by Dr. C.H. Weaver M.D. updated 8/2020

Doctors who specialize in treating cancers with radiation are known as radiation oncologists. During radiation therapy, high-energy x-rays are used to kill cancer cells. Radiation therapy can be given by a machine that aims x-rays at the body (external beam radiation) or by placing small capsules of radioactive material directly into the cervix (internal or implant radiation or brachytherapy). Many patients receive both kinds of radiation therapy. For stage I cervical cancer, radiation therapy may be used instead of surgery or it may be used after surgery to destroy remaining cancer cells. For stages IB-IVA cervical cancer, radiation therapy is usually administered concurrently with chemotherapy.

Although patients do not feel anything while receiving radiation treatment, the effects of radiation gradually build up over time. Many patients become tired as treatment continues. Loose stools and diarrhea are also common. Urination may become more frequent or uncomfortable. Some patients may experience loss of pubic hair or irritation of the skin. After the radiation therapy is completed, the vagina can become narrower and less flexible. Finally, radiation therapy to the pelvis can stop the ovaries from functioning, thereby causing younger women to enter menopause early and subsequently be infertile.

With any treatment of cancer, you must first understand your responsibility, your medical team’s role, explore treatment options and get a second opinion(s) before you begin treatment. Since the side effects of radiation can be significant, talk to your doctor before treatment begins so that you understand the specific kind of radiation you will receive and the expected side effects. The following list of questions is meant as a guide to issues you should discuss with your radiation oncologist and medical team before undergoing radiation therapy for cervical cancer.

Questions to Ask When Exploring Your Options

  • What is the stage of my cancer?
  • Why do you recommend radiation?
  • What are my options besides radiation?
  • Is radiation the standard therapy for my stage of disease?
  • Are there clinical trials for my stage of disease?
  • Will I have chemotherapy concurrently with radiation?
  • Are there any protocols for neoadjuvant therapy for my stage of disease?
  • Are there any pre-radiation procedures I might benefit from to protect my fertility?

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Questions to Ask about Radiation

  • What is your experience with complications from radiation?
  • What should I expect as far as complications and side effects?
  • Considering my age and general health, am I at higher or lower risk for complications and side effects?
  • Will my radiation treatments be external, internal or both?
  • How many treatments will I have?
  • How will the treatments be administered?
  • If I have both external and internal radiation, what type of internal radiation is used and when?
  • During external radiation treatments, do you use shields to protect the small bowel and other organs?
  • Will the beam be directed at all four sides (front, back, and laterals) to help diminish side effects?
  • If, for modesty reasons, I am uncomfortable having male technicians, is it possible to have only female technicians attend me during my treatments?
  • Have my radiation treatments been approved by my insurance?

Questions to Ask about Side Effects

  • What are the expected side effects and how do I deal with them?
  • Are the treatments painful?
  • How will treatment affect my sexuality, both long and short term?
  • Do you recommend use of a vaginal dilator? If so, how and when should I use it?
  • Do you prescribe medications to help me with emotional issues?
  • Will I get advice on my diet and supplemental nutrition from a registered nutritionist?
  • Will I get advice on caring for the radiated area from an oncology nurse?

Questions to Ask about Recovery

  • How long will my recovery take when I have completed my radiation treatment?
  • Who can I call with questions or concerns?
  • If my radiation therapy induces menopause, would I benefit from estrogen replacement therapy?
  • Who will be my follow-up doctor?

Determining that radiation therapy is the right treatment for you, as well as asking your radiation oncologist about treatment procedures and side effects are critical to making informed decisions about your disease. Exploring emotional and physical side effects of radiation therapy will give you some insight into potential problems before they occur. Although managing and living with these side effects may still be difficult, at least you will be aware and informed if they occur. Before undergoing any treatment for you disease you should understand your responsibility, your medical team’s role, explore treatment options, ask questions and get a second opinion(s).

Information presented in The Daily Tip is offered as a guide to augment a patient’s research of cancer and treatment and does not replace the advice of a doctor.