Radiotherapy for Cervical Cancer

What is radiotherapy?

Radiotherapy, also known as radiation therapy, utilises high-energy X-rays to target and destroy cancer cells. For patients diagnosed with cervical cancer, this effective treatment option aims to shrink tumours, alleviate symptoms, and improve overall outcomes. Understanding the role of radiotherapy in your treatment plan is crucial for making informed decisions about your health.

When is radiotherapy given?

Radiation therapy serves as an important treatment option for various medical conditions. Your healthcare team may recommend radiation therapy in several scenarios:

Cancer treatment

• Primary treatment: Used as the main treatment for certain cancers to shrink or eliminate tumours

• Combined treatment: Often used alongside other treatments such as chemotherapy or surgery

• Before surgery (Pre-operative): To shrink tumours, making them easier to remove surgically

• After surgery (Post-operative): To target any remaining cancer cells and reduce the risk of recurrence

• Palliative care: To help manage symptoms and improve quality of life in advanced cases

Non-cancerous conditions

• Treatment of benign tumours

• Management of certain blood disorders

• Control of specific inflammatory conditions

Other considerations for administering radiotherapy

Healthcare providers determine the timing and dosage of radiation therapy based on several factors:

• Type and stage of the condition: 

  • The tumour’s size and spread, dictate the appropriate timing and dosage of radiotherapy.

  • Early-stage cancers may respond well to radiation as a primary treatment, while later-stage cancers may require a more integrated approach with other therapies.

• Patient health status: 

  • A patient's overall health, including any pre-existing conditions, performance status, and ability to tolerate treatments, plays a vital role in determining when radiotherapy should begin. 

  • Patients with compromised health may need to postpone treatment until they are in a better condition.

• Response to previous treatments: 

  • If a patient has undergone surgery or chemotherapy, the healthcare team evaluates how well the cancer responded to those treatments. This assessment can affect the timing of radiotherapy. 

  • If tumours have decreased post-chemotherapy, radiotherapy may be scheduled sooner to maximise its effectiveness.

• Personal preferences and lifestyle factors: 

  • Each patient's individual circumstances, such as work commitments, family responsibilities, and emotional readiness, are also considered. Open communication between the patient and healthcare providers ensures that treatment plans align with the patient’s needs and expectations

Types of radiotherapy

In cases of early-stage or locally advanced cervical cancer, the primary treatment typically involves external radiotherapy combined with chemotherapy, a method known as chemoradiotherapy. This is often followed by internal radiotherapy, also referred to as brachytherapy.

External beam radiation therapy (EBRT)

External beam radiation therapy (EBRT) is a main cervical cancer treatment option, particularly for cases where the disease has progressed beyond the cervix. This method involves the use of a specialised machine that precisely directs radiation beams at the tumour and surrounding tissues from outside the body. The treatment is administered in short bursts, typically once a day, five days a week, for a duration of five to six weeks. The radiation source is located outside your body, hence the name external radiotherapy.

Internal radiotherapy (brachytherapy)

Internal radiotherapy, commonly known as brachytherapy, is a targeted cancer treatment that delivers radiation directly to the cervical cancer cells of the tumor from within the body. This approach allows for a higher radiation dose to be administered precisely to the cancerous tissue while minimizing exposure to surrounding healthy cells. Brachytherapy is particularly effective in treating cervical cancer and is often employed in conjunction with external beam radiation therapy (EBRT) as part of a comprehensive treatment plan.

Brachytherapy involves placing a source of radiation in or near the tumor, utilizing devices inserted into the vagina and, in some instances, the cervix. The radiation emitted from these sources has a limited range, which confines its effects predominantly to the targeted area, thereby reducing the risk of damage to adjacent tissues such as the bladder and bowel.

Learn more about brachytherapy here.

What happens during radiation therapy?

Before treatment

A CT scan is done to map out the areas that require treatment. Before radiation therapy, patients may be asked to empty their bowels and drink water to ensure their bladder is comfortably full. This preparation is crucial as it helps maintain consistency in the positioning of pelvic organs like the cervix and uterus. This allows for precise targeting of the radiation dose to the affected areas.

During treatment

During radiation therapy sessions, you will lie on a treatment table in a specific position. The radiation therapy team will ensure you are comfortable and positioned correctly using supports or cushions. The machine (linear accelerator) will move around you but won't touch you. The radiation therapist will then guide the radiation source within (internal radiation therapy) or outside (EBRT) your body to target the cervical cancer cells located at the cervix, pelvic lymph nodes or other affected areas.

Each session typically takes about 15-20 minutes.

Points to note during treatment:

• You must remain still during the treatment

• The radiographer will leave the room but monitor you through cameras

• You can communicate with the team via an intercom system

• The treatment itself is painless, similar to having an X-ray

• You will not be radioactive after external beam radiation therapy

After treatment

You may experience some side effects following radiation therapy. Regular follow-up appointments are vital to monitor recovery and check for any signs of recurrence. These visits often include physical examinations, imaging tests, and discussions about any lingering side effects or concerns. Healthcare teams will also assess the effectiveness of the treatment and make any necessary adjustments to the care plan.

Common side effects of radiation therapy for cervical cancer

Radiation therapy is an effective treatment for cervical cancer, targeting cancerous cells while striving to minimize damage to surrounding healthy tissues. However, like any medical intervention, it can lead to various side effects. Understanding these side effects can empower patients to manage and prepare for any challenges that may arise.

Short-term side effects

1. Fatigue: One of the most prevalent side effects is fatigue. This can range from mild tiredness to extreme exhaustion, often building up over the course of treatment. Prioritizing rest and self-care is essential during this time.

2. Skin problems: Radiation aimed at the pelvic area may cause skin irritation in the treated region. Symptoms can include redness, dryness, or peeling, akin to a sunburn. Keeping the skin moisturized and avoiding tight or abrasive clothing can help alleviate discomfort.

3. Bladder problems: Radiation therapy can irritate the bladder, leading to discomfort and an increased urge to urinate frequently. Patients may require hydration management and medications to ease these symptoms.

4. Changes in blood cell counts: Radiation may lead to low blood cell counts, increasing susceptibility to infections and bleeding. Regular monitoring of blood cell counts is crucial for prompt intervention if necessary.

Long-term side effects

1. Lymphedema: Some patients may develop lymphedema, which is characterized by swelling due to fluid accumulation, particularly in the legs. This condition may require ongoing management and lifestyle adjustments.

2. Osteoporosis: Radiation can impact bone density, leading to osteoporosis over time. Continuous monitoring and preventive measures may be necessary to mitigate risks associated with weakened bones.

3. Sexual problems: Radiation therapy can affect sexual health, leading to issues such as vaginal dryness or discomfort during intercourse. Patients should discuss these matters openly with their healthcare team, as various treatments and lubricants can alleviate discomfort.

4. Menstrual changes: Women of reproductive age may experience irregular menstruation or early menopause due to radiation therapy, affecting both fertility and hormonal balance. It is essential for discussions about these potential changes to occur during pre-treatment consultations.

For detailed information about radiation therapy and personalised treatment planning, request for an appointment with our specialists at Thomson Medical.

FAQ

How long does External Beam Radiation Therapy (EBRT) last?

The treatment lasts about 15 minutes per session and is painless. Radiation dosage is calculated to target cancer cells while sparing healthy tissues. Techniques like intensity-modulated radiation therapy (IMRT) allow for customized doses, protecting surrounding organs. This tailored approach improves treatment effectiveness and reduces side effects, enhancing the patient's quality of life. Often, EBRT is combined with chemotherapy, known as chemoradiation, which boosts treatment outcomes for advanced cervical cancer. Overall, EBRT is vital in the multidisciplinary treatment of cervical cancer, focusing on optimal results and patient safety.

How many radiotherapy sessions for cervical cancer?

The number of radiotherapy sessions for cervical cancer varies depending on the stage of cancer and the treatment plan. Typically, external beam radiation therapy (EBRT) is given 5 days a week for about 5 to 6 weeks. This may be combined with brachytherapy (internal radiation), which involves 1–5 sessions depending on the case. Your oncologist will tailor the exact schedule to your specific needs.

How long do you have to stay away from someone after radiation?

Patients do not become radioactive and do not need to avoid contact with others.

What are the late effects of radiation for cervical cancer?

• Changes in vaginal tissue elasticity

• Bowel or bladder changes

• Impact on ovarian function

• Possible changes in bone density

• Risk of lymphoedema

Regular follow-up care helps monitor and manage any late effects.

Is radiation effective for cervical cancer?

Yes, radiation therapy is an established and effective treatment for cervical cancer. Its effectiveness depends on several factors:

The stage of cancer Overall treatment plan Combination with other treatments like chemotherapy Individual response to treatment Modern radiation techniques have significantly improved treatment outcomes.

Is radiotherapy painful?

Radiotherapy itself is not painful during treatment. However, side effects from radiotherapy, such as skin irritation or inflammation, may cause discomfort over time. Internal radiation (brachytherapy) may involve some mild discomfort or cramping during the procedure, but it is generally well-tolerated with appropriate pain management.

Can I continue daily activities during radiotherapy?

Yes. Light activities like walking or household chores are usually manageable, but fatigue, a common side effect, may limit energy levels. Patients are encouraged to listen to their bodies and rest as needed. It’s advisable to avoid heavy lifting or strenuous physical activities during the treatment period.

What are the chances of recurrence after radiotherapy?

The risk of recurrence depends on factors such as the stage of cervical cancer at diagnosis, the type of radiotherapy used, and how well the cancer responds to treatment. For early to locally advanced stages, radiotherapy combined with chemotherapy has been shown to significantly reduce recurrence rates. However, advanced-stage cervical cancer may have a higher likelihood of recurrence even after treatment. Regular follow-up appointments are essential to monitor for any signs of recurrence.

How does radiotherapy compare with normal surgery?

Radiotherapy and surgery are both effective treatments for cervical cancer, but their use depends on the stage of cancer and patient-specific factors:

• Surgery:

  • Preferred for early-stage cervical cancer

  • Offers the potential to preserve fertility (e.g. trachelectomy)

  • Requires recovery time but avoids some of the long-term side effects of radiotherapy

• Radiotherapy:

  • Often used for locally advanced cervical cancer or when surgery is not an option

  • May be combined with chemotherapy (chemoradiation) for better results

  • Effective at targeting cancer cells in a broader area

Your oncologist will recommend the best treatment approach based on the type, stage, and progression of your cancer, as well as your overall health and personal preferences.

What stage of cervical cancer requires radiation?

Radiation therapy is typically required for stage 2 to stage 4 cervical cancer, where the cancer has spread beyond the cervix to nearby tissues or distant organs. It is often combined with chemotherapy (chemoradiation) for locally advanced stages. In some cases, it may also be used post-surgery to reduce the risk of recurrence.

The information provided is intended for general guidance only and should not be considered medical advice. For personalised recommendations and tailored advice, please consult a specialist at Thomson Medical. Book an appointment with Thomson Medical today.