What is radiation therapy?

Radiation therapy is a treatment for cancer that uses beams of energy, usually X-rays. Radiation therapy is also called radiotherapy. Its goal is to kill or shrink cancer cells.

There are 2 main types of radiation therapy:

• External radiation. The radiation comes from a large machine and is aimed at the skin over the tumor. It's a lot like a dental X-ray or chest X-ray, but the radiation is stronger.

• Internal radiation (brachytherapy). Radioactive material is put inside the vagina, near the tumor. This allows a large dose of radiation to go right to the tumor.

When might radiation therapy be used?

In most cases, both external and internal radiation are used to treat vaginal cancer. Sometimes chemotherapy is given along with radiation to help it work better.

Radiation treatment might be suggested for any of these reasons:

• As part of the main treatment for vaginal cancer. It might be the only treatment needed for small tumors that haven't spread. It can also be used along with other treatments, like chemo, to treat bigger tumors.

• To try to kill any cancer cells left after surgery. Radiation can be used after surgery to treat nearby lymph nodes and kill any cancer cells that may have not been removed.

• To ease symptoms. Treating the vagina and pelvis can help reduce bleeding, pain, and other problems the tumor is causing.

Deciding on a radiation treatment plan

To plan your treatment, you'll meet with a team of cancer specialists. This might include a surgeon, radiation oncologist, and medical oncologist.

A radiation oncologist is a healthcare provider who specializes in both cancer and radiation. This healthcare provider works with you to decide the kind of radiation you need. He or she also determines the dose and how long treatment will last. During this visit, ask what you can expect during and after the treatment. 

Internal radiation therapy

This type of radiation therapy is also called brachytherapy. It uses a radioactive material that's inside a cylinder-shaped tube. The tube is put in the vagina. The radiation doesn't go far, so it mostly affects the tissues near the tube.

There are 2 types of internal radiation therapy:

• LDR (low-dose radiation) brachytherapy. The tube stays in for a day or 2. Gauze packing is put in the vagina to hold the tube in place. You stay in bed in the hospital during treatment.

• HDR (high-dose radiation) brachytherapy.  Stronger radiation in the tube means it doesn't have to stay in as long. Each treatment takes less than 20 minutes, and is done as an outpatient. 

Getting ready for internal radiation

Imaging tests, like a CT scan or MRI, will be done to see exactly where the tumor is. This helps your healthcare provider see your vagina and the nearby tissues so he or she can map out exactly where the radiation needs to be placed.

On the day you get radiation

You will be treated in a special room that keeps any radiation inside. You may be given drugs to make you sleepy if you're getting LDR and packing will be used to keep the tube in place.

Your provider will put the tube in place in your vagina. It's left there for LDR. How long it stays depends on where the cancer is and how big it is. You stay in the hospital during treatment.

For HDR, a machine might be used to send bursts of radiation into the tube. The tube doesn't stay in very long. Three or 4 treatments might be done a few weeks apart.

For both types of internal radiation, the radioactive material is taken out before you go home – none is left in your body. You are not radioactive, so you do not pose a risk to those around you. 

External beam radiation

External radiation therapy is done in a hospital or a clinic. You get it as an outpatient. This means you go in for treatment and then go home the same day. Treatment is usually done 5 days a week for 5 weeks.

Getting ready for radiation

Before your first treatment, you will have a planning appointment called a simulation. This is needed to find exactly where in your body the radiation beam needs to be directed. It may take up to 2 hours.

During this session, imaging tests such as CT or MRI scans may be done. These tests help your healthcare providers know the exact location of the tumor so they can aim the radiation right at it. Also at this session, body molds might be made to put you in the exact same position for each treatment and help keep you from moving.

Then, you’ll lie still on a table while a radiation therapist uses a machine to define your treatment field. The field is the exact area on your body where the radiation will be aimed. Sometimes it’s called your port. The therapist may mark your skin with tiny dots of semi-permanent ink or tattoos. This is so the radiation will be aimed at the exact same place each time.

You can then go home and the radiation oncologist and team will design your radiation plan. This can take up to a week.

On the days you get radiation

On the days you get treatment, you’ll lie on a table while the machine is placed over you. You may have to wear a hospital gown. Treatment a lot like getting an X-ray, but takes longer, up to 15 to 30 minutes. You should plan on being there for about an hour total.

At the start of the treatment session, a radiation therapist helps you get into position and may use blocks or special shields to protect parts of your body from exposure to radiation. The therapist then lines up lights on the machine with the marks on your skin so the radiation is directed to the right spot. When you’re ready, the therapist leaves the room and turns the machine on. You may hear whirring or clicking noises as the machine moves during radiation. This may sound like a vacuum cleaner. When the machine sends radiation to your tumor, you'll need to be very still. You don't have to hold your breath. The machine won't touch you. During the session, you’ll be able to talk to and hear the therapist over an intercom. You can’t feel radiation, so the process will be painless. You will not be radioactive afterward.

What to expect after radiation

Because radiation affects normal cells as well as cancer cells, you may have some side effects. The side effects from radiation are normally limited to the area being treated. Some people have few or no side effects. If you do have them, your healthcare provider may change the dose of your radiation or how often you get treatment. Or treatment may be stopped until your side effects clear up. Tell your healthcare provider about any side effects you have right away. It's important to treat them before they get worse.

Also talk to your healthcare provider about whether you can have sex during treatment and if there are any precautions you should take.

Possible side effects

Talk to your healthcare provider about what you might feel like during and after radiation. All cancer treatments can cause side effects. Radiation side effects often get worse as treatment goes on, but most can be treated.

The side effects of radiation therapy include:

• Skin in the treated becomes irritated, sore, red, raw, and blistered like a sunburn. This can also happen inside your vagina.

• Hair loss in the area being treated (this can be permanent)

• Feeling very tired or weak

• Nausea or vomiting

• Diarrhea and bloody stool

• Bladder problems, and things like discomfort and urgency when passing urine

• Low blood counts

Most side effects go away over time after you stop treatment. Still, if you have any of these side effects, talk with your healthcare provider about how to deal with them. Side effects tend to be worse if you get chemotherapy along with radiation.

Some long-term side effects of radiation may not show up for many years after you finish treatment. For instance, radiation can:

• Damage the ovaries and cause early menopause and infertility (inability to have children)

• Damage the bowels, which can cause blockages (bowel obstructions) and holes (called perforations)

• Cause vaginal dryness and pain during sex

• Weaken pelvis bones, so they might break more easily

• Cause scar tissue in the vagina (called a stricture) that can make it shorter or more narrow (called stenosis)

• Cause abnormal connections to form between organs in your pelvis, like the vagina, bladder, bowels, and uterus. These are called fistulas.

Talk to your healthcare provider about what side effects you can expect. Also talk about what can be done to prevent or ease them. Ask your healthcare provider what symptoms to watch out for. Know when you should call your healthcare team and how to get help after office hours and on weekends and holidays.