Radiotherapy for Cervical Cancer

What is radiotherapy?

Radiotherapy (also called radiation therapy) uses high-energy radiation to kill or damage cancer cells. The goal is to control or eradicate the tumour while minimising damage to surrounding healthy tissue. The treatment is carefully planned and targeted using imaging (CT/MRI) for precision.

When is radiotherapy used in cervical cancer?

For patients diagnosed with cervical cancer, this 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.

A) Early Stage (Stage I & II)

• Radiotherapy may be used as the main treatment if surgery is not suitable.

• Can be given after surgery to destroy any remaining cancer cells and reduce recurrence risk.

B) Locally Advanced Cervical Cancer (Stage III & IV)

• Often combined with chemotherapy in a treatment called chemoradiation.

• Chemotherapy helps make cancer cells more sensitive to radiation.

• Used when surgery is not possible because of tumour size, location, or spread.

C) Adjuvant Therapy (After Surgery)

• Recommended if there’s a risk of cancer cells remaining.

• Common when there are positive lymph nodes or other high-risk features.

D) Palliative Treatment

• Used when cancer is advanced or has spread to control symptoms like pain or bleeding.

• Aims to improve quality of life, not cure.

E) Inoperable Cases

• When surgery is not an option, radiation may be used as the primary treatment for early or locally advanced cervical cancer.

Types of radiotherapy for cervical cancer

Radiotherapy can be delivered in two main ways: External Beam Radiation Therapy (EBRT) and Brachytherapy (BT).Often, both methods are used together for the best treatment results.

External beam radiation therapy (EBRT)

• Type: External radiation (source is outside the body).

• How it works:

  • High-energy X-rays are directed at the tumour and nearby tissues using a linear accelerator.

  • The machine moves around to target the cancer from different angles while the patient lies on a treatment table.

• Treatment schedule:

  • Given in fractions (small daily doses) over 4–6 weeks.

  • Usually an outpatient procedure — you can return home after each session.

• Uses in cervical cancer:

  • Treats the primary tumour, cervix, and surrounding pelvic lymph nodes.

  • Common for locally advanced disease (Stage II–IV).

• Advantages:

  • Non-invasive, painless during procedure, and allows for continuation of normal activities.

Brachytherapy (BT)

• Type: Internal radiation (source placed inside the body).

• How it works:

  • A small radioactive device is placed inside the vagina and uterus, close to the tumour.

  • Can be placed intermittently (short sessions) or continuously over a few days.

• Advantages:

  • Delivers a high dose directly to the tumour while sparing nearby healthy tissues like the bladder and rectum.

  • Especially effective for localised cervical cancer and often used after EBRT to boost the dose.

• Procedure setting:

  • Usually done in a hospital, the device is removed after each session or at the end of treatment

What to Expect During Radiotherapy for Cervical Cancer

During external beam radiotherapy (EBRT)

• You will lie still on a treatment table.

• A large machine called a linear accelerator will move around you to deliver the radiation beams.

• The beams are precisely targeted to the tumour using imaging guidance.

• You will not feel the radiation — it is painless.

• The treatment takes only a few minutes, but the session may last 10–30 minutes to allow for positioning and set-up.

• You may need to attend daily sessions (Monday–Friday) for 4–6 weeks.

During brachytherapy (internal radiotherapy)

• A small radioactive applicator is inserted into your vagina and uterus to deliver radiation directly to the tumour.

• This is usually done under anaesthesia or sedation to reduce discomfort.

• You will not feel the radiation itself.

• The applicator may be placed for a short time (a few minutes) or left in place for longer (hours to days) depending on the treatment plan.

• Brachytherapy sessions are often done 1–2 times per week over several weeks.

Is radiotherapy painful?

• The radiation itself is painless — similar to having an X-ray.

• Some discomfort may occur from holding still during EBRT or from the insertion of applicators in brachytherapy, but your medical team will take steps to minimise this.

Treatment timelines

Side effects of radiotherapy for cervical cancer

The side effects of radiotherapy vary depending on:

• The type of radiotherapy used (external beam or brachytherapy)

• The area being treated

• The individual’s overall health and response to treatment

Side effects are usually divided into short-term (acute) and long-term (late) effects.

Acute side effects (during or shortly after treatment)

These effects usually appear within days to weeks of starting treatment and may improve gradually after treatment ends.

• Fatigue: 

  • Feeling unusually tired during and after treatment.

• Skin changes: 

  • Redness, dryness, or irritation in the treated area (abdomen, pelvis, or vagina).

• Gastrointestinal symptoms: 

  • Nausea, vomiting, diarrhoea, or reduced appetite due to radiation affecting the bowel or stomach area.

• Urinary problems: 

  • Pain when urinating, frequent urination, or bladder irritation.

• Vaginal symptoms: 

  • Dryness, burning, or discomfort, especially after brachytherapy.

• Pain or discomfort during sexual activity: 

  • Caused by irritation or changes in vaginal tissues.

Late side effects (months or years after treatment)

These may develop long after treatment is over and can sometimes be permanent.

• Fertility issues: 

  • Damage to the ovaries may cause infertility or early menopause.

• Chronic fatigue: 

  • Persistent tiredness that continues beyond recovery.

• Bowel or bladder changes: 

  • Long-term changes in bowel movements or urinary function.

• Vaginal narrowing or stiffness: 

  • Can make sexual activity or pelvic exams difficult

• Premature menopause:

  • Radiation can damage the ovaries, leading to early menopause in younger women.

• Second cancers: 

  • There is a small risk of developing a second cancer in the treated area many years after radiation therapy.

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

FAQ

What should I expect after radiotherapy for cervical cancers?

After radiotherapy for cervical cancer, regular follow-up visits are crucial to monitor for any recurrence of cancer and manage any long-term side effects. These visits may include:

• Physical examinations.

• Pap smears or HPV testing to check for cancer recurrence.

• Imaging to check for any signs of metastasis or localised recurrence.

• Counselling and support for managing long-term side effects, including fertility counselling if the woman is of childbearing age.

• Pain medications, anti-nausea drugs, and vaginal lubricants or moisturisers may be prescribed to help alleviate symptoms. 

• Supportive care, including emotional support or counselling, can also be helpful, as dealing with the side effects of treatment can be physically and emotionally challenging.

Can radiotherapy affect fertility?

Yes, radiotherapy can lead to infertility, particularly if the ovaries are within the radiation field. For women of childbearing age, radiation to the pelvic area may damage the ovaries and lead to permanent infertility. However, the risk depends on factors such as the dose and location of radiation and the patient's age. Some women may consider fertility preservation options, such as egg freezing, before starting treatment.

Can cervical cancer recur after radiotherapy?

Yes, cervical cancer can recur after radiotherapy, especially in advanced stages or if the initial tumour was not completely eradicated. After treatment, patients typically undergo regular follow-up exams, including imaging and Pap tests, to monitor for any signs of recurrence. Early detection is crucial for managing a recurrence, and further treatment options (such as surgery, chemotherapy, or additional radiation) may be considered.

How does radiotherapy for cervical cancer affect sexual function?

Radiotherapy can affect sexual function in several ways:

• Vaginal stenosis: 

  • The vagina may become narrower and drier, leading to discomfort or pain during intercourse. Vaginal dilation therapy may be recommended to maintain vaginal elasticity.

• Vaginal dryness:

  • Radiation can cause vaginal dryness, making sexual intercourse painful. Lubricants or vaginal moisturisers may help you manage this.

• Loss of libido: 

  • Some women experience changes in sexual desire or arousal due to hormonal changes and the physical effects of treatment.

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.