Also known as radiotherapy, radiation therapy uses a controlled dose of radiation to kill or damage cancer cells. The radiation is usually in the form of x-ray beams. It is targeted at the parts of the body with cancer or at areas the cancer cells might have spread to. Treatment is carefully planned to do as little harm as possible to healthy tissues.
Learn more about:
- When radiation therapy is given
- Chemoradiation
- External beam radiation therapy (EBRT)
- Internal radiation therapy
- Side effects of radiation therapy
- Video: What is radiation therapy?
When radiation therapy is given
Radiation therapy may be given:
- in combination with chemotherapy as the main treatment for cervical cancer (chemoradiation)
- after surgery to help destroy any remaining cancer cells and reduce the chance of the cancer coming back (adjuvant therapy).
There are 2 main ways of delivering radiation therapy: externally or internally. It is common to have both types to treat cervical cancer.
For more on this, see our general section on Radiation therapy.
Chemoradiation
When radiation therapy is given at the same time as chemotherapy, it is known as chemoradiation. The chemotherapy drugs make the cancer cells more sensitive to radiation therapy.
If you have chemoradiation, you will usually receive chemotherapy once a week a few hours before the radiation therapy appointment.
Side effects of chemoradiation include:
- fatigue
- diarrhoea
- needing to pass urine more often or in a hurry
- cystitis (irritation of the bladder)
- dry and itchy skin in the treatment area
- nausea.
Chemoradiation can also affect blood cells, and weekly blood tests may be needed during treatment to monitor your blood cell levels.
Talk to your treatment team about ways to manage the side effects of chemoradiation.
External beam radiation therapy
In external beam radiation therapy (EBRT), a machine precisely directs radiation beams from outside the body to the cervix, lymph nodes and other organs that need treatment. You will have a planning session, including a CT scan, to work out where to direct the radiation. To help direct the treatment, up to 4 small tattoos the size of a freckle may be applied to the skin on your pelvis. These marks are usually permanent. Learn about other markers that may be used.
Preparing for CT scans and treatments
You may be asked to empty your bowels and/or drink some water so that your bladder is comfortably full before the CT scan and treatments. This helps to ensure that organs in the pelvic area – including the cervix and uterus – are in the same position for each treatment and the radiation beams are delivered to the targeted area.
What to expect during outpatient treatments
You will probably have EBRT as daily treatments, Monday to Friday, over 4–6 weeks as an outpatient. You will lie on a table and the radiation therapy machine will move around you. It is important that you lie still and breathe normally. The radiation therapist will leave the room during treatment, but will be able to talk to you through an intercom and watch you on a screen. The EBRT session may take up to 45 minutes, but the actual treatment takes about 15 minutes and is painless.
External beam radiation therapy and HDR brachytherapy will not make you radioactive. It is safe for you to be with both adults and children after your treatment sessions.
Internal radiation therapy
Also known as brachytherapy, internal radiation therapy delivers radiation directly to the tumour from inside your body (usually through the vagina). It allows a higher radiation dose to be delivered to the tumour, while reducing the amount of radiation delivered to nearby organs such as the bowel and bladder. Brachytherapy is usually given after the course of EBRT is finished. The main type of internal radiation therapy used for cervical cancer is high-dose-rate (HDR) brachytherapy.
With HDR brachytherapy, only a few treatments are needed to receive the required radiation dose. Your treatment team will develop a personalised treatment plan to suit your body and target the cancer while limiting the radiation dose to other organs.
You will have treatment as a day patient or may stay in hospital overnight. You will probably have 3–4 sessions over 2–3 weeks, and will be given a general or spinal anaesthetic at each session.
During treatment
Devices called applicators are used to deliver the radiation source to the cancer. They are available in different sizes. Your radiation oncologist will examine you to choose suitable applicators for your situation. Applicators are placed into the cervix under ultrasound guidance to make sure they are in the right place. To hold the applicators in place, you will have gauze padding put into your vagina, and may have a stitch placed in the vulva.
You will also have a small tube (catheter) inserted to empty your bladder of urine during treatment. You will have a CT or MRI scan to check the position of the applicator. If you have a general anaesthetic, you may be woken after the applicator is put in place and given patient-controlled pain medicine for the rest of the procedure.
The radiation dose is delivered from a shielded container through cables to the applicator. The radiation stays in the applicator for about 10–20 minutes and is then taken out.
After treatment
As several sessions are needed, you may stay in hospital with the applicator in place (and no radiation inside) so that a second treatment can be given. Otherwise, the applicator may be taken out after the radiation dose is delivered and then reinserted before each session.
After brachytherapy, you may feel uncomfortable in the vaginal region or have a small amount of bleeding. Pain medicines can help.
Radiation therapy after surgery (adjuvant therapy)
If you’ve had surgery, your doctor may recommend that you also have additional radiation therapy. Usually, about 4–6 weeks after surgery, you will have EBRT in combination with chemotherapy. Occasionally, some women will have brachytherapy to deliver radiation to the top of the vagina.
This brachytherapy is done as an outpatient procedure and does not require anaesthetic. A cylinder-shaped applicator is inserted into the vagina, then removed after each session. You may need to have 2–4 sessions to deliver the right amount of radiation to treat the cancer. Each treatment session takes about 30 minutes.
For more on this, see our general section on Radiation therapy.
→ READ MORE: Side effects of radiation therapy
For me, the hardest part of cancer and treatment is the ongoing emotional side. My doctors have told me to be vigilant about everything abnormal, such as any vaginal bleeding or pain. Sometimes I panic when I feel unwell and rush to my doctor for reassurance. Mostly now, it feels like it was a bad dream, and I focus on living my life to the full.
Anne
Video: What is radiation therapy?
Learn more about radiation therapy in this short video.
Podcast: Making Treatment Decisions
Listen to more episodes from our podcast for people affected by cancer
More resources
Prof Martin Oehler, Director of Gynaecological Oncology, Royal Adelaide Hospital, and Clinical Professor, University of Adelaide, SA; Dawn Bedwell, 13 11 20 Consultant, Cancer Council QLD; Gemma Busuttil, Radiation Therapist, Crown Princess Mary Cancer Centre, Westmead Hospital, NSW; Dr Antonia Jones, Gynaecological Oncologist, The Royal Women’s Hospital and Mercy Hospital for Women, VIC; Angela Keating, Senior Psychologist, Royal Hospital for Women, NSW; Anne Mellon, Clinical Nurse Consultant – Gynaecological Oncology, Hunter New England Centre for Gynaecological Cancer, NSW; Dr Inger Olesen, Medical Oncologist, Andrew Love Cancer Centre, Barwon Health, Geelong, VIC; Dr Serena Sia, Radiation Oncologist, Fiona Stanley Hospital and King Edward Memorial Hospital, WA; A/Prof Megan Smith, Co-lead, Cervical Cancer and HPV Stream, The Daffodil Centre, Cancer Council NSW and The University of Sydney, NSW; Emily Stevens, Gynaecology Oncology Nurse Coordinator, Southern Adelaide Local Health Network, Flinders Medical Centre, SA; Melissa Whalen, Consumer.
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