Cervical Cancer Facts

Treatment | Surgery | Chemotherapy | Radiation Therapy

Goal of Radiation Therapy for Cervical Cancer

Radiation therapy is another way to treat cervical cancer. It is also called radiotherapy. The goal is to kill cancer cells with high-energy X-rays. Women with cervical cancer treated with radiation often get low-dose chemotherapy at the same time. This can make the radiation therapy work better. This is called radiosentization or concomitant chemoradiotherapy. For smaller cancers that have not spread far, known as early-stage, radiation works as well as surgery. This is good to know because not all women can have surgery. Radiation is also used for larger cancers, and ones that have spread, known as advanced cancers, and may help cure them.

In some cases, you may have radiation after surgery. In that case, the goal may be to make sure any cancer cells left behind are killed. Or if cancer cannot be cured, the goal may be to ease symptoms, such as pain or bleeding.

Making the Decision to Have Radiation Therapy for Cervical Cancer

If you have radiation therapy, you'll see a doctor called a radiation oncologist. This doctor sets the treatment plan. The plan details the kind of radiation therapy you'll have and how long the treatment will last.

Radiotherapy is a local therapy. That means it only affects the cancer cells in the treated area. Your doctor may suggest this type of treatment in these cases.

  • You have cervical cancer that has spread beyond the cervix.
  • You have a large cancer that is found only in the pelvis. When cancers are 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 as an alternative to surgery.
  • Radiation therapy is as effective as radical hysterectomy for treating small cervical cancers.
  • You cannot have surgery because you have other medical problems.
  • You need treatment to shrink a tumor before surgery. (There is no evidence that this is better than radiation alone.)

There are 2 ways to get radiation. You may get only one of these types of radiation or both of them.

  • External radiation comes from a machine. This is sometimes called EBRT, which stands for external-beam radiation therapy. Tumors are thicker in some places than others. Traditional radiation therapy sends the same strength of radiation across the whole tumor. That means some parts may get too little or too much radiation. A new form of external beam radiation therapy called intensity modulated radiation therapy (IMRT) helps make sure the whole tumor gets the same amount of radiation. IMRT uses small beams of different strengths to better fit the tumor's shape and size.
  • Internal radiation is when radioactive material is placed inside you. The doctor puts it directly into, or near, the tumor. This type of radiation is also called brachytherapy. Brachy means "near" and refers to how close the radiation is to your tumor.

What Happens During External Beam Radiation Therapy for Cervical Cancer

You can receive external radiation as an outpatient. That means you may have it at a hospital or a clinic, but you don't have to stay the night.

Preparing for External Radiation

Before your first radiation treatment, you'll have an appointment to plan exactly where on your body the radiation beam needs to be directed. This process is called simulation. The appointment may take up to 2 hours. Here's what you can expect to happen.

  • You'll lie still on a table while a radiation therapist uses a machine to define your treatment fields. These are also called treatment ports. The field is the exact area on your body where the therapist will aim the radiation. 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 tattoos so that the radiation will be aimed at the exact same place each time you come in for treatment.
  • You may also have imaging tests, such as computed tomography (CT scans), to help doctors know the exact location of your tumor. This helps to better aim the radiation.

On the Days You Get Radiation

External beam radiation therapy (ERBT) is like getting a chest X-ray, except that it lasts for a few minutes and you usually receive it each day for 4 to 5 weeks. External radiotherapy does not hurt. Many women continue to carry on a normal life during therapy.

At the start of the treatment session, a radiation therapist may place blocks or special shields to protect parts of your body that don't need to be exposed to radiation. The therapist then lines up the machine so that radiation is directed to the spot that was marked during the simulation. When you are ready, the therapist leaves the room and turns the machine on. You may hear whirring or clicking noises while the radiation is being given. During the session, you will be able to talk to the therapist over an intercom. You can't feel radiation, so the process will be painless. Also, you will not be "radioactive" afterward.

At the end of treatment, the radiation therapist may direct extra radiation at the area where the tumor first started. This is called a "boost."

What to Expect After External Radiation Therapy for Cervical Cancer

Radiation therapy affects normal cells as well as cancer cells. The side effects of radiation depend on the amount and the type of radiation you get. Be sure to let your doctor know of any side effects you have.

Here's an overview of how you might feel during or after having EBRT.

  • You may have diarrhea, with or without blood in the stool. You may also have cramping or feel like you need to have a bowel movement. If you have these effects, they are likely to occur in the second or third week of treatment.
  • The skin around the area treated may get irritated. The skin may be red, flake, or drain fluid. You may also have a vaginal discharge.
  • You may lose your pubic hair. Some of it may grow back.
  • You may feel like you have to urinate often or all the time. Or you may have a burning feeling when you're urinating. You also may have blood in your urine. If you have these kinds of problems, they usually occur about 3 to 5 weeks into your radiation treatment.
  • You may feel very tired, called fatigue, until about a month after your treatment is done.
  • You may have swelling in your legs. This is rare but occurs more often in women who have had a lymph node biopsy.
  • You may have a loss of appetite or be nauseated.

The following effects may continue after EBRT ends. Or they may not appear for a few years after EBRT ends.

  • Bowel problems, such as diarrhea or cramping
  • Urinary problems, such as needing to go to the bathroom more often or having trouble controlling your urine.

Talk with your doctor about ways to deal with these longer-lasting side effects. Also, be clear that radiation harms the ovaries. They will never drop eggs for ovulation again. This means you will be infertile and cannot have children without medical help. You also will stop having periods and experience an early menopause, if you haven't already passed menopause.

You might find that your vagina is narrower and less flexible. The doctor may give you a dilator to help with these problems. Sexual intercourse may be hard because the skin can be sensitive.

It's likely that after external radiation you'll need treatment with internal radiation.

What Happens During Internal Radiation Therapy for Cervical Cancer?

Internal radiation therapy uses radioactive needles or seeds to place radioactive material inside your body near the tumor to kills cancer cells without harming much tissue around them.

There are 2 main types of radiation therapy.

  • Implant therapy, also called low-dose rate (LDR) brachytherapy. This is the more traditional type of internal radiation. It uses a lower dose of radiation. For it, you may have to stay in the hospital for 2 to 3 days.
  • High-dose rate (HDR) brachytherapy, which is also called alternative implant therapy. This is a newer type of treatment. As the name suggests, it uses a higher dose of radiation. For it, you get the radiation more rapidly—over the course of several minutes—although the procedure may take a few hours. You can go home on the same day.

Here's how internal radiation works.

  • The doctor places radioactive material inside your vagina against the cervix.
  • The material stays in place for a while to kill the abnormal cells. How long it stays inside you depends on the type of internal radiation you're getting. As long as it's inside you, you cannot be around other people.
  • The doctor removes it before you go home.
  • Radiation does not remain in your body after the treatment ends. So others are not at risk for radiation exposure by being around you.
  • It's likely that you will receive internal radiation once a week for several weeks.

What to Expect After Internal Radiation Therapy for Cervical Cancer

Radiation therapy affects normal cells as well as cancer cells. The side effects of radiation depend on the amount and the type of radiation you get. Be sure to let your doctor know of any side effects you have.

These are common side effects of internal radiation therapy.

  • Fatigue
  • Skin changes
  • Loss of appetite
  • Nausea
  • Diarrhea
  • Frequent urination

Sexual intercourse may be hard because the skin can be sensitive. The doctor may prescribe estrogen creams to help with vaginal dryness. Your vagina may become narrower and less flexible. The doctor may tell you to use a dilator to help you stretch your vagina.

It's important to know that radiation therapy turns off the ovaries. They will never work again. Other long-term side effects of radiation are listed below.

  • Vaginal injury
  • Chronic intestinal inflammation, called radiation enteritis
  • Abnormal connection of intestinal tissue, called fistulas

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