The reactions caused by cervical cancer radiotherapy are divided into short-term reactions and long-term reactions, with rectal and bladder reactions being the most obvious. Radiotherapy reactions are unavoidable in radiotherapy, but radiation damage should be avoided.
1. Recent reaction refers to the reaction that occurred during or within 3 months of radiotherapy.
(1) Systemic reactions: headache, dizziness, fatigue, loss of appetite, nausea, and individual patients have vomiting. White blood cells and platelets decreased slightly. The systemic reaction is severe in patients with chemotherapy. The degree of reaction is related to factors such as age and general condition. Generally symptomatic treatment, radiotherapy can be continued.
(2) Rectal reaction: It mostly occurs 2 weeks after the start of radiotherapy, and almost all patients will have different degrees of reaction. Mainly manifested as tenesmus, diarrhea, mucous stools, stool pain, blood in the stool, and hemorrhoids have more serious reactions. Patients can be instructed to use high-protein, multi-vitamin, and digestible foods. Treat symptomatically with antidiarrheal drugs such as loperamide, hexadecagonal montmorillonite, and live bifidus triad. In severe cases, suspend radiotherapy and resume irradiation when symptoms improve.
(3) Bladder reaction: It usually occurs 3 weeks after the start of radiotherapy, manifested as frequent urination, urgency, painful urination, and some may have hematuria. Improved after anti-inflammatory and hemostatic treatment. In severe cases, radiotherapy should be suspended.
(4) Reactions related to internal irradiation: 1. Bleeding and pain during the operation, mostly not severe. If the bleeding is large, hemostatic drugs or gauze can be used to fill it. 2. The incidence of uterine perforation is low. In order to further reduce its incidence and the resulting incidence of intestinal fistula and enteritis, it is recommended to check and read the film before the operation, and be careful during the operation. Once the uterine cavity is too deep and "bottomless" ", stop the operation immediately. For suspected perforations, perform B-ultrasound and CT to confirm, remove the applicator or reduce the residence position, reduce the dose, and take the patient semi-recumbent to prevent infection.
(5) Vulvitis: Due to the irritation of vaginal discharge and the influence of radiation, different degrees of vulvar radiation reactions are more likely to occur. The local area should be kept clean and dry to protect the wound and promote healing.
(6) Vaginitis: Radiation, especially intracavity irradiation, can cause physical inflammation of the vagina, manifested as vaginal mucosal edema, congestion, pain and increased discharge. Vaginal washing should be strengthened, and antibiotics should be applied locally.
2. Long-term complications. Patients with diabetes, hypertension or a history of pelvic surgery may increase the possibility of long-term complications.
(1) Radiation cystitis: It mostly occurs about 1 year after radiotherapy, and the main manifestations are frequent urination, urgency, and painful urination. Severe cases have vesicovaginal fistula. For mild to moderate radiation cystitis, conservative treatment is given priority to, anti-inflammatory, hemostasis, keeping the bladder empty, and bladder lavage with normal saline + antibiotics + hemostatic drugs. In severe cases, surgery.
(2) Radiation enterocolitis: The small intestine fixation in the abdomen and pelvis can aggravate the radiation damage of the small intestine for any reason, which manifests as loose stools, increased stool frequency, mucus stools, abdominal pain, etc., which can be treated symptomatically. In severe cases, the small intestine has perforation or obstruction and requires surgical treatment.
(3) Pelvic fibrosis: After high-dose total pelvic irradiation, pelvic fibrosis may be caused. In severe cases, ureteral obstruction and lymphatic obstruction may occur, leading to hydronephrosis, renal dysfunction, and lower extremity edema. It can be treated with traditional Chinese medicine that promotes blood circulation and removes blood stasis. Patients with ureteral stenosis and obstruction require early surgical treatment.
(4) Vaginal stenosis: It is recommended to wash the vagina for half a year after radiotherapy, once every 2-3 days, and wear a vaginal mold if necessary. It is recommended to start sexual life 3 months after radiotherapy.
(5) Radiation proctitis and sigmoid colitis: It often occurs half a year to a year after radiotherapy. The main symptoms are diarrhea, mucus in the stool, tenesmus, blood in the stool, and sometimes constipation. A small number of rectal stenosis may occur, and severe cases may lead to rectal-vaginal fistula. The treatment is mainly anti-inflammatory, hemostatic and symptomatic treatment, plus vitamin C, vitamin E, vitamin A, and enema mixture retention enema (opium tincture, belladonna tincture, prednisone, Bletilla striata glue, adrenaline). It can also be treated with traditional Chinese medicine, mainly to clear away heat and detoxify, relieve inflammation and relieve pain, converge and stop bleeding, and replenish qi. If rectal stenosis, obstruction, fistula, or perforation occurs, surgical treatment is considered.