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About cervical cancer radiotherapy

Radiotherapy uses high energy waves to treat cancer. For cervical cancer, most women have chemotherapy alongside their radiotherapy treatment.

How you have treatment

You can have radiotherapy for cervical cancer externally or internally. External treatment means the beams are directed at your body from a machine. Internal radiotherapy means a radioactive source is put into your vagina and up into the womb. This gives an extra boost of treatment to the cancer itself, and the area close by. Usually you have both these treatments for early cervical cancer.

External radiotherapy

You have external radiotherapy in the hospital radiotherapy department, usually once a day, 5 days a week. Your first visit is to plan your treatment. Marks are made on your skin to help the radiographer line the machine up for your treatment each day. External radiotherapy for early cervical cancer usually lasts for 5 weeks. It takes just a few minutes, and does not hurt. It does not make you radioactive.

Internal radiotherapy (brachytherapy)

When you have internal radiotherapy you have radioactive sources placed into your vagina. You may have it as an outpatient as a short treatment every week for up to 5 weeks. Or you may have it as an inpatient treatment, which takes between 12 hours to 4 days. You usually have internal radiotherapy within 1 week of finishing external radiotherapy.

 

CR PDF Icon You can view and print the quick guides for all the pages in the treating cervical cancer section.

 

 

Having radiotherapy for cervical cancer

Radiotherapy uses high energy waves to treat cancer. You can have radiotherapy for cervical cancer externally or internally. 

External radiotherapy treatment means the beams are directed at your body from a machine called a linear accelerator (LINAC). This type of treatment is given in the hospital radiotherapy department. You usually have this once a day from Monday to Friday with a rest over the weekend. External radiotherapy treatment for early cervical cancer usually lasts for 5 weeks. Before your planning scan and daily treatment you may be asked to drink a few cups of water. This is so you have a full bladder which is roughly the same size everyday.

Internal radiotherapy means a radioactive source is put into your vagina and up into the womb. This stays in for either hours or days to give an extra boost of treatment to the cancer itself and the area close by. Usually you have both this and radiotherapy, for early cervical cancer. Sometimes doctors use radiotherapy after surgery.

Before starting radiotherapy you have a blood test to check for anaemia. Anaemia is common if you have been bleeding from the vagina. You may need to have a blood transfusion before you start your treatment.

 

Radiotherapy and chemotherapy together

For the past few years, combined radiotherapy and chemotherapy (chemoradiotherapy) is the recommended treatment for most women with a cervical cancer that is larger than 4cm, or has spread beyond the cervix. Research has shown that this combination of treatment is more likely to cure a cervical cancer than radiotherapy alone. 

For chemoradiotherapy, you have external radiotherapy as normal, but you have chemotherapy at the same time. Most often, this means an injection of a chemotherapy drug called cisplatin once a week throughout your course of radiotherapy.

 

Planning external radiotherapy

Before you begin your treatment, the radiotherapy team carefully plan your external beam radiotherapy. This means working out how much radiation you need to treat the cancer and exactly where you need it. 

Your planning appointment may take from 15 minutes up to a couple of hours. You have a planning CT scan. The scan shows the cancer and the structures around it.

Before your planning scan and daily treatment you may be asked to drink a few cups of water. This is so you have a full bladder which is roughly the same size and in same position everyday. The radiographers will explain the procedure in more detail during your planning appointment.

CT scanner

You lie on the scanner couch with the treatment area exposed. The radiographers put some markers on your skin. You need to lie very still. Once you are in position the radiographers move the couch up and through the scanner. The scanner is a doughnut shape. 

The radiographers leave the room and the scan starts. It takes up to 5 minutes. You won't feel anything. The radiographers watch from the next door room.

Before the planning appointment you may also have other scans, such as MRI scans or PET scans. Your treatment team can feed the other scans into the planning scanner.

Ink marks

Once the treatment team has planned your radiotherapy, they may put ink marks on your skin to make sure they treat exactly the same area every day. They may also make pin point sized tattoo marks in these areas.

After your planning session

You may have to wait a few days or up to 2 weeks before you start treatment. During this time the physicists and your radiotherapy doctor decide the final details of your plan. 

Your doctor plans the areas that need treatment and outlines areas to limit the dose to, or avoid completely. They call this contouring. Then the physicists and staff called dosimetrists plan the treatment very precisely using advanced computers.

 

Having external radiotherapy

Radiotherapy machines are very big. The machine may be fixed in one position or able to rotate around your body to give treatment from different directions. Before your first treatment your radiographers explain what you see and hear. The treatment rooms usually have docks for you to plug in music players. So you can listen to your own music.

You can't feel radiotherapy when you actually have the treatment. It takes anything between 20 to 40 minutes. It is important to lie in the same position each time, so the radiographers may take a little while to get you ready.

A photo of a linear accelerator, which gives radiotherapy

Once you are in the right position the staff leave you alone in the room for the treatment. They watch you carefully on a closed circuit television screen.

Our page about having external radiotherapy has a video about having radiotherapy that you may want to watch.

External radiotherapy doesn't make you radioactive. It is perfectly safe to be with other people, including children, throughout your course of treatment.

 

High dose rate treatment

HDR brachytherapy is a temporary treatment. It involves placing applicators in the vagina as close to the cervix as possible. Applicators are taken out once the treatment is over. You are only radioactive when the treatment machine is switched on. So you are safe to be around everyone including children.

The treatment is given by a special brachytherapy machine which is kept in a purpose built room. The machine contains a small radioactive pellet which leaves the machine and enters the applicator. Once inside it releases radiation. You won’t feel anything. This can last between 10 to 45 minutes depending on the treatment.

You can have this treatment in a number of different ways depending on what the doctor prescribes.

Outpatient treatment

Before treatment

The doctor gives you a physical examination to check what size applicator can be used for the treatment. The applicator is a tube which comes in different sizes. This tube is then inserted in your vagina and held in place with a clamp. The doctor uses a jelly to help insert the applicator in so it’s as comfortable as possible. 

You have a CT scan which takes a short time. The radiographers wait outside while this happens. The radiographers remove the applicator after the scan and you are free to go home.

During treatment

You come back for treatment within a week. You stay in the same position as you were for the CT scan. The same tube is inserted and connected to the brachytherapy machine. The radiographers leave the room and observe you from outside from a CCTV screen during treatment.

After treatment

The radiographers remove the tube once treatment is completed. You are then free to go home. You usually have between 2 to 4 treatments. The treatment is the same every time.

Inpatient treatment

Before treatment

This treatment is usually given after radiotherapy. You go into hospital before your treatment. You are taken to theatre and have an anaesthetic. The anaesthetic may be an injection into your spine (epidural) so you are numb below the waist, or a general anaesthetic, which puts you to sleep.

The doctor puts the applicators into and the vagina and cervix. The applicators are made up of tubes and/or needles. Gauze is placed inside the vagina to hold the applicators in place. A tube (catheter) is placed in your bladder.

Once the applicators are in place, you are unable to get out of bed and need to remain lying flat. The nurses on the ward make sure you are comfortable. If you experience pain or discomfort during your treatment, pain relief is readily available. When you wake up you have a CT and/or MRI scan to check the position of the applicators. You remain on the ward while the treatment team produce a treatment plan.

Diagram showing the position of the applicators for internal radiotherapy for cervical cancer

During treatment

Once the plan is ready you come down from the ward to the brachytherapy room. The radiographers connect the applicators to the machine. During the treatment, they leave the room and watch you from outside on a CCTV screen.

Afterwards the radiographers disconnect the applicators from the machine and take you back to the ward. This happens for either 3 or 4 days, depending on what the doctor has prescribed. You may have 2 treatments in a day.

It can be difficult staying flat throughout the treatment, however the nurses make sure you are as comfortable as possible. You are free to have visitors during ward visiting hours as you are not radioactive.

After treatment

After the last treatment, a member of the brachytherapy team removes the applicators and catheter. This is done without anaesthetic but is quick. You have pain medicine beforehand and gas and air is available. You may be able to go home either that same day or the following day.

 

Low dose rate treatment

LDR brachytherapy is a treatment given constantly over a long period of time. Throughout the treatment the radiation dose is low. Patients have applicators inserted into the vagina and cervix. You stay in an purpose built, single room overnight in the hospital. You are radioactive during this time and are unable to have any visitors.

Once the applicators are removed, you can move around and have visitors. You may be able to go home either that same day or the following day.

Before treatment

You are admitted overnight at the hospital for this treatment. You may stay on the ward the night before the procedure. When you have the treatment, you will be taken to theatre and have an anaesthetic. The anaesthetic may be an injection into your spine (epidural) so you feel nothing below the waist. Or you may have a general anaesthetic, which puts you to sleep.

The doctor places the applicators inside the vagina and cervix. This is held in place by gauze pack in the vagina. The doctor also puts a catheter (tube) into the bladder.

During treatment

When you wake up, you are returned to a purpose built, single room on the ward. Your treatment can last between 1 to 3 days. You need to remain lying flat in bed. If you move around there is a small possibility that the applicators may move. The nurses make sure you are as comfortable as possible.

You have a call bell to hand so you can ring the nurses if you need anything. Your room has a camera so that the nurses can observe you on a CCTV screen outside.

After treatment

The applicators and gauze pack are removed once the treatment is complete. You may be able to go home either that same day or the following day.

 

Finding out more about radiotherapy

Find out about

External radiotherapy

Internal radiotherapy

Radiotherapy planning

Radiotherapy skin markings

Chemotherapy and radiotherapy

Cisplatin

For general information and support

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Updated: 20 August 2014