Find out about the different types of internal radiotherapy for vaginal cancer and what happens during treatment.
What is internal radiotherapy
Radiotherapy uses high energy x-rays to kill cancer cells. Internal radiotherapy means giving radiotherapy to the cancer from inside. It is also called brachytherapy.
For vaginal cancer, a radioactive source or implant is placed inside the vagina.
Depending on the type of brachytherapy you have, you might have the treatment in the radiotherapy department as an outpatient or you might stay in hospital for up to 7 days.
The treatment gives a high dose of radiation to the cancer but very little to surrounding tissues.
You might have internal radiotherapy as a treatment on its own. Or you might have it alongside, or following, a course of external radiotherapy.
Types of internal radiotherapy
There are two main types of internal radiotherapy for vaginal cancer. These are:
For this type of internal radiotherapy, you have surgery to put thin tubes or radioactive seeds into the cancer. These are called implants. These can stay in place for a few days, depending on what your doctor decides.
Doctors use this type of therapy for small tumours (less than 2cm wide). In order to put the tubes or seeds in exactly the right place, the tumour must be easy to reach inside the vagina. So you are less likely to have this type of treatment for a tumour high up in the vagina.
Intracavity radiotherapy means putting a radioactive metal object called a source into the vagina. This is only put in place for the treatment and is taken out straight away when the treatment is finished. The doctor or radiographers will do this.
You may have this treatment following a course of external radiotherapy.
You visit the outpatient department for a few short treatments. You have two or more treatments over about 10 minutes each.
Having internal radiotherapy
Internal radiotherapy can be given in a number of different ways to patients with vaginal cancer. How you have the treatment depends on how your doctor decides to treat you.
You may be admitted to hospital the day before and stay on the ward the night before the procedure. When you have the treatment, you are taken to theatre and have an anaesthetic. The anaesthetic might be:
- an injection into your spine (epidural) so you feel nothing below the waist
- a general anaesthetic which puts you to sleep
The doctor places the implants inside the vagina. They are held in place with a vaginal gauze pack to stop them moving. The doctor also puts a tube into the bladder (urinary bladder) to collect your urine.
When you wake up you have a CT and, or an MRI scan, to check the position of the implants. Your doctor uses these scans to plan your brachytherapy treatment.
During your treatment, you are in a purpose built, single room on the ward. You need to remain in bed in while the applicators are in place and stay lying down. You have a call bell to hand so you can ring the nurses if you need anything. They can also see you if they need to via a CCTV screen.
You might have one of the following:
- radioactive implants
- implants that are only radioactive when attached to a machine
With radioactive implants, you are alone for most of the time in your room. You are not allowed visitors and staff come into your room for limited periods of time. You can contact the staff anytime with your call bell or telephone.
If you have implants that are only radioactive when attached to a machine, you can have visitors to your room when you are not having treatment. The radiographer will explain how often and how long you will be connected to the machine. This depends on your treatment plan.
You can have regular pain relief. So do let the staff know if you are in pain or discomfort. The treatment can last between 1 to 4 days, depending on what your doctor decides.
The applicators and gauze pack are removed once the treatment is complete. You might need some pain relief when this is done. You also have your urinary catheter taken out.
Once the implants are removed, all the radiation has gone. You might be able to go home that day or stay overnight, depending on how you feel.
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, 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. They then plan your treatment.
You come back for treatment within a week. You are 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 during treatment, but they can see you via a CCTV screen. The treatment takes about 15 minutes.
You can have pain relief if you need it.
The radiographers remove the tube once treatment is complete. You are then free to go home.
You are only radioactive when the treatment machine is switched on. So following each treatment, you are safe to be around everyone, including children.
You usually have between 2 to 4 treatments. The treatment is the same every time.
Travelling to radiotherapy appointments
Radiotherapy can make you tired, especially if you have a long journey. It might be worth asking a family member or friend to drive you to the hospital if you can.
Tell the radiotherapy staff if you are having treatment as an outpatient and you prefer treatment at a particular time of day. They might be able to arrange this for you.
Car parking can be difficult at hospitals. It’s worth asking the radiotherapy unit staff:
- if they can give you a hospital parking permit
- about discounted parking rates
- where you can get help with travel fares
- for tips on free places to park nearby
The radiotherapy staff can usually help to arrange transport for you if you need it. Some hospitals have their own drivers or can arrange ambulances. Some charities offer hospital transport.