Cervical Cancer

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Treating Cervical Cancer TOPICS

Radiation therapy for cervical cancer

Radiation therapy uses high energy x-rays to kill cancer cells. These x-rays can 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 a woman who still has a uterus, the radioactive material is 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.

To treat some cancers, radioactive material is placed in thin needles that are inserted directly in the tumor. This form of brachytherapy is not often used in the treatment of cervical cancer.

There are 2 main types of brachytherapy treatment: low-dose rate and high-dose rate. 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 external beam radiation therapy include:

  • Fatigue (tiredness)
  • Upset stomach
  • Diarrhea or loose stools
  • Nausea and vomiting

Radiation to the pelvis can also irritate the bladder (radiation cystitis), causing discomfort and an urge to urinate often. Pelvic radiation can also lead to premature menopause.

Skin changes are also common. As the radiation passes through the skin to the cancer, it may damage the skin cells. This can cause irritation ranging from mild, temporary redness to peeling. The skin may release fluid, which can lead to infection, so the area exposed to radiation must be carefully cleaned and protected.

Radiation can affect the vulva and vagina, making them sensitive and sore, and sometimes causing a discharge. This can be seen with both brachytherapy and external beam radiation.

Radiation can also affect the ovaries, leading to menstrual changes and even early menopause

Radiation can also lead to low blood counts, which can cause:

  • Anemia (low red blood cells), which can cause you to feel tired
  • Leukopenia (low white blood cells), which increases the risks of serious infection

The blood counts return to normal in the weeks after radiation is stopped..

These side effects tend to be worse when chemotherapy is given with radiation.

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. Vaginal (local) estrogens may help with vaginal dryness and changes to the vaginal lining, especially if radiation to the pelvis damaged the ovaries, causing early menopause. More information about managing the sexual side effects of cervical cancer treatment can be found in our document Sexuality for the Woman with Cancer.

Radiation to the pelvis can also weaken the bones, leading to fractures. Hip fractures are the most common, and might 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 treatment, 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.

A list of some documents about radiation treatments and its side effects can be found in the section called “Additional resources for cervical cancer.”

Last Medical Review: 04/11/2013
Last Revised: 08/15/2014