Radiation therapy, or radiotherapy, is a common way to treat cervical cancer. With any treatment of cancer you must first understand your responsibility and your medical team’s role as well as explore treatment options and get a second opinion(s) before you begin treatment. Since the side effects of radiation can be significant, talk to your doctor prior to treatment so that you understand the specific kind of radiation you will receive and the expected side effects. Doctors who specialize in treating cancers with radiation are known as radiation oncologists. During radiation therapy, high-energy x-rays are used to kill cancer cells. Radiation therapy can be given by a machine that aims x-rays at the body (external beam radiation) or by placing small capsules of radioactive material directly into the cervix (internal or implant radiation or brachytherapy). Many patients receive both kinds of radiation therapy. For stage I cervical cancer, radiation therapy may be used instead of surgery or it may be used after surgery to destroy remaining cancer cells. For stages IB-IVA cervical cancer, radiation therapy is usually administered concurrently with chemotherapy.
Although patients do not feel anything while receiving radiation treatment, the effects of radiation gradually build up over time. Many patients become tired as treatment continues. Loose stools or diarrhea is also common. Urination may become more frequent or uncomfortable. Some patients may experience loss of pubic hair or irritation of the skin. After the radiation therapy is completed, the vagina can become narrower and less flexible. Finally, radiation therapy to the pelvis can stop the ovaries from functioning, thereby causing younger women to enter menopause early and subsequently be infertile.
Fatigue from radiation therapy can be a cumulative result of the stress from your disease, daily trips for radiation treatment and radiation effects on normal cells in the body. Patients vary in their degree of fatigue and their toleration of a normal work schedule and activities. Some patients suggest that a flexible work schedule is important since fatigue is more noticeable after the first couple of weeks of radiation therapy. Patients who were in a very stressful, high demand job suggested taking time off from work. On the other hand, patients who enjoyed their job suggested maintaining a regular work schedule or adjusted schedule to benefit from some degree of normalcy. In addition, patients suggest taking naps, getting adequate sleep, light exercise and some limitation of normal activities to help with fatigue. Check with your doctor to see what his or her recommendations are for exercise, activities and work load.
Diarrhea and loose stools may be a common temporary side effect or uncommon longer lasting side effect due to the radiation of the pelvis. Managing diarrhea may require anti-diarrhea medication and following nutritional recommendations by your doctor. Avoiding foods high in fiber like raw vegetables, fruit, grains and cereals may decrease the occurrence of diarrhea. A liquid diet at the onset of diarrhea may also help to reduce the occurrence. Check with your doctor for specific medication and nutritional recommendations.
Frequent and uncomfortable urination may be alleviated by drinking a lot of fluids, but avoiding caffeine and carbonated beverages. Your doctor may also prescribe medication to help relieve urination difficulty side effects.
Irritation of the skin is another common side effect associated with radiation therapy. Your doctor may be able to prescribe anti-itch medication for severe itching and irritation. Avoiding unnecessary irritation of the radiated area will also prevent further discomfort. Avoid lotion application within 2 hours of treatment, very hot or very cold water, sun exposure, tight clothing and scratching or scrubbing the affected area. Also, ask your doctor to recommend skin care products that will not irritate the tender skin. Most skin reactions will go away when treatment is over.
Shrinking and scarring (stenosis) of vaginal tissue associated with radiation therapy of the pelvis can be a difficult long-term side effect. This can make sexual relations painful and make future pelvic examinations difficult. In order to manage this side effect, it is important to maintain the pliability of the vagina with frequent sexual intercourse or the use of a dilator. Lubricants and creams may also help with vaginal dryness and sexual function.
Pelvic radiation for the treatment of cervical cancer can cause the ovaries to stop working either temporarily or permanently. In women of child-bearing age, early menopause inducement results from ovarian function cessation. There are many side effects of early menopause ranging from irregular periods, hot flashes and vaginal dryness to infertility and emotional issues. Hormone replacement therapy and other alternative methods may be recommended by your gynecologist to help manage the side effects of early menopause.
The potential loss of fertility associated with ovarian dysfunction resulting from radiation therapy should be discussed with your doctor before treatment begins. Some patients may want to have their eggs harvested for surrogacy before radiation treatment. Also, a highly experimental approach is currently being explored that involves removing an ovary and implanting it in an area of the body that will not be affected by the radiation treatment. This experimental approach may one day be offered to help avoid infertility and early menopause associated with radiation therapy of the pelvis.
Radiation is a common form of therapy in the treatment of cervical cancer. The potential short-term side effects may cause varying degrees of discomfort that can be managed by you and your doctor. Potential long-term effects such as early induced menopause, infertility, vaginal stenosis and bowel problems are reportedly the most difficult for patients to deal with emotionally and physically. Support groups, family support or professional support may help patients cope with these side effects. To understand the specific kind of radiation you will receive and the expected side effects, ask questions and use sources including your medical team, books, the Internet and other people with your disease. Before undergoing any treatment you should understand your responsibility, your medical team’s role, explore treatment options and get a second opinion(s).
