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Macmillan and Cancerbackup merged in 2008. Together we provide free, high quality information for people affected by cancer through our publications, website and phone service. Find out more| .
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Radiotherapy| treats cancer by using high-energy rays which destroy the cancer cells, while doing as little harm as possible to normal cells. Radiotherapy for cancer of the cervix can be given externally or internally, and often as a combination of the two.
Radiotherapy may be given for larger tumours contained in the cervix and it’s usually given if the cancer has spread beyond the cervix and is not curable with surgery alone. Radiotherapy may also be used after surgery if there is a high risk that the cancer may come back. It is often given in combination with chemotherapy| (chemoradiation).
Treatment with radiotherapy may last for 5–8 weeks. Your cancer specialist (clinical oncologist), who plans your treatment, can discuss this treatment in detail with you.
Planning is a very important part of radiotherapy, and makes sure that it is as effective as possible. It may take a few visits. On your first visit to the radiotherapy department, you will be asked to have a CT scan or lie under a machine called a simulator, which takes x-rays of the area to be treated. The treatment is planned by a clinical oncologist. Marks will be made on your skin to show the radiographer (the person who gives you your treatment) where the rays are to be directed.
External radiotherapy is normally given as an outpatient, as a series of short daily treatments in the hospital radiotherapy department. High-energy x-rays are directed from a machine at the area of the cancer. The treatments are usually given from Monday to Friday, with a rest at the weekend.
The number of treatments will depend on the type and size of the cancer, but the whole course of treatment for early cancer will usually last a few weeks. Your doctor or radiographer will discuss the treatment and possible side effects with you.
Before each session of radiotherapy, the radiographer will position you carefully on the couch and make sure that you are comfortable. During your treatment you will be left alone in the room, but you will be able to talk to the radiographer who will be able to see you from the next room.
Positioning the radiotherapy machine
Radiotherapy is not painful but you do have to lie still for a few minutes during treatment. The treatment will not make you radioactive and it’s perfectly safe for you to be with other people, including children, afterwards.
Internal radiotherapy (also called brachytherapy) gives radiation directly to the cervix and the area close by. It’s often given following external beam radiotherapy.
To give internal radiotherapy, applicators (specially designed tubes) which give the radiation are placed into your vagina, close to the cervix. If the cervix has been removed during surgery, the tubes are placed at the vaginal vault which is at the top of the vagina.
Internal radiotherapy may be given as low dose rate treatment or high dose rate treatment. Both low dose rate and high dose rate treatment give the same total dose of radiotherapy but over different time periods.
Low dose rate treatment is given as an inpatient over a few days using a machine which feeds small radioactive balls of caesium into the applicator tubes. One type of machine which gives this treatment is known as Selectron.
The applicators are put into your vagina or womb during a short anaesthetic and gauze packing is used to stop them moving about. This can be uncomfortable so painkillers are often given.
The applicators are usually left in place for one or two days. The radioactive balls (sources) can be withdrawn into the machine when people come into the room. This is to keep the dose of radioactivity to visitors and nurses as low as possible.
Visitors are usually restricted and children are not encouraged to visit while you’re having your treatment. You will be asked to stay in bed to make sure that the applicators stay in the right position during the treatment.
For the same reason, you will have a urinary catheter in place. This is a small tube (catheter) which is passed into your bladder and which drains your urine into a collecting bag.
The safety measures and visiting restrictions might make you feel isolated, worried and depressed at a time when you might want people around you. If you have these feelings, it’s important to tell someone so that you can get some support. It might also help to take in plenty of reading material, an MP3 player and things to keep you occupied while you’re in isolation. You only need to be in isolation while the applicators are in place. Once they are removed the radioactivity disappears and it’s perfectly safe to be with other people.
The applicators will be removed by one of the doctors or nurses and this may be a bit uncomfortable (you will have painkillers beforehand). Sometimes sedation or gas and air (entonox) may be given to make it easier for you.
With high dose rate treatment a machine (microSelectron)containing a radioactive source of iridium or cobalt is used to give a higher dose of radioactivity over a few minutes.
Before the treatment you will have an anaesthetic so that the doctors can place the applicators through your vagina and into your womb or vaginal vault. Once the tubes have been inserted they are connected to the machine that passes the radioactive sources into the tubes. When the treatment is finished the tubes are removed.
Treatments may need to be repeated several times, a few days apart, and may be given as an inpatient or outpatient. This treatment does not need a tube (catheter) in the bladder to drain the urine, but a catheter may be needed when x-ray pictures are taken during the planning of the treatment.
This is a new method of giving brachytherapy which is only available in some specialist centres. In this treatment the applicators stay in place for the same length of time as low dose rate treatment, but the radiation dose is given in pulses rather than as a continuous low dose.
It’s usual to have slight vaginal bleeding or discharge once the radiotherapy treatment has ended. If it continues for more than a couple of weeks or becomes heavy it’s important to let your doctor or nurse know.
Radiotherapy to the pelvic area can cause side effects such as tiredness, diarrhoea and a burning sensation when passing urine. These side effects can be mild or more troublesome depending on the strength of the radiotherapy dose and the length of your treatment. Your specialist will be able to advise you what to expect.
Most of these side effects can be treated with medicines. Your cancer specialist will be able to help you. Any side effects should gradually disappear once your treatment is over.
We have information about the early and late effects of pelvic radiotherapy in women| , and ways of dealing with them.
Diarrhoea is a possible side effect following radiotherapy to the pelvic area. It’s important to drink plenty of fluids if you experience this so that you don’t become dehydrated. If your diarrhoea is not controlled with medicines, let your doctor or nurse know.
You may feel sick during treatment, but this is not common.
If you don’t feel like eating, you can have nutritious high-calorie drinks instead of meals. The drinks are available from most chemists and can be prescribed by your GP. Our eating well section| has some helpful tips on eating when you feel ill.
Your skin may get sore in the area being treated. Perfumed soaps, creams or deodorants may irritate the skin and should not be used during the treatment. Your radiographer or nurse can talk to you about taking care of your skin during this time.
Unfortunately, radiotherapy for cancer of the cervix affects the ovaries. This will bring on the menopause (if you’ve not already been through it), usually about three months after the treatment starts. This means that your periods will stop and you will have menopausal side effects such as hot flushes, dry skin and possibly loss of concentration. Some women become less interested in sex and notice that their vagina is dry.
Sometimes radiotherapy causes a narrowing of the vagina, which can make sex uncomfortable. It can be very hard to cope with the prospect of an early menopause, but help is available to support you through this. For example, the menopausal side effects can be reduced by taking HRT (hormone replacement treatment) as tablets or skin patches.
These can be prescribed by your gynaecologist during the radiotherapy treatment or shortly after it has ended. There is also psychological support from professionals and support groups. Coping with the effect on your fertility can be particularly difficult, especially if you have not yet started (or completed) your family. See our information about how to deal with effects on your sex life and fertility| .
Some women may have an operation before radiotherapy to reposition their ovaries lower in the abdomen out of the radiotherapy site. This is known as ovarian transposition and is usually carried out at the same time as initial surgery (if it’s thought radiotherapy will be needed afterwards). It prevents an early menopause as the ovaries are not affected by the radiotherapy treatment. It’s also possible to perform ovarian transposition through keyhole (laparoscopic) surgery.
Radiotherapy can make you very tired. It’s important to get as much rest as you can, especially if you have to travel a long way for treatment each day. See our information about coping with tiredness| .
Radiotherapy to the pelvic area can sometimes lead to long-term side effects (sometimes called late effects) but these are not common. Ways of dealing with the long-term effects of radiotherapy are discussed in our information about pelvic radiotherapy in women| – possible late effects.
In a small number of women, the bowel or bladder may be permanently affected by the radiotherapy. If this happens the increased bowel motions and diarrhoea may continue, or you may need to pass urine more often than before. The blood vessels in the bowel and bladder can become more fragile after radiotherapy treatment and this can cause blood in the urine or bowel movements.
These effects can take many months or years to occur. If you notice any bleeding it’s important to let your doctor know so that tests can be done and appropriate treatment given.
Radiotherapy can make the tissue in the vagina lose some of its elasticity (stretchiness), which may make it narrower and shorter. This can make sexual intercourse difficult and painful. Using vaginal dilators can help to keep the vagina open, but they don’t keep the vagina supple. Hormone creams can also help.
Radiotherapy can cause small fragile blood vessels to develop in the vagina, which can lead to slight vaginal bleeding (particularly after sex). Let your doctor or nurse know if this happens so they can check that everything is okay. Often you will need to meet regularly with the clinical nurse specialist who can give you practical advice and support.
Some people find that the radiotherapy affects the lymph nodes in the pelvic area and cause swelling of the legs.
This is known as lymphoedema| and is more likely if you have had surgery as well as radiotherapy.
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