Vaginal Cancer: Radiation Therapy

What is radiation therapy?

Radiation therapy is a treatment for cancer that uses rays of energy. Radiation therapy is also called radiotherapy. Its goal is to kill or shrink cancer cells.

Types of radiation therapy

There are two main types of radiation therapy:

• External radiation. The radiation comes from a machine and is pointed at the skin over the tumor.

• Internal radiation (brachytherapy). Radioactive material is placed inside the vagina, near the tumor. This therapy can help lower the risk of the cancer returning with fewer risks than external beam radiation to the whole pelvis.

In many cases, both external and internal radiation are used together to treat vaginal cancer. 

Deciding on a radiation treatment plan

You will talk with a radiation oncologist. This is a healthcare provider who specializes in both cancer and radiation. You’ll work with your healthcare provider to decide what your treatment will be and how long it will last. During your visit, ask what you can expect during and after the treatment. 

How internal radiation therapy is done

This type of radiation therapy is also called brachytherapy or high-dose rate (HDR) brachytherapy. It is done over a few hours and you can go home the same day. There are two types of internal radiation therapy:

• Intracavitary radiation. This uses radioactive material that is inside a cylindrical container or tube that is put in the vagina. The radiation affects the tissues near the tube.

• Interstitial radiation. This uses needles that contain seeds or wires of radioactive material and are put right into the tumor. 

During internal radiation:

• You may have imaging tests ahead of time to see exactly where the radioactive material should be placed. Then, the oncologist places the radioactive material inside your vagina.

• The material stays in place for a period of time to kill the abnormal cells. How long it stays in place varies. This depends on the stage and location of your cancer.

• The healthcare provider removes the radioactive material before you go home.

• Radiation does not stay in your body after the treatment is done. You are not radioactive, so you do not pose a risk to those around you.  

How external beam radiation therapy is done

External radiation therapy is done in a hospital or a clinic. You go home that day. The standard treatment lasts 5 days a week for 5 weeks. This type of radiation may come from a machine called a linear accelerator. 

Before your first treatment, you will have a session to find exactly where in your body the radiation beam needs to be directed. The process is called simulation. This session may take up to 2 hours. You’ll lie still on a table while a radiation therapist uses a machine to define your treatment field. The field is the exact area on your body where the radiation will be aimed. You may have more than one treatment field if you have cancer in more than one place. The therapist marks your skin with tiny dots of colored permanent ink so that the radiation will be aimed at the exact same place each time.

You may also have imaging scans, such as computed tomography (CT) scans. These are to help healthcare providers know the exact location of your tumor to better aim the radiation. Also at this session, you may have body molds made to put you in the exact same position and help keep you from moving during each treatment.

During the treatment sessions:

• The experience is like getting an X-ray. It takes about 15 minutes to complete. You should plan on being there for about an hour.

• You’ll lie on a table while the machine is placed over you. You may have to wear a hospital gown.

• 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 machine will not touch you.

• When you are in the right position, the therapist will leave the room and turn the machine on. You may hear whirring or clicking noises as the machine gets into position and while the radiation is being given. When the machine sends radiation to your tumor, you will need to be very still. You do not have to hold your breath. You can’t feel radiation, so the process will be painless.

• During the session, you will be able to talk to the therapist over an intercom.

• You will not be radioactive afterward. 

Side effects of radiation therapy

Talk to your healthcare provider about what you might feel like during and after radiation therapy. All cancer treatments have side effects. Side effects often get worse as treatment goes on, but can be treated. Side effects often get better or go away over time after treatment ends. The side effects of radiation therapy include:

• Skin in the treated area that is irritated, dry, red, and blistered like a sunburn, including inside your vagina

• Hair loss in the area being treated

• Feeling tired or weak

• Nausea or vomiting

• Diarrhea

• Discomfort and urgency when urinating

Side effects depend on the part of your body that's being treated. Talk to your healthcare provider about what side effects you can expect and what can be done to prevent or ease them. Ask your healthcare provider what symptoms to watch out for. In some cases, you should call your healthcare team. Your healthcare provider may want you to call if you have signs of infection, such as fever or pain that gets worse. Make sure you know how to get help after office hours and on weekends. Also talk to your healthcare provider about whether you can have sex during treatment and if there are any precautions you should take.

Some long-term side effects of radiation may not show up for many years after you finish treatment. These depend on the dose and location of the radiation. These also depend on how many times you had the treatment. Ask your healthcare provider what you may expect.