Radiation Treatment for Gynecologic Cancers
Radiation therapy is often used to treat gynecologic cancers. The doses of radiation used to destroy cancer cells can also hurt normal cells in the surrounding area. The damage to these normal cells is the cause of the common side effects of radiation treatment. Thus the possible side effects of radiation therapy are directly related to the area of the body being treated. Side effects are caused by the cumulative effect of radiation on the cells; therefore most patients do not experience any side effects until a few weeks into their treatment. While side effects may be unpleasant, there are treatments to help deal with them. Most side effects are temporary, disappearing gradually after therapy is complete.
Most radiation oncologists see their patients at least once a week while the patient is receiving treatment. This visit with the healthcare team serves as an opportunity to ask questions, discuss any side effects, and implement any necessary interventions to help relieve the side effects. However, you can report concerning symptoms any time to your treatment team.
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 progress to look like a sunburn. 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 typically resolves slowly over the weeks and months following treatment.
- Urinary issues such as cystitis (inflammation of the bladder), dysuria (pain with voiding) 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 resolve 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), anemi (low red blood cell count) or thrombocytopenia (low platelet count).
Long-Term Side Effects
The side effects discussed thus far tend to occur during treatment, up until a few months after treatment. Long-term effects can occur 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 include:
- 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. Modern radiation techniques are designed 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 your 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 occur 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.