You may have internal radiotherapy (brachytherapy) or external radiotherapy to treat 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 for cervical cancer:
- if you have early or locally advanced cervical cancer
- after surgery if there is a high risk of the cancer coming back
- to help relieve symptoms such as bleeding.
Radiotherapy may be given:
- externally, from a machine outside the body
- internally, from radioactive material that is put into the treatment area – 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. Doctors call this chemoradiation. The chemotherapy drugs make the cancer cells more sensitive to radiotherapy. The combination of treatments can be more effective than having radiotherapy alone.
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 bring on an early menopause. You may have a period during the course of radiotherapy but no more after this. Your healthcare team will discuss this with you before your treatment starts. They can also give you information about treatments to manage menopausal symptoms.
Some women have an operation to move their ovaries higher up out of the radiotherapy site. Doctors call this ovarian transposition. You have it before radiotherapy starts. The aim is to prevent an early menopause. Whether it can be done will depend on the stage of the cancer and the risk of cancer having spread to the ovaries. Your cancer doctor can talk this over with you.
The ovaries can be moved using laparoscopic (keyhole) surgery. Sometimes they are moved during a hysterectomy for cervical cancer. The surgeon may do this if radiotherapy might be needed after surgery. Ovarian transposition is not always successful at protecting the ovaries. Some women will still have an early menopause.
As well as affecting the ovaries, radiotherapy for cervical cancer also affects the womb. Afterwards, the womb cannot carry a child. If you would like to have children in 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.
External radiotherapy uses a machine called a linear accelerator. It is like a large x-ray machine. A radiographer gives you the treatment in the radiotherapy department at the hospital. You have it as an outpatient once a day from Monday to Friday, with a rest at the weekend. Each session of treatment takes a few minutes. It usually takes about 5 to 5.5 weeks to have the full course of treatment.
External radiotherapy is painless. It will not make you radioactive and it is safe for you to be around other people. This includes children and pregnant women.
Planning your treatment
Your radiotherapy will be planned by your clinical oncologist with the support of a technical team. The planning is done to make sure that:
- the radiotherapy targets the cancer accurately
- it causes as little damage as possible to nearby tissue.
Cervical cancer is often treated with image-guided radiotherapy (IGRT). This means that, as well as a first planning visit, you will have further planning done at each treatment. This involves having images taken before each treatment to check the size and position of the tumour. Then adjustments can be made to allow for any changes.
First planning visit
Your first planning visit will take 30 to 60 minutes. The staff in the radiotherapy department will explain what to expect. It is important you feel involved in your treatment, so ask as many questions as you need to. The staff will tell you beforehand if you need to prepare in any way. For example, they may ask you to drink plenty of water or give you an enema to empty your bowel.
You will usually have a CT scan of the area to be treated. This helps your doctor and radiotherapy team plan the precise area for your radiotherapy. Before your scan, they may ask you to remove some of your clothes and to wear a gown.
You may have an injection of dye into a vein when you have the CT scan. This allows particular areas of the body to be seen more clearly. You may also be asked to have a full bladder for the scan and use an enema.
During your scan, you need to lie still on a hard couch. If you feel uncomfortable when the radiographers position you on the couch, let them know so they can make you more comfortable. This is important because, once you are comfortable, the details of your position will be recorded. You will need to lie in the same position on a similar couch for your treatments.
The information from the scan is fed into a planning computer. Your radiotherapy team will use this to work out the precise dose and area of your treatment. It can take up to two weeks to plan your treatment.
The radiographer may need to make some small marks on your skin. This is to help them position you accurately and to show where the rays will be directed. These marks must stay visible throughout your treatment. They are usually permanent marks, like tiny tattoos. These will only be done with your permission. It may be a little uncomfortable while they are done.
At the beginning of each session, your radiographer will explain to you what you will see and hear. They may ask you to have a full bladder for each treatment. They may also ask you to take off some of your clothes and wear a gown. This lets the radiographers see the tiny marks made on your skin so that they can position you correctly. If you are having IGRT, the radiographer will take images just before each treatment. These images are used to make sure the radiotherapy is targeted precisely at the treatment area.
Once you are comfortable and in the correct position, the radiographers will ask you to keep as still as possible. They will leave the room for a few minutes while you have your treatment. You can talk to your radiographer, who will watch you from the next room via closed-circuit TV (CCTV). The radiotherapy machine does not touch you and the treatment is painless. You may hear a slight buzzing noise from it while you are having your treatment.
Once your treatment session has finished, the radiographers will come back and help you off the treatment couch. You will then be able to go home or, if you are staying in hospital, back to the ward.
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.
Brachytherapy if you have not had a hysterectomy
If you have not had a hysterectomy, you will have intrauterine brachytherapy. 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 your cervix into your womb. They may also place applicators alongside the cervix.
The doctor may place padding inside your vagina. This is to help protect your back passage (rectum) and prevent the applicators moving. You will also have a catheter put into your bladder to drain off urine.
The applicators can be uncomfortable, so you may need to take painkillers while they are in.
You will have a scan or x-rays to check the position of the applicators. When it is confirmed that the applicators are in the right position, they are connected to the brachytherapy machine. The machine is operated by a radiographer. It places a radioactive capsule, called a source, into the applicators. The machine then gives the planned dose of radiation.
Internal radiotherapy can be given as high-dose-rate, low-dose-rate or pulsed-dose-rate treatment. Most centres in the UK use high-dose-rate equipment. These different ways of giving internal radiotherapy all work equally well. The type you have will depend on the system your hospital uses. Your cancer specialist and specialist nurse will explain more so that you know what to expect.
This is the most common way of giving brachytherapy to the cervix. You have each treatment over a few minutes. You will have several treatments. How high-dose-rate treatments are given varies from hospital to hospital. Usually, each treatment takes about 10 to 15 minutes.
If you stay in hospital, you will have your treatments over several days. The applicators may be removed between treatments. Or they may be left in place and removed after your final treatment.
If you have your treatment as an outpatient, you go to the hospital three or four times over several days or a week. A nurse will remove the applicators before you go home.
You may have a tube (catheter) put into your bladder to drain urine during high-dose-rate treatment. A nurse will take this out before you go home.
If you have this treatment, you will usually be in hospital for 12 to 24 hours. But sometimes it may be given over a few days. Your doctor, nurse or radiographer will tell you more about low-dose-rate treatment.
Pulsed-dose-rate brachytherapyThis treatment is given over the same length of time as low-dose-rate treatment. But the radiation dose is given in pulses rather than as a continuous dose. Your doctor, nurse or radiographer will give you more information.
You may develop side effects over the course of your treatment. We have more information about possible side effects of pelvic radiotherapy. 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 effects you have during or after treatment. There are often things that can help.
The side effects of radiotherapy are made worse by smoking. 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. Organisations such as QUIT can also offer advice and support.
Sometimes radiotherapy for cervical cancer can also cause side effects that either:
- start during or shortly after treatment and last for longer than 3 months – these are sometimes called long-term effects
- do not affect you during treatment but begin months or even years later, as a delayed response to treatment. These are called late effects.
We have more information about late effects of pelvic radiotherapy.
Below is a sample of the sources used in our cervical cancer information. If you would like more information about the sources we use, please contact us at firstname.lastname@example.org
Marth C, et al. on behalf of the ESMO Guidelines Committee. Cervical cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Annals of Oncology. 2017. 28(s4): iv72-iv83. Available at www.annalsofoncology.org/article/S0923-7534(19)42148-0/pdf
National Institute for Health and Care Excellence (NICE). Menopause. Quality standard (QS143). 2017. Available at www.nice.org.uk/guidance/qs143
Farthing AJ and Ghaem-Maghami S on behalf of the Rotal Collage of Obstetricians and Gynaecologists (RCOG). Fertility Sparing Treatments in Gynaecological Cancers. 2013. Available at www.rcog.org.uk/globalassets/documents/guidelines/scientific-impact-papers/sip_35.pdf
This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical and health professionals and people living with cancer. It has been approved by Senior Medical Editor, Professor Nick Reed, Consultant Clinical Oncologist.
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