Radiotherapy for cervical cancer

Radiotherapy for cancer of the cervix can be given: 

• externally (from outside the body, using equipment similar to a large x-ray machine), or
• internally (through special tubes placed into the vagina).

It’s often given as a combination of the two. Treatment with radiotherapy may last for 5–8 weeks. External radiotherapy| is usually given as a series of short daily treatments, with a break at the weekend. Internal radiotherapy| (also called brachytherapy ) may be given to you as an inpatient over a few days or in shorter sessions repeated a few days apart.

When is it given? Back to top

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 ).

Your cancer specialist (clinical oncologist), who plans your treatment, will be able to discuss this treatment in detail with you.

Radiotherapy to the pelvic area can cause short-term side effects such as vaginal bleeding, sore skin, diarrhoea and tiredness, but most of these side effects will improve once the treatment is finished. Unfortunately, radiotherapy for cervical cancer can cause long-term side effects such as an early menopause and a type of swelling of the legs called lymphoedema . Your specialist will be able to advise you on what to expect, and there are usually medications and treatments to help if you do experience side effects.

Planning your treatment Back to top

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 Back to top

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.

 

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 Back to top

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

Low dose rate treatment is given as an inpatient over a few days using a machine which feeds small balls of caesium (the radioactive source) 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.

High Dose Rate Treatment;

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 to you 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.

Pulsed Dose Rate Brachytherapy (PDR)

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 short doses of higher dose radiation are given in pulses rather than as a continuous low dose.