Radiation oncologists have long understood the potential benefit of radiation therapy (RT) in palliating the distressing symptoms of advanced abdominal and pelvic cancers. Often, the role of external beam radiation therapy (EBRT) or brachytherapy in controlling bleeding or obstructive symptoms finds only a passing reference and most palliative medicine texts are silent on this important topic. Palliative RT achieves hemostasis in patients with unresectable gastric carcinoma not fit for systemic chemotherapy and is associated with a statistically significant rise in their hemoglobin levels. RT has been used for symptom relief in gynecological malignancies for many years. For abdominal malignancies, bony landmarks are less reliable for treatment planning, as compared to pelvic malignancies. This chapter discusses some case scenarios which illustrate the role of palliative radiation therapy in the treatment of bladder cancer, vaginal bleeding, rectal cancer, vulvar cancer, and liver metastasis.