Radiation therapy uses high energy x-rays to kill cancer cells. These x-rays may be given externally in a procedure that is much like having a diagnostic x-ray. This is called external beam radiation therapy. This treatment usually takes 6 to 7 weeks to complete. For cervical cancer, this type of radiation therapy is often given along with low doses of chemotherapy with a drug called cisplatin.
Another type of radiation therapy is called brachytherapy, or internal radiation therapy. To treat cervical cancer in women who have had a hysterectomy, the radioactive material is placed in a cylinder in the vagina. To treat someone with an intact uterus, the radioactive material may be placed in a small metal tube called a tandem that goes in the uterus, along with small round metal holders called ovoids placed near the cervix. This is sometimes called tandem and ovoid treatment. For some cancers, radioactive material may be placed in thin needles that are inserted directly in the tumor. This is not often used in the treatment of cervical cancer.
There are 2 main types of treatment: low-dose rate and high-dose rate brachytherapy. Low-dose rate brachytherapy is completed in just a few days. During that time, the patient remains in bed the hospital with instruments holding the radioactive material in place. High-dose rate brachytherapy is done as an outpatient over several treatments. For each high-dose treatment, the radioactive material is inserted for a few minutes and then removed. The advantage of high-dose rate treatment is that you do not have to stay still for long periods of time.
Common side effects of radiation therapy include tiredness, upset stomach, or loose bowels. Some people have problems with nausea and vomiting. These side effects tend to be worse when chemotherapy is given with radiation. Radiation can also lead to low blood counts, causing anemia (low red blood cells) and leukopenia (low white blood cells). Low white blood cell counts increase the risks of infection. The blood counts usually return to normal after radiation is stopped. Skin changes are also common, with the skin in the treated area looking and feeling sunburned.
Pelvic radiation therapy may cause scar tissue to form in the vagina. The scar tissue can make the vagina more narrow (called vaginal stenosis) or even shorter, which makes vaginal intercourse painful. A woman can help prevent this problem by stretching the walls of her vagina several times a week. Although this can be done by engaging in sexual intercourse 3 to 4 times per week, most women find that hard to do during treatment. The other way to stretch out the walls of the vagina is by using a vaginal dilator (a plastic or rubber tube used to stretch out the vagina). A woman getting pelvic radiation does not have to start using the dilator during the weeks that radiation is being given, but she should start by 2 to 4 weeks after treatment ends. Because it can take a long time to see the effects of radiation, some experts recommend that the dilator be used indefinitely.
Vaginal dryness and painful intercourse can be long-term side effects from radiation. Pelvic radiation can damage the ovaries, causing premature menopause. Radiation can irritate the bladder and problems with urination may occur. Vaginal (local) estrogens may also be used to help with vaginal dryness and atrophy.
Radiation to the pelvis can also weaken the bones, leading to fractures. Hip fractures are the most common, and may occur 2 to 4 years after radiation. Bone density studies are recommended.
Treating lymph nodes with radiation can lead to fluid drainage problems in the leg. This can cause severe swelling in the leg, a condition called lymphedema.
If you are having side effects from radiation, discuss them with your cancer care team.
It is important to know that smoking increases the side effects from radiation. If you smoke, you should stop.
Feedback
