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Long Term Side Effects Of Radiation Treatment For Cervical Cancer

Managing The Side Effects Of Radiation Therapy

What Are the Long-Term Effects of Radiation?

The most common side effects of radiation therapy are:

  • An increased need to urinate
  • Irregular menstruation or early menopause
  • An increased likelihood of bruising and infection

As is the case with chemotherapy, many of the side effects of radiation therapy can be managed through medications. Patients may also be instructed to wear loose, nonrestrictive clothing and use medicated lotions to help alleviate skin irritation. Vaginal pain usually goes away a few weeks after treatment is complete, but patients can use lubricants and temporarily avoid intercourse until the discomfort subsides.

Treatment Areas And Possible Side Effects

Part of the body being treated Possible side effects

Healthy cells that are damaged during radiation treatment usually recover within a few months after treatment is over. But sometimes people may have side effects that do not improve. Other side effects may show up months or years after radiation therapy is over. These are called late effects. Whether you might have late effects, and what they might be, depends on the part of your body that was treated, other cancer treatments you’ve had, genetics, and other factors, such as smoking.Ask your doctor or nurse which late effects you should watch for. See the section on Late Effects to learn more.

  • Reviewed:January 11, 2022

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What Time Of Day Is Best For Radiation Therapy

New research from Roswell Park Comprehensive Cancer Center, to be presented at the American Association for Cancer Research Annual Meeting 2019 in Atlanta, reports that administering radiation treatments in the morning as opposed to later in the day can significantly reduce severity of mucositis and its related

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What To Expect During Brachytherapy

  • Low-dose rate brachytherapy. This is done over a few days. You stay in bed in the hospital during this time with the radioactive material in place near the cervix.

  • High-dose rate brachytherapy. This is done with several treatments as an outpatient. That means you dont stay overnight in the hospital. The radioactive material is put in place for just a short time. Its then taken out before you go home.

External Beam Radiation Therapy

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With this type of treatment, radiation is delivered from outside the body in a procedure that’s a lot like getting an x-ray. It ‘s sometimes used along with chemotherapy to treat more advanced cancers. It can shrink tumors so they can be easier to remove with surgery. Radiation alone might be used to treat lymph nodes in the groin and pelvis.

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Heart Or Lung Problems

Some women experience lung inflammation years after radiation therapy. This is especially true if they have also had chemotherapy. If there is significant heart exposure because of left breast radiation, in some cases injury to the heart can occur, causing heart conditions or heart disease. This is not as common these days, thanks to greater understanding of this potential link.

Causes And Risk Factors

Radiation therapy works by damaging DNA in cells. This damage isn’t isolated to cancer cells, though normal cells can be damaged as well. While radiation therapy has improved significantly such that less damage occurs to healthy cells than in the past, some healthy tissues are inevitably exposed.

Several variables can increase or decrease your risk of developing long-term side effects of radiotherapy. Some of these are:

  • Your age at the time of radiation
  • The dose of radiation you receive
  • The number of treatment sessions
  • The type of cancer treated
  • The area of the body that receives radiation
  • Other cancer treatments, such as chemotherapy
  • Other health conditions, such as heart disease or diabetes

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Long Term Side Effects Of Radiotherapy

Depending on the area of the body you have treated, you might have any of these long term side effects after radiotherapy:

  • your skin might look darker than it was before in the treated area as if it is suntanned
  • your skin in the treatment area will always be slightly more sensitive to the sun
  • your skin might feel different to touch
  • your hair might grow back a different colour or texture in the treatment area
  • you might have permanent hair loss within the treated area
  • you might develop red spidery marks on your skin caused by small broken blood vessels
  • drainage channels to the arms or legs can become partly blocked resulting in swelling called lymphoedema
  • you might be unable to become pregnant or father a child if your ovaries or testicles were in the radiotherapy field

Physical Emotional And Social Effects Of Cancer

What Are the Side Effects of Radiation Treatment?

Cancer and its treatment cause physical symptoms and side effects, as well as emotional, social, and financial effects. Managing all of these effects is called palliative care or supportive care. It is an important part of your care that is included along with treatments intended to slow, stop, or eliminate the cancer.

Palliative care focuses on improving how you feel during treatment by managing symptoms and supporting patients and their families with other, non-medical needs. Any person, regardless of age or type and stage of cancer, may receive this type of care. And it often works best when it is started right after a cancer diagnosis. People who receive palliative care along with treatment for the cancer often have less severe symptoms, better quality of life, and report that they are more satisfied with treatment.

Palliative treatments vary widely and often include medication, nutritional changes, relaxation techniques, emotional and spiritual support, and other therapies. You may also receive palliative treatments similar to those meant to get rid of the cancer, such as chemotherapy, surgery, or radiation therapy.

Learn more about the importance of tracking side effects in another part of this guide. Learn more about palliative care in a separate section of this website.

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Problems Moving Your Arm And Shoulder

Radiotherapy might make it harder to move your arm and shoulder. This can affect your activities and work. It usually improves when the treatment finishes. Your nurse or physiotherapist can give you exercises to help.

Its important to continue the arm exercise you were shown after your surgery. This will make it easier for you to lift your arm to the correct position during radiotherapy. It can also help stop your arm and shoulder from becoming stiff.

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Questions To Ask The Health Care Team

Learn as much as you can about the potential long-term effects of your cancer treatment from your health care team. You may want to schedule a special appointment to review your treatment summary. This document should include information about your cancer, treatment, and follow-up care. The American Society of Clinical Oncology offers cancer treatment summary forms to store this information.

Consider asking your health care team these questions:

  • Can you write down which treatment I received?

  • Am I at risk for specific late effects?

  • Is there anything I can do to help prevent long-term side effects?

  • What other specialists should I see to watch for potential late effects?

  • What signs or symptoms of late effects should I watch for?

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Prevention And Mitigation Of Radiation Enteropathy

Strategies or interventions for protecting normal tissues from radiation injury may be divided into two conceptual categories . The first approach is to directly protect against or mitigate the oxygen free radical injury that occurs during and after radiotherapy. Examples of mitigators of this type include antioxidants, free radical scavengers, and various cytoprotectors . The second approach is to target downstream tissue responses from radiation exposure. Examples include immune-modulators , enterotrophic drugs , compounds that regulate intraluminal contents , drugs that inhibit key signal transduction pathways , and alteration of fibroblast metabolic radiotherapy response . It is not possible to discuss all agents under development in this review. We summarize studies that provide quantitative data on extent of protection for preclinical and clinical studies .

Two important issues should be addressed when considering potential mitigators of radiotherapy damage. These two issues are relevant to all drugs: scheduling of mitigators with radiotherapy and verifying that mitigators do not protect tumor against radiotherapy damage. Examples of these considerations are shown below.

What Are The Side Effects Of Radiation For Cervical Cancer

Esophagus Cancer Radiation Side Effects

Long term side effects

  • Skin changes. Generally, radiotherapy can make body tissues become tighter and less elastic.
  • Changes to the ovaries. If you have not already had the menopause, your radiotherapy will cause an early menopause.

What are the long term effects of radiation for cervical cancer?

Long-term or late effects

Radiation can scar the lymph nodes and vessels and stop them draining lymph fluid properly. This may lead to swelling of the legs or genital area. This can occur months or years after radiation therapy.

How many radiation sessions are needed for cervical cancer?

You will probably have 34 sessions over 24 weeks. You will be given a general or spinal anaesthetic at each brachytherapy session. Applicators are used to deliver the radiation source to the cancer.

How long does it take to recover from pelvic radiation?

Your skin will gradually heal, but it may take 3 or 4 weeks after your treatment is finished. Below are guidelines to help you care for your skin during treatment. Follow these guidelines until your skin gets better.

What are the long term side effects of pelvic radiation?

Long term effects on the pelvis

Radiotherapy to the pelvic area might cause: changes to your bowel habit. bladder inflammation causing pain in your tummy and feeling like you need to pass urine more often fine cracks in the pelvic bones.

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Pain And Skin Changes

During and just after treatment, your treated breast may be sore. Talk with your health care provider about using mild pain relievers such as ibuprofen, naproxen or acetaminophen to ease breast tenderness.

The treated breast may also be rough to the touch, red , swollen and itchy. Sometimes the skin may peel, as if sunburned. Your health care provider may suggest special creams to ease this discomfort.

Sometimes the skin peels further and the area becomes tender and sensitive. Its most common in the skin folds and the underside of the breast. If this occurs, let your radiation team know. They can give you creams and pads to make the area more comfortable until it heals.

Fatigue is common during radiation therapy and may last for several weeks after treatment ends.

Fatigue is mainly a short-term problem, but for some, it can persist .

You may feel like you dont have any energy and may feel tired all of the time. Resting may not help.

Regular exercise, even just walking for 20 minutes every day, may help reduce fatigue . Getting a good nights sleep is also important.

Talk with your health care provider if you are fatigued or have insomnia .

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If You Have Side Effects

Let your doctor or nurse know if you have side effects or are worried about anything.

When treatment ends you usually have regular appointments for about 5 years afterwards. You can talk to your doctor or nurse at these appointments. But you dont have to wait for your next appointment if you get a new side effect or are worried about anything. You can bring the appointment forward.

  • National Institute for Health and Care Excellence June 2018

  • Treatment of primary breast cancerScottish Intercollegiate Guidelines Network, September 2013

  • Postoperative radiotherapy for Breast Cancer: UK consensus statement

    The Royal College of Radiologists, 2016

  • Early Breast Cancer: ESMO Clinical Practice Guidelines 2019F Cardoso and others

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Causes Of Cervical Cancer

In almost all cases, cervical cancer is the result of a change in cell DNA caused by the human papilloma virus .

Cancer begins with a change in the structure of the DNA that’s present in all human cells. DNA provides the cells with a basic set of instructions, including when to grow and reproduce.

A change in the DNA’s structure is known as a mutation. It can alter the instructions that control cell growth, which means the cells continue growing instead of stopping when they should. If the cells reproduce uncontrollably, they produce a lump of tissue called a tumour.

Working With Your Healthcare Provider

#LetsTalk: pelvic radiation disease after cervical cancer

Talk with your healthcare providers about what problems to look for and when to call them. Make sure you know what number to call with questions. Is there a different number for evenings and weekends?It may be helpful to keep a diary of your side effects. Write down physical, thinking, and emotional changes. A written list will make it easier for you to remember your questions when you go to your appointments. It will also make it easier for you to work with your healthcare team to make a plan to manage any side effects you might have.

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How Should We Move Forward

As a result of our report were calling for increased awareness about the far-reaching, long-term consequences of cervical cancer to ensure women are receiving the treatment that they both need and deserve.

NHS England and NHS Improvement must introduce a national tariff for the management of long-term consequences of cancer. This would drive investment in interventions and treatments to ensure that there are services available for women. It would also promote research, improvements and adequate training in this relatively unexplored field.

A recovery package should be available for each patient to support professionals in delivering patient-centred care, helping to identify and address changing needs early. Furthermore, a treatment summary with details of all treatment received, potential symptoms and key contacts encourages seamless transition from secondary to primary care, ensuring a joined-up approach to long-term care.

The swift implementation of the new quality of life metric to rarer cancers would also provide a clear imperative for healthcare providers to support people to live well after treatment and highlight areas where improvements in cancer care are needed.

Targeted Therapy For Cervical Cancer

Targeted therapy is designed to identify and counteract unique qualities of specific cancer cells. Targeted therapy drugs work by attaching themselves to proteins or receptors on cancer cells, either killing the cells or helping other therapies, such as chemotherapy, work better. Among the drugs used in targeted therapy are so-called angiogenesis inhibitors, designed to prevent cancer cells from developing blood vessels that feed tumors.

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Newer Ways Of Giving Radiotherapy

Radiotherapy is more accurate than it has ever been. Current radiotherapy techniques, such as conformal radiotherapy and intensity modulated radiotherapy , accurately shape the radiotherapy beams to fit the cancer. This means less healthy tissue receives radiation, and so there are fewer side effects.

Research continues to look into ways to make radiotherapy even more precise.

  • Devita, Hellman and Rosenberg’s Cancer Principles and Practice of Oncology VT Devita, TS Lawrence and SA RosenbergWolters Kluwer Health, 2019

  • Radiation Dermatitis Guidelines for Radiotherapy Healthcare Professionals , April 2020

    The Society and College of Radiographers

Chemotherapy For Cervical Cancer

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Chemotherapy treats cancer with drugs that kill cancerous cells or prevent cancerous cells from spreading. Its recommended for a significant percentage of cervical cancer patients. For women treated primarily with radiation therapy, chemotherapy may be added to the treatment regimen to help improve responses.

Chemotherapy regimens may consist of a single drug or a combination of drugs at set times over weeks or months. The cancer care team carefully calculates the types of drugs, dosages and times administered to the patient to maximize their effect on the cancer while limiting their harm to healthy cells.

Like radiation therapy, chemotherapy harms healthy cells in its quest to kill cancer, which causes side effects. Most go away after treatment.

Common side effects include:

During chemotherapy, the care team will provide supportive care services to help ease side effects. For example, our naturopathic clinicians may suggest supplements to reduce nausea.

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What Is Brachytherapy Or Internal Radiation Therapy

Brachytherapy is one of the two types of radiation therapy thats used to treat cervical cancer. Its typically used along with external beam radiation therapy. Its rarely used by itself.

Once the implant is in place, radioactive material is carefully placed inside of it. This radiation source acts to either kill cancer cells or prevent them from growing and dividing.

Brachytherapy takes advantage of something called the inverse square law, in which the dose of radiation rapidly declines as the distance from its source increases. Due to this, brachytherapy can provide a high dose of radiation to a nearby tumor while sparing other tissues or organs from damage.

Potential Early Side Effects From Brachytherapy

Risks of the procedure include:

  • Risks from having an anaesthetic
  • Chance of developing an infection
  • DVT as a result of lying in the same position for some hours
  • Perforation where the applicator is not in position in the centre of the uterus but goes out through the wall. Risk of this is small as the procedure is done under ultrasound guidance. If this happens the patient is usually not treated on the day, may be kept in hospital overnight and given antibiotics.
  • Discomfort from having applicators in place. Resolves when applicators are removed.

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