Episode 424: Radiation Site-Specific Side Effects: Cancers of the Pelvis

“Think about what organs lie in the radiation field, and anything that lies in that radiation field is likely going to have some potential temporary—hopefully temporary—side effects. If you think about the pelvis, the things that live in there are the bladder, urethra, some bowel, rectum, reproductive organs, skin, some lymph nodes. And so, all of those things could potentially have associated side effects,” ONS member Kayla Kafka-Peterson, BSN, RN, ROCN™, nurse navigator and leader in the brachytherapy and peri-anesthesia programs at UCLA Health, in Los Angeles, CA, told Lenise Taylor, MN, RN, AOCNS^®, TCTCN™, oncology clinical specialist at ONS, during a conversation about radiation side effects in cancers of the pelvis.

Music Credit: “Fireflies and Stardust” by Kevin MacLeod

Licensed under Creative Commons by Attribution 3.0 

Earn 0.75 contact hours of nursing continuing professional development (NCPD) by listening to the full recording and completing an evaluation at courses.ons.org by July 17, 2027. The planners and faculty for this episode have no relevant financial relationships with ineligible companies to disclose. ONS is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center’s Commission on Accreditation.

Learning outcome: Learners will report an increase in knowledge related to radiation to the pelvis.

Episode Notes 

• Complete this evaluation for free NCPD. 
• ONS Podcast™ episodes:
• Radiation Site-Specific Side Effects series
• Episode 301: Radiation Oncology: Side Effect and Care Coordination Best Practices
• Episode 298: Radiation Oncology: Nursing’s Essential Roles
• ONS Voice articles:
• Highly Localized, Precision Radiation Therapies Require Nurses to Drive Care Coordination, Patient Education
• The Intersection of Pelvic Health and Oncology Optimizes Sexual Symptom Management
• ONS book: Manual for Radiation Oncology Nursing Practice and Education (fifth edition)
• ONS courses:
• Nurse Navigation and Care During Brachytherapy for Cervical Cancer: 2025 ONS Bridge™ Session
• ONS ROCN™ Certification Review™
• ONS/ONCC^® Radiation Therapy Certificate™
• Clinical Journal of Oncology Nursing articles:
• Updated Interventions for Radiation-Induced Diarrhea: Putting Evidence Into Practice With the Oncology Nursing Society
• Genitourinary Distress: Common Side Effect
• Sexual Dysfunction: Common Side Effect
• Brachytherapy: Increased Use in Patients With Intermediate- and High-Risk Prostate Cancers
• Oncology Nursing Forum article: Effect of Foot Reflexology and Aromatherapy on Anxiety and Pain During Brachytherapy for Cervical Cancer
• ONS Guidelines™ and Symptom Management Resources:
• Radiodermatitis
• Radiation-Induced Diarrhea
• Brachytherapy Huddle Card
• American Brachytherapy Society
• American Society for Radiation Oncology (ASTRO)
• European Society for Radiotherapy and Oncology (ESTRO)
• GEC-ESTRO Committee
• International Gynecologic Cancer Society
• Nursing Certificate Program

To discuss the information in this episode with other oncology nurses, visit the ONS Communities.

To find resources for creating an ONS Podcast club in your chapter or nursing community, visit the ONS Podcast Library.

To provide feedback or otherwise reach ONS about the podcast, email [e-mail].

Highlights From This Episode

“Brachytherapy is delivered two main ways. The most common is LDR and HDR. LDR stands for low-dose-rate radiation, which is the older type of brachytherapy, but it is still very much practiced today. And it is where we put radioactive seeds directly into the tumor or tumor resection bed, depending on what you’re treating. And those pieces of radioactive material, such as iodine-125 or palladium-103, those will give off radiation over time and treat the area that they are in, and they will place more or less seeds into the tumor, depending on that patient’s needs and their anatomy.” TS 3:26

“The most common [side effect] for external beam is bladder irritation—cystitis. It can be some burning, some frequency, some urgency, and it can often mimic a UTI [urinary tract infection]. We also have to make sure our patients do not have a UTI. Most of the time they don’t, but we don’t want to miss that. Once a UTI has been ruled out, the mucosa in the bladder and the urethra, it has a very high cell turnover rate. And things with a high cellular turnover rate like mucosal linings, they respond to radiation very quickly. They also heal very quickly, but they start to break down quite quickly during radiation.” TS 16:15

“For the bladder, some things that we can teach the patients … to keep their urinary system as comfortable as possible during treatment. We really encourage hydration because the more hydrated they are, the more diluted their urine will be and the less acidic it will be. As those tissues start to respond to the radiation, they will become, for lack of a better word, a little bit raw. And if you think of something acidic going on something that is raw, it’s going to burn, and these patients do get burning. And so by promoting hydration, their urine becomes less acidic; it doesn’t burn as much when they do urinate. And I find a lot of patients who are experiencing the urinary side effects, they don’t want to drink because they’re afraid to urinate. And it actually makes the burning worse because their urine gets ultra-concentrated.” TS 22:29

“Anybody who has a vagina, who receives treatment to the pelvis—it doesn’t matter if it’s for vaginal cancer or if it’s for bowel or rectal—if they have received radiation to the pelvis, they are at risk for vaginal stenosis and adhesions. And this, of course, can be more pronounced in patients who have a higher dose in the vagina or a larger surface volume of the vagina treated. But over time, that tissue, even long after radiation is done, will undergo late changes where they will have continued scar formation, and it starts to lose its elasticity and its functionality. And at times it can stick to itself, causing these adhesions.” TS 28:15

“I think a common misconception is that you cannot safely work around radiation. That is something that I have heard a lot. In certain regions of the world, the nurses actually report that they have been having trouble getting good applicants because nobody wants to work in radiation because they think that you’ll get radiated, that it’s not safe. We’ve really tried to make radiation safety a big part of our teaching to show that actually, you can safely work around radiation with today’s technology.” TS 41:43