Cervical Cancer: Radiation

Radiation therapy is often used as part of a treatment plan for cervical cancer. Radiation uses rays of energy to kill the cancer cells. Chemotherapy is often given along with radiation therapy. (This may be called chemoradiation.)

When radiation therapy is used

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

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

• You have a large cancer that is found only in the pelvis. When cancer is large, radiation therapy is the preferred treatment.

• You need treatment 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 can’t have surgery because you have other health problems.

• You need treatment to shrink a tumor before surgery.

Women with cervical cancer who are treated with radiation often receive low-dose chemotherapy at the same time. This makes the radiation work more effectively. For smaller cancer or one that has not spread, radiation works as well as surgery.

Deciding on a radiation treatment plan

You will work with a radiation oncologist to decide on your treatment plan. This is a doctor who specializes in treating cancer with radiation therapy. Each person’s treatment plan is different. This doctor 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 decide on your treatment. These tests take pictures of the inside of your body. They help show where you need treatment. They may include X-rays and CT 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 learn how you may feel during and after the 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. During your visit, ask what the goal of radiation therapy is and how you can expect to feel during and after treatment.

Types of radiation treatment

There are 2 main types of radiation treatment:

• External beam radiation (EBRT). For this type, a special machine directs the rays of energy to the area of cancer.

• Internal radiation (brachytherapy). For this type, a small radiation source is placed in the 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. Brachytherapy may be used along with EBRT.

What to expect during EBRT

EBRT is often given once a day, 5 days a week, for a certain number of weeks. The treatments are like getting an X-ray. But the radiation dose is much stronger 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, imaging scans will be done in the area of your cancer. This is done to measure the exact location of the tumor so the beams of radiation can be focused there. Small marks may be put on your skin to mark the treatment area. This ensures that the radiation reaches only the tumor, and not 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. These help the therapist know you are in the right position. The therapist will leave the room while the machine sends radiation to your tumor. During this time, he or she 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 likely take less than an hour.

What to expect during brachytherapy

The radiation used in brachytherapy travels only a short distance. So it mostly affects the cervix and the inside of the vagina. There are 2 types of brachytherapy:

• Low-dose rate brachytherapy. This is done over a few days. You stay in bed in the hospital during this time with the radioactive material in place near the cervix.

• High-dose rate brachytherapy. This is done with several treatments as an outpatient. That means you don’t stay overnight in the hospital. The radioactive material is put in place for just a short time. It’s then taken out before you go home.

Common side effects of radiation therapy

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

• Diarrhea (most common)

• Tiredness

• Skin changes where the radiation beams go into your body

• Loss of appetite

• Nausea and vomiting

• Vaginal irritation and discharge

• Loss of pubic hair (can be permanent)

• Vaginal dryness and painful intercourse, which can be long-term, but can be treated

• Shortening of the vagina and higher risk of bleeding. Shortening of the vagina can lead to painful intercourse.

• Damage to the ovaries that causes early menopause. This can lead to bone weakening.

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

• Bladder irritation and problems with urination

• Weakened hip (pelvic) bones and increased risk of breaks, a long-term side effect

• 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). Or it can make it even shorter, which can make 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 long-term. 

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 doctor about your risk for lymphedema and what you can do to try to keep it from starting.

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 doctor or nurse 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.

Working with your healthcare provider

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, thinking, and emotional changes. A written list will make it easier for you to remember your questions when you go to your appointments. It will also make it easier for you to work with your healthcare team to make a plan to manage any side effects you might have.