Vaginal Cancer

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Treating Vaginal Cancer TOPICS

Radiation therapy 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 less bladder and bowel side effects than what is 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 intracavitary 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 side effects of radiation therapy include tiredness, upset stomach, or loose bowels. Serious fatigue might also occur, but sometimes not until about 2 weeks after treatment begins. When radiation is given to the pelvis, diarrhea is common, but can usually be controlled with over-the-counter medicines. Nausea and vomiting may also occur, but can be treated with medicines. These side effects tend to be worse when chemotherapy is given with radiation. Pelvic radiation can lead to premature menopause. It can also weaken the bones, making them more likely to break from a fall or other trauma.

Skin changes can also be a side effect of radiation. These may range from mild temporary redness to permanent discoloration. The skin may become raw and tender. It may also release fluid, making infection more likely, so care must be taken to clean and protect the area exposed to radiation.

Radiation to the pelvis can also cause severe irritation of the intestines and rectum (called radiation colitis), leading to diarrhea and bloody stool. If severe, radiation colitis can cause holes or tears forming 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.

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, sex (vaginal intercourse) 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 may be hard to do while getting cancer treatment, 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 our document Understanding Radiation Therapy: A Guide for Patients and Families.

Last Medical Review: 01/30/2013
Last Revised: 02/13/2014