel or see anything.

On some days the radiographers will need to take X-ray pictures to check you are in the correct position.

Once your treatment has finished, the radiographers will come back in to the room and help you off the couch. You will then be free to get dressed and leave the department.
 

Some patients will be given drug treatment (chemotherapy) during their radiotherapy. This is usually given once a week for five weeks. Other patients may complete their course of chemotherapy before they start radiotherapy. The chemotherapy increases the activity of the radiotherapy against cancer cells. Your doctor will tell you which chemotherapy you will be having.

Patients receiving chemotherapy, and radiotherapy, may experience additional side effects to those listed here, depending on the drug regimen used. Chemotherapy may increase the likelihood of feeling sick with your treatment. It may also cause small ulcers in your mouth. Your doctor and specialist nurse will discuss these issues with you. You will be given medicines to control any side-effects. You will be given detailed fact sheets about any chemotherapy drugs you may receive by the chemotherapy nurses.

Internal radiotherapy, or brachytherapy, is a form of high dose radiotherapy that only treats to a short distance. Radioactive sources are placed directly inside the female organs via special applicators.

If you have received external beam radiotherapy to your pelvis, your doctors may advise you to have brachytherapy to complete your treatment.
For patients with cervical cancer, brachytherapy usually involves an anaesthetic and a short in-patient admission. For patients with uterine cancer, no anaesthetic is required, and treatment is given as a day procedure. Having brachytherapy is similar to having a smear test or examination by your gynaecologist.

We have specialist brachytherapy radiographers who will meet with you several times during your radiotherapy to discuss this part of your treatment. They will discuss the treatment process with you, give you written information and answer any questions or worries that you may have.

Although you will not feel anything during treatment, there will be some side effects which will gradually appear during your course of radiotherapy. These effects will vary from patient to patient. There are side effects occurring during treatment, some happening soon after treatment, and some appearing months or years after radiotherapy.

The risk and severity of side effects occurring will depend on the dose of radiotherapy given and the exact area which receives the radiotherapy. Your doctor will discuss the risks of treatment fully with you before you sign a consent form.
However, there will still be plenty of opportunity to talk about anything that you feel needs further discussion. The main side effects that occur during treatment are:

Skin changes/hair loss
The skin in the area being treated may gradually change colour. Your skin may gradually become pink /red or darker, depending on your skin colour. You may get some dry peeling of the skin in the treatment area, which may become itchy.

You may experience peeling of the skin in the treatment area, which can be sore, particularly the skin between your legs and around your back passage (anus) or vulva. If your skin peels and is sore, you will be referred to the radiotherapy review team for appropriate skin care advice.

During treatment, we advise that you wash using warm water and the soap products you would normally use. It is not advisable to sit and soak in a hot bath. Gently pat your skin dry with a soft towel. Gently press the towel around your pelvic area.

Radiotherapy skin reactions cannot be prevented, but to minimise any skin irritation we recommend using a moisturiser of your choice. Use the moisturiser frequently and gently smooth it on to your skin until it is absorbed. You do not need to wipe the moisturiser off before treatment, but please do not apply moisturiser immediately before treatment.

If your skin becomes irritated or peels, stop using the moisturiser. You will be referred to the radiotherapy review team for appropriate skin care. If you do not currently use a moisturiser, then speak with your radiotherapy team and they will be able to suggest some options for you.

Hair loss
Radiotherapy will cause hair loss in the treatment area, but this usually grows back several months after treatment has finished.

Do not wax or your use cream or laser hair removal in your pelvic area during radiotherapy.

Bowel changes
About three to four weeks into treatment you may experience some discomfort and pain on opening your bowels. This is called proctitis. Very occasionally, this may be associated with a feeling of wanting to strain (whether or not you actually need to pass a bowel movement). This is called tenesmus. There may be some blood and mucus (slime) in your stools. Inform the radiographers or nurses if you experience such a problem as medication can be given. You may also experience abdominal pains or colicky or wind pains.

Your stools may become loose as you progress through treatment. This may lead to diarrhoea. We advise that you continue to eat a normal diet and try to drink plenty of fluids (at least eight glasses or one to two litres per day). If the diarrhoea becomes persistent, please inform a member of staff as soon as possible as medication can be prescribed. If you have piles (haemorrhoids) or have had these treated in the past, they may get worse during treatment. Please inform a member of staff as your doctor can prescribe medication to help.

Bladder changes
You may find that you have to pass urine more often both day and night. You may have a burning sensation when you do pass urine. This is called radiation cystitis and is caused by the radiotherapy inflaming your bladder. If you experience a burning sensation, please inform the radiographers or radiotherapy review team. They will get you to produce a urine sample to check that it is radiation cystitis and not an infection.

It may help if you drink plenty of fluids. Drinks such as cranberry juice have been found to help, whilst drinks such as tea and coffee can make the bladder worse. Reducing drinks that may irritate the bladder such as fizzy drinks, alcohol, and drinks containing caffeine (tea, coffee and cola) may also help.
 

However, you should not drink cranberry juice if you are on Warfarin. If you have any concerns or questions, please speak to the radiographers treating you or the radiotherapy review team.

Genitals
During treatment your vagina and vulva may become irritated, which can cause discomfort, soreness and narrowing. You may notice an increase in vaginal discharge. Please let your doctor and the radiotherapy review team know if this is heavy and/or has an offensive odour. Do not use tampons, feminine deodorisers, douches or talc as they could cause further discomfort and soreness and possible increase the risk of infection.

If you feel like it, having sexual intercourse during treatment is ok. If appropriate, you will need to take adequate contraceptive precautions. Your doctor or specialist nurse will discuss this with you.

Radiotherapy will reduce the amount of natural lubrication produced by the vagina. Having sexual intercourse may be a little uncomfortable. If your vagina feels dry during intercourse a water-based lubricant may be helpful.

There may be some spotting of blood initially after intercourse. This is normal, but do mention it to your doctor, radiotherapy review team or specialist nurse when you see them.

Besides these physical changes, having cancer and undergoing treatment can cause you to feel physically and emotionally tired. All of these concerns may mean that you lose interest in your sexual relationships. A full recovery from the physical and emotional impact of your treatment normally happens over the following months once treatment is finished.

There are female gynaecological nurse specialists and clinical psychologists available to discuss any concerns you may have.

Sickness/nausea
Radiotherapy to the pelvis may make you feel sick (nauseous). This may be worse if you are having chemotherapy at the same time. If you are feeling sick, and/or are being sick, please let someone know as you can be given medicine to relieve this.

Tiredness
Tiredness is a very common side effect of radiotherapy. You may feel more tired than usual and have less energy, both during and after treatment. Do not worry, this is normal. It is usually a combination of travelling to hospital every day, the side effects of treatment, coping with a diagnosis of a tumour and continuing with normal life.

We recommend that you listen to your body. Do as much as you feel you can and rest when you need to. However, gentle exercise has been found to improve fatigue levels in patients and we would recommend walking as a good form of exercise.
Please tell us if you are finding things difficult, as we will be able to offer practical advice and information.

Appetite
It is important that you try to eat a nourishing, balanced diet throughout your treatment, to help you feel stronger and more able to cope with treatment. It is also important to drink plenty of fluids (two litres a day) during your radiotherapy treatment.

Some patients experience a loss of appetite. This may be due to their illness but also to a number of other factors, such as anxiety about treatment or side effects of radiotherapy and chemotherapy. If you do experience any significant weight loss or would like to speak to someone about your diet, you can be referred to specialist dietitians.

At your first treatment appointment the radiographers will discuss the treatment with you and explain any possible side effects you may experience. They will see you every day and ask how you are and how you are feeling. You will also be seen in a weekly review clinic by a member of your clinical team or the radiotherapy review team, to discuss any side effects you may be experiencing. It is important to tell them if you are experiencing any side effects or are having any difficulties.

Late side effects incurred during treatment can appear to develop many months or years after radiotherapy has finished. They are the hardest to accurately predict and, unfortunately, when they do occur, they are usually permanent. Your doctor will discuss the possibility of these late side effects with you, at the time you sign your treatment consent form. Possible late side effects may include:

Bowel changes
About 50% of women notice permanent changes in their bowel habits. This is often looser or more frequent motions than before radiotherapy. Sometimes, a change in diet and/or fluid intake and/or medication may be needed to regulate your bowel on a longer-term basis.

Very occasionally, scar tissue may develop that can affect the bowel and add to the problems of diarrhoea.

Very rarely, after surgery and radiotherapy, the tissue surrounding the bowel can stick together (adhesions) causing a blockage. This can sometimes require further surgery to correct.

Bladder changes
Very rarely, scar tissue may develop in the wall of the bladder which can cause some shrinkage of the bladder. Some women find that they have to pass urine more frequently than before radiotherapy. Some women may find it difficult to “hold on”, requiring them to get to a toilet more urgently.

Bleeding
After treatment is complete, small blood vessels can occasionally form within the rectum and bladder. These blood vessels are more delicate than normal and can break down, producing minor bleeding when you pass urine or open your bowels. If you experience any bleeding, please contact your GP or specialist nurse, as any bleeding post-radiotherapy would need to be investigated to exclude a cause other than radiotherapy damage.

Any vaginal bleeding after treatment and during follow-up should be reported to your specialist nurse.

Please tell your doctor, specialist nurse or GP if you experience any bowel and/or bladder problems so you can be assessed and referred for specialist advice if needed.

Ovaries (for pre-menopausal women)
Women who are still having periods before radiotherapy will go through an early menopause due to the effects of the radiotherapy on their ovaries. As a result of this you will become infertile (unable to become pregnant).
An early menopause is different to a natural menopause, as there is a sudden change in your hormone levels. The symptoms of an early menopause may not occur immediately, but a few months after the completion of your treatment.
An induced early menopause may lead to hot flushes, feeling low, fatigue, lack of energy, anxiety, irritability, night sweats, vaginal dryness and loss of libido.

There are a variety of treatments for menopausal symptoms, including hormone replacement therapy (HRT), in some cases, and many complementary therapies. You can discuss the options with your specialist nurse.

It is important you tell your doctor if you want to have children in the future, as they will arrange an urgent appointment with a fertility doctor before your treatment starts.

Sexual function and sexuality
Radiotherapy can affect the cells that produce the natural lubricant in your vagina. And you may experience vaginal dryness. This can make sexual intercourse uncomfortable. This can be helped by using a vaginal moisturiser and/or lubricant.

Radiotherapy can affect the muscles of the vagina, causing them to lose their flexibility. This may result in your vagina feeling tighter and smaller. This can make sexual intercourse and vaginal examinations in follow up clinics more difficult and uncomfortable.

After pelvic radiotherapy, your specialist nurse will talk to you about the introduction of pelvic care. The aim of pelvic care is to reduce the formation of scar tissue to ensure vaginal examinations and sexual intercourse are not difficult and/or uncomfortable.

The use of a vaginal dilator can help keep the vagina open (dilated), to prevent the formation of scar tissue in the vagina. You will be contacted by your specialist nurse and asked to attend a nurse-led end of treatment clinic, usually four to six weeks after radiotherapy has finished. At this appointment they will talk to you about dilator use and you will be given an opportunity to raise any concerns at this point in your treatment journey.

Continuing to have an active sex life during and after pelvic radiotherapy can be difficult for both you and your partner. You may lose interest or have less confidence, or it may be that there are other things going on in your life which you feel are more important.

Talk to your partner to help share your feelings and work through this time together. Your partner may be worried about hurting you, or that your cancer may be contagious. You can assure them that the cancer cannot be passed on through physical contact. You may also find it easier to try different sexual positions and activities that are more comfortable for you.

Following pelvic radiotherapy, vaginal bleeding can occur after sex, even years later. This does not mean your cancer has returned, but it does need to be checked out. For most women, bleeding will be from fragile superficial blood vessels within the vagina, which bleed with very little pressure. This can be treated and should not prevent you and your partner continuing and enjoying a fulfilling sex life. It will mean, however, that you may need to wear external sanitary protection for twenty- four hours after sexual intercourse.

Please don’t be embarrassed to talk to your specialist nurse, doctor, gynaecologist or GP. We are here to help you and are experienced in dealing with these problems.

There is a clinical psychologist who sees many women after pelvic radiotherapy, helping them to cope with what has happened or is happening. If you feel this would help you, please ask to see them and your specialist nurse can refer you.

Lymph nodes
Radiotherapy and surgery can affect the lymphatic vessels in the pelvis and upper legs causing them to become narrowed. The lymph fluid in the body cannot drain properly, and this can cause swelling, or lymphoedema, in the legs or, very rarely, the pelvis. After having radiotherapy, it is important to look after your legs. Pay particular attention to any cuts, grazes or insect bites and use an antiseptic lotion to minimise the risk of infection. Regularly use a moisturiser to keep your skin healthy.

If you notice any swelling in your feet, legs or pelvic area, it is important to let your doctor, specialist nurse or GP know.

Bones
Radiotherapy can affect the density of your bones in the treated area. It causes fine, hair-like cracks in the bone called “pelvic insufficiency fractures”. This may occur a few months to a few years after radiotherapy. It can cause a dull, constant ache in the pelvis. These fractures can be treated with drugs, exercise and a diet rich in calcium.

Rarely, the pain may be severe and may require regular pain medication. Let you doctor, specialist nurse or GP know if you experience any pain in your pelvis, as they will need to do further investigations.

Second malignancy
Having radiotherapy carries a small risk of causing a new, different cancer in the treated area. This is a very small risk (less than 1%) for most patients and is something that may happen many years later. Please talk to your doctor or specialist nurse if you have any concerns about this.

This information deals with the physical aspects of your treatment, but your emotional wellbeing and that of your family is just as important.

Having treatment can be deeply distressing for some patients. Within the radiotherapy department there will be access and support from your consultant radiographer, specialist nurse, the radiotherapy review team, the Macmillan radiotherapy information and support team and the treatment radiographers. However, if you feel you require further medical or emotional support you can be referred to a variety of health professionals who can help with any worries or difficulties you may be having.

Toilet cards are available, which may make it easier to access toilets in places where there are no public toilets. These are available from Macmillan Cancer Support, but we do keep a stock in the department. Please ask a member of staff if you would like one.

The gynaecological cancer support group provides a safe space to talk to others, share experiences or simply listen. The group is facilitated by a support and information specialist and a clinical nurse specialist. The group meets on the 3rd Wednesday of each month, from 10:30am to 12pm. You can join either in person, at the Macmillan Support and Information Service, or online (on Zoom).

For more information or to book your place:

• call 020 3447 3816
• email uclh.supportandinformation@nhs.net (please include your full name, hospital number and the group you'd like to join in your email)
• visit the Macmillan Support and Information Service, on the ground floor of the Macmillan Cancer Centre.

All staff are here to make sure your treatment goes as smoothly as possible and to support you through this difficult period. We will try to help you.

After your radiotherapy treatment has finished, you will be given a follow-up appointment to see your clinical team in four to six weeks’ time. This will either be at University College Hospital or your referring hospital. You should also receive an appointment to see the gynae specialist nurse to discuss dilation. Usually, any side effects you may be experiencing during treatment will carry on, and can become worse, for a short while after you have finished treatment. However, they will settle down within four to six weeks. Please try not to worry. During this time, you should continue to follow the advice given to you during your treatment. Continue to use any creams or prescribed medications for the side effects until they settle down.

Please feel free to contact the radiotherapy review team or your specialist nurse if you are worried about any side effects after treatment.

My Gynae-Oncology Clinical Nurse Specialist (CNS)
Telephone: 020 3447 8636

For advice about treatment side effects Radiotherapy review team (via radiotherapy reception)
Telephone: 020 3447 3700/01

For any other question about your condition

Gynaecological Oncology Team Co-ordinator
Telephone: 020 3447 8636
Monday to Friday: 09:00 to 17:00, answer phone available outside these hours

Gynaecological Oncology Secretaries
Telephone: 020 3447 8025
 
For information about appointments

Radiotherapy reception
Telephone: 020 3447 3700/ 020 3447 3701

For information, support, or any other queries

Macmillan support and information team
Telephone: 07816 096619
Email: uclh.radiotherapyinformationandsupport@nhs.net

Out of hours oncology advice number (available 24 hours) 
Telephone: 07947 959020

If you have any concerns that you would like to discuss in confidence, please contact our PALS (Patient Advice and Liaison Service) for information and advice.

Telephone: 020 3447 3042
Website: www.uclh.nhs.uk

Jo’s Cervical Cancer Trust (Jo’s Trust ) 
Telephone: 0808 802 8000
Website: www.jostrust.org.uk

GO Girls
Telephone: 01305 255719
Website: www.gogirlssupport.org/contact

Ovacome
Telephone: 0800 008 7054
Website: www.ovacome.org.uk

Vulval Awareness Campaign Organisation 
Telephone: 0161 747 5911
Email: vacouk@yahoo.com
Website: www.vaco.co.uk
 
Daisy Network: Premature menopause support group
Email: info@daisynetwork.org.uk
Website: www.daisynetwork.org

Maggie’s (Providing cancer information and support in centres across the UK and online)
Website: maggies.org

Live Though This (cancer support for LGBTIQ+ community)
Website: outpatients.org.uk

Shine Cancer Support (cancer support for adults in their 20s, 30s and 40s)
Telephone: 07804 479413
Email: hi@shinecancersupport.org
Website: shinecancersupport.org

Trekstock (for young adults in their 20s and 30s with cancer)
Telephone: 020 4541 7601
Email: hello@trekstock.com
Website: www.trekstock.com

Life After Cancer
Website: www.life-aftercancer.co.uk

Macmillan Cancer Support
Telephone: 0808 808 0000
Email: cancerline@macmillan.org.uk
Website: www.macmillan.org.uk

Cancer Research UK 
Telephone: 0808 800 4040
Website: www.cancerresearchuk.org
 
Carers UK
Telephone: 0808 808 7777
Email: adviceline@carersuk.org
Website: www.carersuk.org

NHS Choices website: www.nhs.uk

UCLH cannot accept responsibility for information provided by other organisations.