Cervical Cancer: Radiation
Radiation therapy or radiotherapy is often used as part of treatment for cervical
cancer. Radiation uses beams of energy to kill the cancer cells.
When radiation therapy is used
Radiotherapy is a local therapy. That means it only affects the cancer cells in the
area that's treated. It doesn’t affect the whole body. Your healthcare provider may
suggest radiation therapy in these cases:
You have cervical cancer that has spread beyond your cervix to nearby tissues, blood
vessels, or lymph nodes.
You have a large tumor that's found only in your pelvis.
You need radiation after surgery to make sure that all the cancer cells are gone.
You have early-stage cervical cancer, so you can have radiation instead of surgery.
(Early stage means the cancer is small and is only in the cervix.)
You don't want to have surgery or can’t have surgery because of other health problems.
Radiation might help shrink a tumor so it's easier to remove with surgery.
Most women with cervical cancer who are treated with radiation get chemotherapy at
the same time. This makes the radiation work better. For a smaller cancer or one that
has not spread, radiation alone can work as well as surgery.
Deciding on a radiation treatment plan
You will work with a radiation oncologist to decide on your treatment plan. This is
a healthcare provider who specializes in treating cancer with radiation therapy. Each
woman’s treatment plan is different. This healthcare provider will talk with you about:
The goal of radiation therapy
The type (or types) of radiation you need (internal, external, or both)
The dose you need
How long and how often you need treatment
Your radiation oncologist may do some imaging tests to help decide on the best treatment
for you. These tests take pictures of the inside of your body. They help show exactly
where the cancer is. They may include X-rays, MRIs magnetic resonance imaging) and
PET/CT (positron emission tomography/computed tomography) scans. You may have the
same tests after treatment to see how well it worked.
Your radiation oncologist can tell you what to expect during treatment. You'll also
talk about how you might feel during and after treatment. You'll have to decide if
you want to be able to get pregnant in the future because this impacts your treatment
plan. Talk with your healthcare provider about your fertility concerns before starting
treatment. It may help to bring a family member or friend with you to appointments.
Make a list of questions and concerns you want to talk about.
Types of radiation treatment
There are two main types of radiation treatment used to treat cervical cancer:
External beam radiation (EBRT). For this type, a special machine directs the beams of energy at the tumor from outside
Internal radiation (brachytherapy). For this type, a radiation source is put into your vagina or uterus so it's close
to the cancer on the cervix. The radioactive sources are inside you for minutes to
hours, depending on the kind of treatment.
Most women are treated with both kinds of radiation.
What to expect during EBRT
External radiation is given once a day, 5 days a week, for 4 to 6 weeks. The treatments
are like getting an X-ray. But the radiation dose is much stronger than an X-ray and
it comes from a large machine. The machine doesn't touch you during the treatment. The
treatments don't hurt, and they are quick.
Before you start treatment, simulation scans will be done. This is done to map the
exact location and size of the tumor so the beams of radiation can be focused there.
Small marks (tattoos) may be put on your skin to mark the treatment area. Special
molds might be made to put you in the same position for each treatment. This makes
sure that the radiation reaches the tumor while staying away from healthy parts of
On the day of treatment, you are carefully put into the right position. You may see
lights from the machine lined up with the marks on your skin. This helps the therapist
aim the radiation.
The therapist will leave the room while the machine sends radiation to your tumor.
During this time, they can see you, hear you, and talk to you. When the machine sends
radiation to your tumor, you will need to be very still. But you don't have to hold
your breath. The treatment only lasts a few minutes, and the whole process will take
less than an hour.
What to expect during brachytherapy
The radiation used in brachytherapy has to be put close to the tumor because it travels
only a short distance. This means it mostly affects the cervix and the inside of the
vagina. There's less damage to nearby organs, like the bladder and rectum.
The radioactive material is put in a device that fits in your vagina, next to your
cervix. If you still have your uterus, a small metal tube holding radiation might
be put through the opening of your cervix to treat that area.
There are two types of brachytherapy:
Low-dose rate brachytherapy. The radioactive material is put in near the cervix and left there for a few days.
You stay in bed in the hospital during this time. This is rarely used nowadays.
High-dose rate brachytherapy. This is done as several outpatient treatments. You don’t stay in the hospital. The
radioactive material is put in for just a short time. It’s then taken out before you
go home. It might be done once a week for many weeks.
Common side effects of radiation therapy
Radiation treatment affects normal cells as well as cancer cells. This can cause side
effects. These depend on how much radiation you get and how it's given. Common side
Skin changes where the radiation beams go into your body
Loss of appetite
Nausea and vomiting
Vaginal irritation, bleeding, and discharge
Loss of pubic hair (can be permanent)
Vaginal dryness and scarring, which can make the vagina shorter, narrower, and less
able to stretch. This can cause pain during sex and pelvic exams. This can be a long-term
problem, but there are things you can do to help keep it from happening.
Rectal bleeding, narrowing, and scarring. Treatment may be needed.
Damage to the ovaries that causes early menopause. This can lead to bones getting
Reduced fertility or infertility (can’t become pregnant)
Bladder irritation and problems with urination
Weakened hip (pelvic) bones and increased risk of fractures can be a long-term side
effect, especially with falls
Low blood counts, causing low levels of red blood cells (anemia) and white blood cells
The radiation therapy may cause scar tissue to form in the vagina. The scar tissue
can make the vagina more narrow (vaginal stenosis). This can make the vagina even
shorter, which can make having sex (vaginal intercourse) painful. Talk with your radiation
oncologist about the use of a dilator to prevent this problem. It's best to start
about 2 to 4 weeks after treatment ends. You may need to use the vaginal dilator for
up to a year.
If lymph nodes in your pelvis are treated with radiation, you may develop a side effect
called lymphedema. This is swelling in the leg that's hard to treat once it begins.
It can happen any time after treatment. Talk with your healthcare provider about your
risk for lymphedema and what you can do to try to keep it from starting. This is most
common if you have surgery followed by radiation.
Most problems often go away or get better within a few months after radiation ends. Many
can be treated, so be sure to talk with your healthcare provider about any problems
you have. Also ask about long-term side effects that may develop months or even years
after treatment. There may be things you can do to help prevent them from happening.
And you need to know what to watch for so you can get treatment right away.
Working with your healthcare provider
Talk with your healthcare providers about what problems to look for and when to call
them. Make sure you know what number to call with questions. Is there a different
number for evenings and weekends? It may be helpful to keep a diary of your side effects.
Write down physical and emotional changes, and changes in thought patterns. A written
list will make it easier for you to remember your questions when you go to your appointments.
It will also help you and your healthcare team make a plan to manage any side effects
you might have.