Cervical Cancer: Radiation

Radiotherapy is a local therapy. That means it only affects the cancer cells in the area that's treated. It doesn’t affect the whole body. Your healthcare provider may suggest radiation therapy in these cases:

• You have cervical cancer that has spread beyond your cervix to nearby tissues, blood vessels, or lymph nodes.

• You have a large tumor that's found only in your pelvis.

• You need radiation after surgery to make sure that all the cancer cells are gone.

• You have early-stage cervical cancer, so you can have radiation instead of surgery. (Early stage means the cancer is small and is only in the cervix.)

• You don't want to have surgery or can’t have surgery because of other health problems.

• Radiation might help shrink a tumor so it's easier to remove with surgery.

Most women with cervical cancer who are treated with radiation get chemotherapy at the same time. This makes the radiation work better. For a smaller cancer or one that has not spread, radiation alone can work as well as surgery.

You will work with a radiation oncologist to decide on your treatment plan. This is a healthcare provider who specializes in treating cancer with radiation therapy. Each woman’s treatment plan is different. This healthcare provider will talk with you about:

• The goal of radiation therapy

• The type (or types) of radiation you need (internal, external, or both)

• The dose you need

• How long and how often you need treatment

Your radiation oncologist may do some imaging tests to help decide on the best treatment for you. These tests take pictures of the inside of your body. They help show exactly where the cancer is. They may include X-rays, MRIs magnetic resonance imaging) and PET/CT (positron emission tomography/computed tomography) scans. You may have the same tests after treatment to see how well it worked. 

Your radiation oncologist can tell you what to expect during treatment. You'll also talk about how you might feel during and after treatment. You'll have to decide if you want to be able to get pregnant in the future because this impacts your treatment plan. Talk with your healthcare provider about your fertility concerns before starting treatment. It may help to bring a family member or friend with you to appointments. Make a list of questions and concerns you want to talk about.

There are two main types of radiation treatment used to treat cervical cancer:

• External beam radiation (EBRT). For this type, a special machine directs the beams of energy at the tumor from outside your body.

• Internal radiation (brachytherapy). For this type, a radiation source is put into your vagina or uterus so it's close to the cancer on the cervix. The radioactive sources are inside you for minutes to hours, depending on the kind of treatment. 

Most women are treated with both kinds of radiation.

External radiation is given once a day, 5 days a week, for 4 to 6 weeks. The treatments are like getting an X-ray. But the radiation dose is much stronger than an X-ray and it comes from a large machine. The machine doesn't touch you during the treatment. The treatments don't hurt, and they are quick.

Before you start treatment, simulation scans will be done. This is done to map the exact location and size of the tumor so the beams of radiation can be focused there. Small marks (tattoos) may be put on your skin to mark the treatment area. Special molds might be made to put you in the same position for each treatment. This makes sure that the radiation reaches the tumor while staying away from healthy parts of your body.

On the day of treatment, you are carefully put into the right position. You may see lights from the machine lined up with the marks on your skin. This helps the therapist aim the radiation.

The therapist will leave the room while the machine sends radiation to your tumor. During this time, they can see you, hear you, and talk to you. When the machine sends radiation to your tumor, you will need to be very still. But you don't have to hold your breath. The treatment only lasts a few minutes, and the whole process will take less than an hour.

The radiation used in brachytherapy has to be put close to the tumor because it travels only a short distance. This means it mostly affects the cervix and the inside of the vagina. There's less damage to nearby organs, like the bladder and rectum.

The radioactive material is put in a device that fits in your vagina, next to your cervix. If you still have your uterus, a small metal tube holding radiation might be put through the opening of your cervix to treat that area.

There are two types of brachytherapy:

• Low-dose rate brachytherapy. The radioactive material is put in near the cervix and left there for a few days. You stay in bed in the hospital during this time. This is rarely used nowadays.

• High-dose rate brachytherapy. This is done as several outpatient treatments. You don’t stay in the hospital. The radioactive material is put in for just a short time. It’s then taken out before you go home. It might be done once a week for many weeks.

Radiation treatment affects normal cells as well as cancer cells. This can cause side effects. These depend on how much radiation you get and how it's given. Common side effects include:

• Diarrhea

• Tiredness

• Skin changes where the radiation beams go into your body

• Loss of appetite

• Nausea and vomiting

• Vaginal irritation, bleeding, and discharge

• Loss of pubic hair (can be permanent)

• Vaginal dryness and scarring, which can make the vagina shorter, narrower, and less able to stretch. This can cause pain during sex and pelvic exams. This can be a long-term problem, but there are things you can do to help keep it from happening.

• Rectal bleeding, narrowing, and scarring. Treatment may be needed.

• Damage to the ovaries that causes early menopause. This can lead to bones getting weaker.

• Reduced fertility or infertility (can’t become pregnant)

• Bladder irritation and problems with urination

• Weakened hip (pelvic) bones and increased risk of fractures can be a long-term side effect, especially with falls

• Low blood counts, causing low levels of red blood cells (anemia) and white blood cells (leukopenia)

The radiation therapy may cause scar tissue to form in the vagina. The scar tissue can make the vagina more narrow (vaginal stenosis). This can make the vagina even shorter, which can make having sex (vaginal intercourse) painful. Talk with your radiation oncologist about the use of a dilator to prevent this problem. It's best to start about 2 to 4 weeks after treatment ends. You may need to use the vaginal dilator for up to a year.

If lymph nodes in your pelvis are treated with radiation, you may develop a side effect called lymphedema. This is swelling in the leg that's hard to treat once it begins. It can happen any time after treatment. Talk with your healthcare provider about your risk for lymphedema and what you can do to try to keep it from starting. This is most common if you have surgery followed by radiation.

Most problems often go away or get better within a few months after radiation ends. Many can be treated, so be sure to talk with your healthcare provider about any problems you have. Also ask about long-term side effects that may develop months or even years after treatment. There may be things you can do to help prevent them from happening. And you need to know what to watch for so you can get treatment right away.

Talk with your healthcare providers about what problems to look for and when to call them. Make sure you know what number to call with questions. Is there a different number for evenings and weekends? It may be helpful to keep a diary of your side effects. Write down physical and emotional changes, and changes in thought patterns. A written list will make it easier for you to remember your questions when you go to your appointments. It will also help you and your healthcare team make a plan to manage any side effects you might have.