Radiotherapy treats cancer using high-energy rays (radiation). They destroy the cancer cells, while doing as little harm as possible to normal cells. It can be given from outside the body (external) or from inside the body (internal radiotherapy). Some women have both external and internal radiotherapy treatment.
Many women with vaginal cancer are treated with radiotherapy. You may have radiotherapy:
- as a treatment on its own
- after surgery to reduce the risk of the cancer coming back
- if the cancer was not completely removed with surgery.
Some women have radiotherapy combined with chemotherapy. This is called chemoradiation. Chemotherapy is usually given once a week during radiotherapy treatment. Having chemotherapy at the same time may make radiotherapy work better. There are more side effects with chemoradiation so you have to be well enough to cope with this treatment.
A cancer doctor who is an expert in treating cancer with radiotherapy (a clinical oncologist) will plan your treatment. They will talk it over with you and answer any questions you have.
External radiotherapy
With external radiotherapy, high-energy x-rays are directed from a machine to the area of the cancer.
It is normally given as a series of short, daily treatments in the hospital radiotherapy department. You have the treatment from Monday–Friday, with a rest at the weekend. Your course may last 4–6 weeks. Radiotherapy isn’t painful, but you have to lie still for a few minutes while it is given.
You will have a CT scan of the area to be treated before your first radiotherapy treatment. Your cancer doctor will use the scan to help them plan your radiotherapy.
Internal radiotherapy (brachytherapy)
Internal radiotherapy is used to give an extra dose of radiation to the tumour after external radiotherapy. The doctor gently inserts an applicator (similar to a plastic tampon) into your vagina. It is connected to a machine which sends radiation into the applicator. The treatment may last several minutes or a few hours, depending on the equipment used.
The staff in the radiotherapy department will explain what will happen. They will show you the equipment before you have treatment.
Side effects of radiotherapy
Your cancer doctor, nurse or radiographer will tell you about the likely side effects of pelvic radiotherapy. They can give you advice on how to manage them and tell you about the treatments that can help.
Most side effects are temporary. They may get worse for a couple of weeks after treatment. After this, side effects usually improve gradually over a few weeks.
Sometimes certain side effects don’t completely go away. Or sometimes, new side effects develop months or years after radiotherapy. These are called late effects.
The side effects of radiotherapy are made worse by smoking. Stopping smoking helps reduce both immediate and late side effects, particularly those that affect the skin. It can be difficult to stop smoking at such a stressful time. If you want help or advice on how to stop, talk to your clinical oncologist, GP or a specialist nurse.
We have more information on giving up smoking that we can send you.
During treatment, you may have some of the side effects explained here. It’s important to tell your radiographer, cancer doctor or specialist nurse about any side effects you have.
Tiredness
Pace yourself so you don’t overdo it and take regular rests. Try to balance this with some physical activity, such as regular short walks. This will help build up your energy levels.
Effects on the skin
Your skin in the treatment area may redden or get darker, and become dry, flaky and itchy. Towards the end of treatment, it may become moist and sore. Your radiographer or nurse will check your skin regularly. Tell them if your skin is sore or you notice any other changes. They can prescribe a cream or dressings to help. They can also prescribe painkillers, if needed.
Pelvic radiotherapy may make the hair around your genital area fall out. It usually grows back a few weeks after radiotherapy is finished.
You may have a slight discharge from the vagina after treatment has finished. It is important to let your doctor or nurse know if it continues for more than a few weeks, or becomes heavy.
Effects on the bowel
Diarrhoea is a common side effect. Your doctor can prescribe drugs to control this. It’s important to drink 2–3 litres of fluid a day if you have diarrhoea.
Effect on the bladder
You may feel you need to pass urine often and have a burning sensation when you pass urine (cystitis). Drinking plenty of fluids will help. Try to avoid or cut down on drinks containing caffeine or alcohol.
If you are having problems, ask your nurse or radiographer for advice. Let them know if your side effects don’t improve.
Early menopause
In younger women, pelvic radiotherapy stops the ovaries working and causes an early menopause. Your periods stop and you may have menopausal side effects, such as:
- hot flushes and sweats
- vaginal dryness
- lower sex drive
- mood swings and poor concentration.
You can usually have hormonal replacement therapy (HRT) to replace the hormones your ovaries are no longer producing. This can improve some menopausal symptoms. If HRT is not suitable for you or if you don’t want to have it, there are other ways to manage menopausal symptoms.
Your specialist nurse can give you advice about managing menopausal symptoms. The Daisy Network is an organisation for women who have had an early menopause. It also provides information. The menopause means your ovaries are no longer producing eggs. This means you will not be able to get pregnant (become infertile). This can be difficult to cope with and some women may need counselling. Let your nurse know if you find this hard to deal with.
Effects on the vagina
Radiotherapy to the pelvis can make the vagina narrower, less stretchy and drier. Your nurse may recommend you use vaginal dilators (tampon shaped plastic tube) with a lubricant. This is to try to prevent the vagina from narrowing. Your nurse will explain how to use them. Using a dilator regularly may make having sex after treatment easier. It can also make it easier to have internal examinations.
There are lots of vaginal lubricants and creams that help with vaginal dryness. Your doctor can also prescribe hormone creams to help with dryness and vaginal narrowing.
Possible late side effects of radiotherapy
These are side effects that don’t go away, or that develop months or years later. Newer ways of giving radiotherapy are designed help to reduce the chance of developing late effects. Your cancer doctor or nurse can give you more information.
Bowel and bladder effects
The most common late effects are changes to the bowel and bladder. This may cause you to have loose bowel motions, diarrhoea, or feel you need to pass urine more often than before.
Bleeding
Small blood vessels in the bowel and bladder can become more fragile after radiotherapy. This may cause blood to appear in your urine or bowel motions. You may also have bleeding from small blood vessels in the vagina. Always tell your cancer doctor or nurse straightaway if you have bleeding or discharge from any of these areas.
Lymphoedema
Radiotherapy can affect the lymph nodes in the pelvic area. This may cause swelling of one or occasionally both legs, called lymphoedema. You have more risk of lymphoedema if you had surgery as well as radiotherapy. Your nurse will explain what you can do to reduce the risk of lymphoedema. If you notice any swelling in your legs, contact your nurse or doctor straightaway. Always tell your cancer doctor or nurse if you have new symptoms or side effects that don’t improve.