Vaginal Cancer: Radiation Therapy

What is radiation therapy?

Radiation therapy is a treatment for cancer that uses rays of energy. A machine directs the rays of energy to the area of cancer. Radiation therapy is also called radiotherapy. Its goal is to kill or shrink cancer cells.


Types of radiation therapy

There are two main types of radiation therapy:

  • External radiation. The radiation comes from a machine and is pointed at the skin over the tumor.

  • Internal radiation (brachytherapy). This is the most common type of radiation therapy for endometrial cancer. It is usually done after surgery. Radioactive material is placed inside the vagina, near the tumor. This therapy can help lower the risk of the cancer returning with fewer risks than external beam radiation to the whole pelvis.

In many cases, both external and internal radiation are used together to treat vaginal cancer. 

Deciding on a radiation treatment plan

You will talk with a radiation oncologist. This is a doctor who specializes in both cancer and radiation. You’ll work with your doctor to decide what your treatment will be and how long it will last. During your visit, ask what you can expect to feel during and after the treatment. 

How internal radiation therapy is done

This type of radiation therapy is also called brachytherapy. Low-dose rate (LDR) brachytherapy is done in the hospital over a period of 48 to 72 hours. High-dose rate (HDR) brachytherapy is done over a few hours and you can go home that day. There are two types of internal radiation therapy:

  • Intracavitary radiation. This uses radioactive material that is inside a cylindrical container or tube that is put in the vagina.

  • Interstitial radiation. This uses needles that contain radioactive material and are placed directly into the tumor and nearby tissues. 

During internal radiation:

  • You may have tests ahead of time to see where the radioactive material should be placed. Then, the oncologist places radioactive material inside your vagina.

  • The material stays in place for a period of time to kill the abnormal cells. How long it stays in place varies. This depends on the stage and location of your cancer.

  • The doctor removes the radioactive material before you go home.

  • Radiation does not stay in your body after the treatment is done. You are not radioactive, so you do not pose a risk to those around you. But during treatment, your doctor may want you to remain a certain distance from visitors and pregnant women and children. Talk with your healthcare provider about these safety steps before your treatment. 

How external beam radiation therapy is done

External radiation therapy is done in a hospital or a clinic. You go home that day. The standard treatment lasts 5 days a week for 5 weeks. This type of radiation may come from a machine called a linear accelerator. 

Before your first treatment, you will have a session to find exactly where on your body the radiation beam needs to be directed. The process is called simulation. This session may take up to 2 hours. 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. You may have more than one treatment field if you have cancer in more than one place. The therapist marks your skin with tiny dots of colored permanent ink so that the radiation will be aimed at the exact same place each time.

You may also have imaging scans, such as computed tomography (CT) scans. These are to help doctors know the exact location of your tumor to better aim the radiation. Also at this session, you may have body molds made to help keep you from moving during the treatment.

During the treatment sessions:

  • The experience is like getting an X-ray. It takes about 15 minutes to complete. You should plan on being there for about an hour.

  • You’ll lie on a table while the machine is placed over you. You may have to wear a hospital gown.

  • You may see lights from the machine lined up with the marks on your skin. These help the therapist know you are in the right position. The machine will not touch you.

  • When you are in the right position, the therapist will leave the room and turn the machine on. You may hear whirring or clicking noises while the radiation is being given. When the machine sends radiation to your tumor, you will need to be very still. You do not have to hold your breath. You can’t feel radiation, so the process will be painless.

  • During the session, you will be able to talk to the therapist over an intercom.

  • You will not be radioactive afterward. 

Side effects of radiation therapy

Talk to your doctor about what you might feel like during and after radiation therapy. All cancer treatments have side effects. Side effects often get worse as treatment goes on, but can be treated. Side effects often get better or go away over time after treatment ends. The side effects of radiation therapy include:

  • Skin in the treated area that is irritated, dry, red, and blistered like a sunburn, including inside your vagina

  • Hair loss in the area being treated

  • Feeling tired or weak

  • Nausea or diarrhea

Side effects depend on the part of your body that's being treated. Talk to your doctor about what side effects you can expect and what can be done to prevent or ease them. Ask your doctor what symptoms to watch out for. In some cases, you should call your healthcare team. Your doctor may want you to call if you have signs of infection, such as fever or pain that gets worse.

Some long-term side effects of radiation may not show up for many years after you finish treatment. These depend on the dose and location of the radiation. These also depend on how many times you had the treatment. Ask your doctor what you may expect.