Radiation therapy for cancer of the uterus

Glossary

Also known as radiotherapy, radiation therapy is the use of targeted radiation to kill or damage cancer cells so they cannot grow, multiply or spread. The radiation is usually in the form of x-ray beams. Treatment is carefully planned to limit damage to the surrounding healthy tissues.

For cancer of the uterus, radiation therapy is commonly used as an additional treatment after surgery to reduce the chance of the disease coming back. This is called adjuvant therapy. In some cases, radiation therapy may be recommended as the main treatment if other health conditions mean you are not well enough for a major operation.

There are two main ways of delivering radiation therapy: internally or externally. Some women are treated with both types of radiation therapy. Your radiation oncologist will recommend the course of treatment most suitable for you.

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Internal radiation therapy (brachytherapy)

Internal radiation therapy may be used after a hysterectomy to deliver radiation directly to the top of the vagina (vaginal vault) from inside your body. This is known as vaginal vault brachytherapy.

During each treatment session, a plastic cylinder (the applicator) is inserted into the vagina. The applicator is connected by plastic tubes to a machine that contains radioactive material in the form of a small metal seed. Next, this seed is moved from the machine through the tubes into your body. After a few minutes, the seed is returned to the machine. The applicator is taken out after each session.

Brachytherapy does not need any anaesthetic, and each treatment session usually takes only 20−30 minutes. You are likely to have 3–6 treatment sessions as an outpatient over 1−2 weeks.

If a hysterectomy has not been done and radiation is given as the main treatment, the internal radiation therapy may involve an applicator being placed inside the uterus. This is done under general anaesthetic or sedation, and may require a short hospital stay.

External beam radiation therapy

External beam radiation therapy (EBRT) directs the radiation at the cancer and surrounding tissue from outside the body. For cancer of the uterus, the lower abdominal area and pelvis are treated, but if the cancer has spread (metastasised), other areas may also be treated.

You will lie on a treatment table under a large machine known as a linear accelerator, which delivers the radiation. The actual treatment takes only a few minutes each time and is painless (like having an x-ray). However, the planning may involve a number of visits to your doctor to have more tests, such as blood tests and scans.

You will probably have EBRT sessions from Monday to Friday for 4–6 weeks. You usually receive this treatment as an outpatient and won’t need to stay in hospital.

It’s very important that you attend all of your scheduled sessions to ensure you receive enough radiation to kill the cancer cells or relieve symptoms.

Side effects of radiation therapy

The side effects you experience will vary depending on the type of radiation, the dose of radiation and the areas treated. Brachytherapy tends to have fewer side effects than EBRT.

Side effects often get worse during treatment and just after the course of treatment has ended. They usually get better within weeks, through some may continue for longer. Some side effects may not show up until many months or years after treatment. These are called late effects.

Short-term side effects

fatigue

 

Your body uses a lot of energy to recover, and travelling to treatment can also be tiring. The fatigue may last for weeks after treatment ends. Exercise can help manage fatigue.

bowel and bladder problems 

Radiation therapy can cause inflammation and swelling of the bowel (radiation proctitis) and bladder (radiation cystitis). Bowel motions may be more frequent, urgent or loose (diarrhoea), or you may pass more wind than normal. Less commonly, there may be blood in the stools. You may also pass urine more often or with more urgency, or with a burning sensation. Your treatment team will prescribe medicines to reduce these side effects.

nausea and vomiting

Because the radiation therapy is directed near your abdomen, you may feel sick (nauseous), with or without vomiting, for several hours after each treatment. Your doctor may prescribe anti-nausea medicine to help prevent this.

vaginal discharge

Radiation therapy may cause or increase vaginal discharge. Let your treatment team know if it smells bad or has blood in it. Do not wash inside the vagina with douches as this may cause infection.

skin redness, soreness and swelling

The vulva and the skin in the groin area may become sore and swollen. It may start by being pink or red and feeling itchy, and then peel, blister or weep. Your treatment team will recommend creams and pain relief to use. Wash the vulva with lukewarm water or weak salt baths, avoid perfumed products, and wear cotton underwear.

Long-term or late effects

hair loss

You may lose your pubic hair. For some women, this can be permanent. Radiation therapy to the pelvis will not affect  the hair on your head or other parts of your body.

bowel and bladder changes 

Bowel changes, such as diarrhoea, wind or constipation, and bladder changes, such as frequent or painful urination, can also be late effects, appearing months or years after treatment. Bleeding from the bowel or bladder can also occur. In rare cases, women experience loss of bowel control (faecal incontinence) or blockage of the bowel. It is important to let your doctor know if you have any bleeding or if you have pain in the abdomen and cannot open your bowels.

lymphoedema

 

Radiation can scar the lymph nodes and vessels and stop them draining lymph fluid properly from the legs, making the legs swollen. This can occur months or years after radiation therapy. Lymphoedema is easier to treat if recognised early.

narrowing of the vagina

The vagina can become drier, shorter and narrower (vaginal stenosis), which may make sex and pelvic examinations uncomfortable or difficult. Your treatment team will suggest strategies to prevent this, such as the use of vaginal dilators.

menopause

In premenopausal women, radiation therapy to the pelvis can stop the ovaries producing hormones, and this causes early menopause. Your periods will stop, you will no longer be able to become pregnant and you may have menopausal symptoms. Talk to your radiation oncologist about these issues. You may be able to visit a menopause clinic.

Video: What is radiation therapy?

Watch this short video to learn more about radiation therapy.

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This information was last reviewed in March 2019
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