Radiotherapy for cervical cancer

Radiotherapy treats cancer by using high-energy x-rays. These destroy the cancer cells while doing as little harm as possible to normal cells.

You may have radiotherapy:

• if you have early or locally advanced cervical cancer
• after surgery, if there is a high risk of the cancer coming back
• if cancer comes back in the pelvis after surgery
• to help relieve symptoms such as bleeding.

Radiotherapy for cervical cancer may be given:

• externally, from a machine outside the body
• internally, from radioactive material that is temporarily put into the part of the body being treated – doctors call this brachytherapy.

You may have both external and internal radiotherapy. The doctor who plans your treatment will discuss this with you.

Radiotherapy for cervical cancer is often given with chemotherapy. This is called chemoradiation. The chemotherapy drugs make the cancer cells more sensitive to radiotherapy. The combination of treatments can be more effective than having radiotherapy on its own.

The chemotherapy drug most commonly used is cisplatin. It is usually given once a week throughout your radiotherapy.

The side effects of chemoradiation are similar to radiotherapy side effects. But they can be more severe. Your doctor, radiographer or specialist nurse can give you more information about chemoradiation and the possible side effects of treatment.

Radiotherapy for cervical cancer affects the ovaries. If you are still having periods, radiotherapy will cause an early menopause. You may have a period during the course of radiotherapy, but your periods will stop after treatment finishes. Your healthcare team will discuss this with you before your treatment starts. They can also give you information about treatments to manage menopausal symptoms.

It is possible to have an operation to move the ovaries. The ovaries are lifted out of the radiation field and attached to the abdomen (tummy) wall. Doctors call this ovarian transposition. You have it before radiotherapy starts. The aim is to prevent an early menopause.

Having ovarian transposition depends on the stage of the cancer and the risk that it has spread to the ovaries. Your cancer doctor can talk to you about this.

Ovarian transposition is usually done using laparoscopic (keyhole) surgery. Sometimes the ovaries are moved at the same time as a hysterectomy for cervical cancer. The surgeon may do this if they think you might need radiotherapy after surgery. Ovarian transposition does not always work, and cervical cancer treatment can still cause early menopause.

Radiotherapy for cervical cancer also affects the womb. After treatment with radiotherapy, the womb is not able to carry a baby. If you would like to get pregnant in the future, your cancer doctor can refer you to a fertility specialist. They can see you before you begin treatment to talk through your fertility options.

Internal radiotherapy is called brachytherapy. It gives radiation directly to the cervix and the area close by. It is usually given after external radiotherapy.

You have one or more hollow tubes, called applicators, put into your womb or vagina. The radiotherapy is given through these tubes. How you have your treatment depends on whether you have had your womb removed.

If you have not had a hysterectomy, you will have intrauterine brachytherapy (radiotherapy given into the womb). You have a general anaesthetic or a spinal anaesthetic first. Your doctor will explain this to you.

Your doctor inserts applicators into your vagina. They pass them up through the cervix into the womb. They may also place applicators alongside the cervix.

The doctor may place padding inside the vagina. This is to help protect your back passage (rectum) and prevent the applicators moving. You also have a catheter put into your bladder to drain urine.

The applicators can be uncomfortable, so you may need to take painkillers while they are in.

If you have had a hysterectomy, a doctor may place one or two applicators into the vagina. This is called vaginal brachytherapy.

Vaginal brachytherapy is a simpler treatment than brachytherapy given into the womb. You do not need any preparation for the treatment. It is unlikely to cause any immediate side effects.

You may develop side effects during your treatment. We have more information about possible pelvic radiotherapy side effects. These usually improve over a few weeks or months after treatment finishes. Your doctor, nurse or radiographer will discuss this with you, so you know what to expect. Tell them about any side affects you have during or after treatment. There are often things that can help.

Smoking makes the side effects of radiotherapy worse. If you smoke, stopping smoking will help. If you want help or advice on how to give up, talk to your clinical oncologist, GP or a specialist nurse. The NHS has information and support to help you give up smoking. 

We have more information about late effects of pelvic radiotherapy.

Macmillan is here to support you. If you would like to talk, you can do the following:

• Call the Macmillan Support Line for free on 0808 808 00 00.
• Chat to our specialists online.
• Visit our radiotherapy and side effects forum to talk with people who have been affected by radiotherapy, share your experience, and ask an expert your questions.