Gynecologic Cancers: Questions & Answers

What does a typical course of radiation for treatment of gynecologic cancer consist of?

A typical course of radiation for endometrial or cervical cancer consists of external pelvic radiation and internal radiation. External radiation is usually 5 weeks of daily treatments. It takes approximately 1/2 hour for each daily treatment. There can be 3-5 additional internal treatments. The internal treatments are delivered with a brachytherapy implant. They are given 1-2 times per week. The exact prescription of external and internal radiation is customized for each patient.

What side effects should I expect?

Side effects of radiation treatment vary from patient to patient. You may have no side effects or only a few mild ones during your treatment. Or you may have more serious side effects. The side effects that you experience depend mostly on the treatment dose and the part of the body treated.

There are two main types of side effects: acute and chronic. Acute, or short-term, side effects occur during the treatment and are usually gone completely within a few weeks of finishing treatment. Chronic, or long-term, side effects may take months or years to develop and may be permanent.

For pelvic radiation, side effects may include diarrhea, frequent urination, decreased blood counts, skin irritation and fatigue. Chronic side effects may include diarrhea (especially related to certain foods), frequent or uncomfortable urination, and vaginal narrowing.

What should I do if I develop diarrhea and cramping?

Diarrhea and cramping can occur as a result of radiation therapy. Radiation can cause changes to the lining of the intestine, causing an increased movement of stool through the intestine. This prevents proper absorption of fat, carbohydrates and proteins, which then causes cramping, gas, diarrhea and mucousy stool. These side effects usually do not develop until approximately the second or third week of treatments, and may or may not be a problem, depending on factors such as the dose of radiation being given, the number of treatments, and individual sensitivity.

If you currently take a laxative or stool softener, stop the use of this as soon as you notice that the stool is softer or there is an increased frequency of bowel movements. A change in the type of foods that you eat, including lowering the roughage in your diet, will help minimize bowel irritation. Roughage (also called fiber) is the material in foods that is undigested and passed in bowel movements. When your intestines are irritated, normal levels of roughage may be too much. Bulking agents may be used to absorb excess fluid in the intestine. These medications will slow the passage of stool in the intestine, decrease the frequency of bowel movements, and relieve spasms. If you have diarrhea or frequent bowel movements, the anal area may become irritated. Sitz baths will help relieve discomfort. Keep the area clean and pat dry; do not rub.

If you develop problem diarrhea, it may be helpful to have frequent small feedings (1-2 ounces) of clear liquids, such as mild carbonated beverages including 7-UP®, ginger ale, non-acid juices including apple and cranberry juice, Hawaiian Punch, Kool-Aid®, Gatorade®, artificially flavored fruit drinks and punches, plain gelatin and Popsicles®.

Avoid coffee, milk and milk products, colas, chocolate, orange and grapefruit juice, prune and grape juice.

Progress slowly to solid food. Plain starchy foods are usually well tolerated, such as crackers, dry toast, plain boiled white rice, plain boiled white potatoes, cooked cereals such as cream of rice, cream of wheat, and oatmeal.

Gradually add protein foods such as cheese, chicken and turkey (baked or roasted). Progress to bland fruits and vegetables including carrots, squash, beets, applesauce and bananas. If tolerating well, follow general guidelines for the Low Roughage Diet.

LOW ROUGHAGE DIET - GENERAL RECOMMENDATIONS

  • Eat smaller amounts at frequent intervals, rather than 2 or 3 larger meals.
  • Avoid eating or drinking very hot or ice-cold beverages or foods, since they stimulate bowel activity
  • Drink an adequate amount of liquids, but include them between meals, rather than with meals, to help prevent fullness.
  • Avoid spicy, greasy and fried foods
  • Include potassium-rich foods in your daily diet. Potassium is an important mineral in the body, and is lost when diarrhea occurs. Good potassium sources include: canned apricots and apricot nectar, bananas, oranges and grapefruit and their juices (if tolerated). Other good sources include cooked asparagus, carrots, mushrooms, winter squash, white and sweet potatoes, spinach, pumpkin and Swiss chard.
  • If you have cramps, stay away from foods that encourage gas or cramps, such as carbonated drinks, beer, beans, cabbage, broccoli, cauliflower, onions and highly spiced foods.
  • Use less roughage in your diet by eating only cooked vegetables, and omitting foods with seeds, tough skins, or whole grain.
FOOD LIST
RECOMMENDED
Foods that May Cause Distress
High protein
Baked or broiled beef, pork, chicken, liver, turkey
Dried peas and beans such as lentils, kidney beans, white beans, nuts, seeds, peanut butter, and very spicy, fatty meats.
Breads, cereals, rice, and pasta
Bread and rolls made from refined, white flour; pasta; converted or instant rice. Refined cereals such as farina, cream of wheat, cream of rice, oatmeal, cornflakes. Pancakes, waffles, cornbread, muffins, graham crackers.
Whole-grain breads and cereals such as whole wheat and rye bread, bran, shredded wheat, granola, wild rice.
Fruits and vegetables
Soups made with allowed cooked vegetables: asparagus tips, beets, carrots, peeled zucchini, mushrooms, celery, tomato paste, tomato puree, tomato sauce, green beans, acorn squash, baked potato without skin. Canned, frozen or fresh fruit.
Fresh, unpeeled fruit, pears, melon. All other vegetables.
Beverages, desserts, and miscellaneous
Butter, margarine, mayonnaise, salad dressing, vegetable oil, cake, cookies, flavored gelatin desserts, sherbet, fruit pie made with allowed fruit, decaffeinated beverages.
Desserts with nuts, coconut, dried fruit, chocolate, licorice, pickles, popcorn; foods with a lot of pepper, chili seasoning, taco seasoning, hot sauces.

 What can I do for urinary problems?

Radiation therapy may cause irritation to the lining of the bladder causing pain with urination, urgency, hesitancy, and/or an increase in frequency both during the day and at night. Drink three liters of fluid a day. Avoid caffeine found in coffee, tea and pop and alcohol. Limit the amount of fluid you drink in the evening to prevent having to urinate frequently during the night. Your doctor may prescribe medications to help with these symptoms. Report cloudy, foul smelling urine, backache, fever, chills, or blood in the urine, which could indicate infection.

Will I continue to have my period during pelvic radiation?

Depending on the radiation dose, women having radiation therapy in the pelvic area may stop menstruating and may have other symptoms of menopause. Treatment also can result in vaginal itching, burning, and dryness. You should report these symptoms to your doctor or nurse, who can suggest treatment.

Can I continue to have intercourse during pelvic radiation?

As long as you are not bleeding heavily from a tumor in your bladder, rectum, uterus, cervix, or vagina, you can usually have intercourse while you’re being treated with pelvic radiation therapy. The outer genitals and vagina are just as sensitive as usual. (Unless intercourse or touching is painful, you should still be able to reach orgasm.)

Some shrinking of vaginal tissues occurs during radiation therapy. After your therapy is finished, your doctor will advise you about sexual intercourse and how to use a dilator, a device that gently stretches the tissues of the vagina.

Can I become pregnant while receiving radiation?

Scientists are still studying how radiation treatment affects fertility. If you are a woman in your childbearing years, you should discuss birth control measures with your doctor. It is not a good idea to become pregnant during radiation therapy.

Radiation may injure the fetus. In addition, pregnancy, childbirth, and caring for a very young child can add to the physical and emotional stress of having cancer. If you are pregnant before beginning radiation therapy, special steps should be taken to protect the fetus from radiation.