Question

Describe late toxicities of radiotherapy for cervical cancer and their management.

Hint:

Managing late toxicities requires a multidisciplinary approach to improve quality of life and minimize long-term effects of radiotherapy in cervical cancer patients.

Answer 1

Radiotherapy for cervical cancer can lead to a variety of late toxicities, which may manifest months to years after treatment. These toxicities can affect both the irradiated area and distant organs.
Step 1: Late Toxicities of Radiotherapy:
1. Gastrointestinal Toxicity: Radiotherapy can cause chronic bowel symptoms, including diarrhea, bowel obstruction, or radiation proctitis, which results in rectal bleeding and pain.
2. Genitourinary Toxicity: Radiotherapy may lead to bladder dysfunction, including urinary frequency, urgency, and incontinence. In severe cases, it can result in radiation cystitis.
3. Sexual Dysfunction: Female sexual dysfunction, including vaginal stenosis, dyspareunia (painful intercourse), and loss of libido, can occur due to radiation affecting the pelvic tissues.
4. Lymphedema: Pelvic radiation can damage the lymphatic system, leading to lymphedema in the lower extremities.
5. Second Malignancies: Long-term radiation exposure may increase the risk of secondary cancers, particularly in the irradiated fields.
Step 2: Management of Late Toxicities:
1. Bowel and Rectal Toxicity: Management includes medications like anti-diarrheals, stool softeners, and rectal treatments such as suppositories or topical steroids.
2. Bladder Dysfunction: Patients may be treated with anticholinergic drugs, bladder training, and surgical interventions if required.
3. Sexual Dysfunction: Vaginal dilators, lubricants, and pelvic floor therapy can help improve sexual function and reduce vaginal stenosis.
4. Lymphedema: Compression garments and physiotherapy are often recommended to manage and reduce the impact of lymphedema.
5. Second Malignancies: Regular screening for secondary cancers is essential for early detection and treatment.