Having your radiotherapy for vaginal cancer
This page is about having radiotherapy for vaginal cancer.
- A quick guide to what's on this page
- External radiotherapy to treat vaginal cancer
- Internal radiotherapy to treat vaginal cancer
- Radioactive sources put inside the vagina
Having radiotherapy for vaginal cancer
Many women have a course of external radiotherapy first and then internal radiotherapy treatment after that.
You go to the hospital for treatment once a day, from Monday to Friday, with a break at weekends. The length of your course of treatment will depend on the type and size of your cancer and on the aim of the treatment. The treatment only takes a few minutes each time. It doesn't hurt. You will not be able to feel it at all. Having external radiotherapy does not make you radioactive.
There are two ways that internal radiotherapy (brachytherapy) may be given for vaginal cancer. It can be from radioactive sources placed inside the vagina (intracavitary radiotherapy). Or from radioactive implants put into the cancer and surrounding tissues (interstitial radiotherapy).
Intracavitary radiotherapy is more commonly used in the UK. You can have this treatment as one long inpatient treatment, over 2 to 5 days. Or in 2 or more short treatments, either as an outpatient or with overnight stays in hospital.
You can view and print the quick guides for all the pages in the treating vaginal cancer section.
You have external radiotherapy treatment in the hospital radiotherapy department as an outpatient. You go to the hospital for treatment once a day, from Monday to Friday, with a break at the weekends. The length of your course of treatment varies, depending on the type and size of your cancer and on the aim of the treatment. Many women have a course of external radiotherapy first and then internal radiotherapy treatment after that.
The daily external treatment only takes a few minutes. The radiographer will help you onto the X-ray couch and make sure you are comfortable. You will be alone in the room for the minute or two the machine is switched on. The staff will be able to hear and see you through an intercom, so you can call if you need them. The treatment doesn't hurt. You will not be able to feel it at all. But the staff will ask you to lie very still for the few minutes it takes to treat you. Here is an example of a treatment room.
Having external radiotherapy doesn't make you radioactive. It is perfectly safe to be with other people, including children, throughout your treatment course.
The treatment can be very tiring, particularly towards the end of your course. This can be partly because you are having to travel back and forth to the hospital each day. But it is also because tiredness is a side effect of radiotherapy treatment. There is information about the side effects of vaginal radiotherapy in this section.
There are two ways that internal radiotherapy (brachytherapy) may be given for vaginal cancer. Many women have a course of external radiotherapy first and then internal radiotherapy treatment after that. Internal radiotherapy can be from
- Radioactive sources put inside the vagina (intracavity radiotherapy)
- Radioactive implants put into the cancer (interstitial radiotherapy)
You can read about these below.
If you have internal radiotherapy there are certain safety precautions that you and your visitors need to take. There is information about radioactive implants and particularly about the safety precautions in the radiotherapy section.
Putting radioactive sources into the vagina is the most commonly used type of internal radiotherapy for vaginal cancer. This type of treatment is called intracavity radiotherapy (or intracavitary radiotherapy). A surgeon puts a radioactive metal object called a source inside the vagina. The source gives a high dose of radiation to the area of the vagina, the cervix and the lower part of the womb. You usually have internal radiotherapy within a few weeks of finishing external radiotherapy. It gives an extra boost of radiation to the immediate area containing the cancer. You can have this treatment in one of two main ways, which you can read about below
- Low dose rate treatment (as one long inpatient treatment, over 2 to 5 days)
- High dose rate treatment (in 2 or more short treatments, either as an out patient or with overnight stays in hospital)
Your specialist decides on the total radiation dose you need and this will be the same, whichever treatment method you have.
Internal radiotherapy for cancer of the vagina sometimes uses a radioactive metal called caesium as the radiation source. It is then called caesium treatment. You normally have this as an inpatient over a few days. Other radioactive metals that release radiation more quickly may be used. With these, you usually have treatment in 2 to 5 sessions of a few minutes each.
The source is usually put in place by a machine. There are different types of machines and these include Selectron, Curitron or Microselectron.
Low dose rate treatment means you have treatment continuously over a few days, rather than in short bursts of a few minutes each.
You need to go into hospital for a few days. During a short general anaesthetic in the operating theatre, your doctor puts plastic tubes (called applicators) into your vagina. These applicators will hold the radioactive sources in the right place later.
You also have a tube coming out of your bladder (a catheter), so you won't have to get out of bed to pass urine. When you get back to the ward, you have a room on your own (or sometimes with one other woman having similar treatment). Your nurse or doctor will connect up the Selectron or Curitron machine to the applicators in your vagina. The machine contains small radioactive metal balls (the sources)
When the machine is switched on, the radioactive sources go into the applicators to give radiotherapy to the vaginal area. The machine automatically pulls the sources back into itself again when it is switched off – for example, if someone comes into your room. This means that other people can come in for a short time (including your visitors) and not be exposed to any radiation.
Your doctor may have packed the applicators into your vagina with gauze to stop them moving about. Or there may be a couple of small stitches holding the applicators in place. This can be uncomfortable, or sometimes painful. So you will have regular painkillers to help keep you comfortable. If you are uncomfortable or in pain, tell your nurse. You may need a different painkiller.
You will not be able to get out of bed in case you dislodge the applicators. You should have a call bell to hand so that you can ring the nurses if you need anything. If you think the applicators have moved tell your nurse or doctor straight away.
The treatment takes anything from 1 to 5 days. The length of time depends on the dose your specialist has planned for you. If you have had external radiotherapy beforehand, then you will have shorter treatment.
Your nurse or doctor will take out the applicators on the ward. You have painkillers beforehand. You may be given gas and air (Entonox) to breathe as your nurse takes them out. The gas and air helps to relax you. Once the radioactive sources are out, all the radiation has gone. You can go home that day, or the next, depending on how you feel.
With this faster type of treatment, the machine contains a radiation source that gives off radiation quite quickly (iridium or cobalt). So it doesn't take as long to reach the dose you need to have. Because the radiation is given more quickly, you have between 2 and 5 short treatments, up to a week apart. These individual treatments are called fractions.
You can have this treatment as an inpatient or outpatient. This depends on your doctor's advice and on how well you feel. You go into hospital the night before or on the morning of your treatment. You should not eat or drink that morning, because you will need to have an anaesthetic. When it is time for your treatment, you go down to the operating theatre and have an anaesthetic. The anaesthetic may be an injection into your spine (epidural) that makes you numb below the waist. Or it may be a general anaesthetic, which puts you to sleep.
Once you have your anaesthetic, the doctor puts the applicators in place inside your vagina. Your doctor or nurse connects the applicators to the machine and you have treatment for about 10 to 15 minutes. Then they take out the applicators and you can go back to your ward to recover. If you have had a general anaesthetic, this may all happen while you are still asleep.
In some treatment units, if your cancer is in the upper third part of your vagina, you have a small plastic cuff left in place in the opening of your cervix after your first treatment. The cuff is a narrow plastic tube that the doctor uses to guide one of the applicators through your cervix and into your womb. If your hospital gives the treatment in this way, you may not have an anaesthetic the second time around because it will be much easier to get the applicator into the right place. Once all your treatment is over, the doctor gently pulls the plastic cuff out. This is quick but can be a bit painful. So you may want to ask for gas and air or other pain relief while it is done.
You may be able to go home the same day, once you are over the anaesthetic. Or your doctor may advise you to stay in hospital overnight. If you do go home, someone will have to take you and stay with you. If you live on your own, your doctor will almost certainly want you to stay in hospital overnight. You may have some bleeding from the vagina after this treatment. But that should clear up within 48 hours.
Specialists in the UK rarely use this type of treatment for vaginal cancer. But we have included it here because your doctor may suggest it in certain circumstances. It is called interstitial radiotherapy, which means radiotherapy in the tissues. You have thin radioactive tubes or wires put directly into the tumour. They stay in place for anything from a few minutes to a few days, depending on how much radiotherapy you need. While the tubes or wires are in place you need to follow certain safety precautions so that other people are not exposed to any radiation.
Your doctor or specialist nurse may ask you to use a vaginal douche from the start of your radiotherapy. This is to keep your vagina clean and reduce the chance of infection. But some hospitals do not recommend douching. You can ask your doctor, nurse or radiographer about the best way to keep the vaginal area clean during your treatment.
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