Radiation Treatment for Gynecologic Cancers
Radiation therapy uses high energy x-rays to damage the DNA of cells. This kills the cancer cells, or stops them from reproducing. It is used to treat many types of cancer.
Radiation therapy is often used to treat gynecologic cancers. Gynecologic cancer includes cervical, endometrial, uterine, fallopian, ovarian, vaginal, vulvar, gestational trophoblastic disease, and choriocarcinoma. The doses of radiation used to destroy cancer cells can also hurt normal cells in the treated area. The damage to these normal cells is the cause of the common side effects of radiation treatment. The possible side effects of radiation therapy are directly related to the area of the body being treated. If you are getting radiation for gynecologic cancer, possible side effects will happen in that area.
What should I expect during treatment?
The side effects of radiation are cumulative, meaning the more treatments you have over time, the higher risk of side effects. Most patients do not have any side effects until a few weeks into their radiation treatment. While side effects may be unpleasant, there are treatments to help deal with them. Most side effects are temporary, going away over time once therapy is complete.
You will often have a visit with your radiation treatment team at least once a week. This visit gives you the chance to ask questions, discuss any side effects, and learn about any necessary interventions to help relieve the side effects. However, you can report any new or worsening symptoms at any time to your treatment team.
Short-Term Side Effects
The following list includes some of the most common side effects of radiation therapy for gynecologic cancers, including external beam or brachytherapy treatments. Remember that the treatments can affect each patient differently, and you may not experience these particular side effects. Talk with your radiation oncologist and health care team about what you can expect from your specific treatment.
- Skin irritation: The skin in the treatment area may become red, irritated, dry, or sensitive. This may start to look like a sunburn after some time. Treat the skin gently to avoid further irritation, and bathe carefully, using only warm water and mild soap. Avoid perfumed or scented lotions or soaps, as these may cause further irritation.
- Fatigue is very common with radiation treatment and tends to begin a few weeks into therapy. Fatigue often gets better slowly over the weeks and months following treatment.
- Urinary issues such as cystitis (inflammation of the bladder), dysuria (pain with peeing) increased frequency, urgency, hesitancy and increased nocturia (waking up at night to urinate). Talk to your healthcare team about ways to manage these symptoms.
- Irritation to the rectal tissue can cause bowel urgency, diarrhea or discomfort with bowel movements. These symptoms tend to get better within a few weeks of finishing treatment. Talk to your healthcare team about ways to manage these symptoms. In some patients, these problems can linger after treatment.
- Nausea and/or vomiting can occur. Your healthcare team can prescribe medications to manage nausea. Dietary changes can also help.
- Loss of hair in the pelvic area. Hair typically starts to regrow a month or so after treatment. However, your hair might not grow back exactly as it was before treatment and for some, the hair loss becomes permanent.
- Reduced blood counts, including neutropenia (low white blood cell count), anemia (low red blood cell count) or thrombocytopenia (low platelet count).
Long-Term Side Effects
The side effects discussed above tend to happen during treatment, up until a few months after treatment. Long-term effects can happen months to many years after cancer treatment. The risks vary depending on the areas included in the field of radiation and the radiation techniques that were used, as these continue to develop and improve. Some of the potential long-term side effects of radiation for gynecologic cancers can be:
- There is a low risk of developing a second cancer in or near the radiation field. These are called secondary cancers, and they develop as a result of the exposure of healthy tissue to radiation. Radiation techniques used today are meant to limit this exposure, but it is not always possible to prevent all exposure and still achieve the desired outcomes.
- Radiation therapy for gynecologic cancers can affect a woman’s fertility. Talk to your oncology team about options for fertility preservation if this is a concern.
- Radiation fields that include the uterus can decrease the size and elasticity of the uterus, increasing the risk of miscarriage or preterm birth. Women who become pregnant should be sure their obstetrician knows their treatment history, and is comfortable caring for a high-risk pregnancy.
- After radiation treatment to the pelvic area, scar tissue forms in the vagina and the tissue becomes less elastic and dry. There may be some shrinking of the vagina and vaginal opening. Scarring of the vaginal tissue can result in "adhesions,” or areas where scar tissue forms, sealing the sides of the vaginal together. This can make it difficult for the healthcare provider to perform vaginal exams and makes sexual intercourse difficult and uncomfortable. Your oncology team will teach you to use vaginal dilators to reduce the severity of this side effect.
- Damage to the drainage (lymphatic) system in the area can lead to a chronic swelling called lymphedema, which can happen at any time after treatment. Learn about lymphedema risk reduction. Notify your healthcare provider if you develop any swelling in the legs or pelvis. A survivor with lymphedema who develops pain or redness in the leg(s), especially with fever, should be evaluated right away, as these signs may indicate infection.
After treatment, talk with your oncology team about receiving a survivorship care plan, which can help you manage the transition to survivorship and learn about life after cancer. You can create your own survivorship care plan using the OncoLife Survivorship Care Plan.
American Cancer Society. (2020). Radiation therapy for cervical cancer. Retrieved from https://www.cancer.org/cancer/cervical-cancer/treating/radiation.html
Tewari, K.S, & DiSaia, P.J. (2002). Journal of Obstetrics and Gynaecology Research. Radiation therapy for gynecologic cancer 28(3) 123-140. DOI 10.1046/j.1341-8076.2002.00036.x.