Radiation Therapy for Vaginal Cancer
This is the most common treatment for vaginal cancer.
Radiation therapy uses high-energy rays (such as gamma rays or x-rays) and particles (such as electrons, protons, or neutrons) to kill cancer cells. In treating vaginal cancers, radiation is delivered from outside the body in a procedure that is much like having a diagnostic x-ray. This is called external beam radiation therapy. It is sometimes used along with chemotherapy to treat more advanced cancers to shrink them so they can be removed with surgery. Radiation alone may be used to treat lymph nodes in the groin and pelvis.
Another way to deliver radiation is to place radioactive material inside the vagina. One way to do this is called intracavitary brachytherapy. The 2 main types of intracavitary brachytherapy are low-dose rate (LDR) and high-dose rate (HDR). With these intracavitary methods, radiation mainly affects the tissue in contact with the cylinder. This often means fewer bladder and bowel side effects than seen with external beam radiation therapy.
- For LDR brachytherapy, the radioactive material is inside a cylindrical container that is placed in the vagina and stays in place for a day or 2. Although gauze packing helps hold the cylinder in place, you have to remain in bed (in the hospital) during the treatment.
- With HDR brachytherapy, the radiation source is still placed in a cylinder, but it doesn’t need to stay in place for long. This allows it to be given in an outpatient setting. Three or four treatments are given 1 or 2 weeks apart.
Another type of brachytherapy, called interstitial radiation, uses radioactive material inside needles that are placed directly into the cancer and surrounding tissues.
Vaginal cancer is most often treated with a combination of external and internal radiation with or without low doses of chemotherapy.
Side effects of radiation therapy
Radiation can destroy nearby healthy tissue along with the cancerous cells. Side effects depend on the area being treated, the amount of radiation, and the way the radiation is given. Side effects tend to be more severe for external beam radiation than for brachytherapy.
Common short-term side effects of radiation therapy include
- Tiredness, which may get worse about 2 weeks after treatment begins
- Nausea and vomiting (more common if radiation is given to the belly or pelvis)
- Diarrhea (more common if radiation is given to the belly or pelvis)
- Skin changes, which can range from mild redness to blistering and peeling. The skin may become raw and tender.
- Low blood counts
The diarrhea caused by radiation can usually be controlled with over-the-counter medicines. Nausea and vomiting can be treated with medicines from your doctor. Skin that becomes raw and tender needs to be kept clean and protected to prevent infection.
These side effects tend to be worse when chemotherapy is given with radiation.
Long-term side effects
Radiation to treat vaginal cancer can also cause some long-term side effects. Pelvic radiation can lead to premature menopause. It can also weaken bones, making them more likely to break from a fall or other trauma.
Radiation to the pelvis can also severely irritate the intestines and rectum (called radiation colitis), leading to diarrhea and bloody stool. If severe, radiation colitis can cause holes or tears to form in the intestines (called perforations).
Pelvic radiation can also cause problems with the bladder (radiation cystitis), leading to discomfort and an urge to urinate often. In rare cases, radiation can cause abnormal connections (called fistulas) to form between the vagina and the bladder, rectum, or uterus.
If the skin was irritated by radiation, when it heals it may be darker and not as soft.
Radiation can cause the normal tissue of the vagina to become irritated and sore. As it heals, scar tissue can form in the vagina. The scar tissue can make the vagina shorter or more narrow (this is called vaginal stenosis). When this happens, vaginal intercourse (sex) can become painful. Stretching the walls of the vagina a few times a week can help prevent this problem.
One way to do this is to have vaginal intercourse at least 3 to 4 times a week. Since this might be uncomfortable while getting cancer treatment (and even after), another option is to use a vaginal dilator. A dilator is a plastic or rubber tube used to stretch out the vagina. It feels much like putting in a large tampon for a few minutes. Even if a woman is not interested in staying sexually active, keeping her vagina normal in size allows comfortable gynecologic exams. This is an important part of follow-up after treatment. Vaginal estrogens may also be used to relieve dryness and prevent painful intercourse and help maintain the size of the vagina. Still, vaginal dryness and pain with intercourse can be long-term side effects from radiation.
For more information on radiation therapy, see Understanding Radiation Therapy: A Guide for Patients and Families.
Last Medical Review: June 17, 2014 Last Revised: February 16, 2016