Internal radiotherapy means giving radiotherapy from inside your body. It is also called brachytherapy.
A small radioactive source goes into your vagina through hollow tubes (applicators). This gives a high dose of radiation to the top of the vagina, but only a little to surrounding tissues. This means there are fewer side effects to other organs in the pelvis.
Doctors often give both brachytherapy and external radiotherapy for womb cancer. Some women with very early cancers may have brachytherapy on its own after surgery.
There are 2 types of brachytherapy - high dose rate brachytherapy (fast treatment) or low dose brachytherapy (slow treatment). These days most women have high dose rate brachytherapy.
High dose rate (HDR) treatment
You lie down on a bed in the brachytherapy treatment room. Your radiographer or doctor examines you to check what size applicator they can use for the treatment. The applicator is a plastic tube which comes in different sizes.
They cover the top of the applicator with anaesthetic gel and gently put it into your vagina. This is not painful but can be a little uncomfortable. The applicator is held in place with a clamp that attaches to the bed.
You have a CT scan of your pelvis with the applicator in place. This helps your doctor to plan treatment. It can take about half an hour.
After the scan you may go back to the brachytherapy room to have treatment. Or your radiographer removes the applicator and you are free to go home. In this case, you go back to the hospital for treatment within a week.
Your radiographer connects the applicator to the brachytherapy machine. They then leave the room and switch on the machine. They can still see you on a CCTV screen and can talk to you through an intercom.
The machine contains a small radioactive pellet, which leaves the machine and enters the applicator. The treatment itself is painless and takes about 5 to 10 minutes.
The machine automatically removes the radioactive source from the applicator when treatment is finished.
Your radiographer removes the applicator. You can then go home. You are not radioactive after treatment, so it is safe for you to be with other people including children.
You usually have between 2 to 4 treatments. This depends on if you’ve already had external radiotherapy.
The treatment is the same every time. You do not normally need a vaginal examination or CT scan at your other treatment sessions.
Low dose rate (LDR) treatment
Low dose rate treatment means you have treatment continuously over a few days, rather than in short bursts of several minutes each.
Throughout the treatment the radiation dose is low. You are radioactive during this time and so you stay in a room on your own or with another woman having the same treatment. The treatment can stop temporarily to allow your nurse or doctor to check on you. Visitors may be able to see you for a short time, but pregnant women or children can’t visit.
Once you’ve finished treatment you are not radioactive, so you can be with other people including children.
You may go into hospital the evening before or morning of your treatment.
First you go to the operating theatre where your doctor puts the applicators into your vagina. This is done under general anaesthetic, so you are asleep. Or you have an injection into your spine (epidural) so you don’t feel anything below your waist.
Your doctor may pack the applicators with gauze to stop them moving about. Or they may use a couple of stitches to keep them in position.
Your doctor also puts a tube (catheter) in your bladder. This means you won’t have to get out of bed to pass urine.
When you are back in your room, your nurse or radiographer connects the brachytherapy machine to the applicators. They leave your room to turn on the machine. The radioactive source leaves the machine and goes into the applicators. Your treatment lasts between 1 to 3 days.
You need to remain lying in bed. If you move around too much there is a possibility that the applicators may move. Your nurse will make sure you are as comfortable as possible.
You have a call bell to hand so you can ring for a nurse if you need anything. Your room has a camera so that they can watch you on a CCTV screen outside.
Your nurse removes the applicators. Some women may find this uncomfortable. So you may have painkillers beforehand. You might have gas and air (Entonox) which also helps to relax you.
You can go home either that day or the following day, depending on how you feel.
Radiotherapy can cause different side effects including:
- bladder problems such as a burning feeling when you pass urine or passing urine more often
- a sore vagina, and vaginal discharge or bleeding
In the longer term, your vagina may become shorter, narrower and less stretchy. To try to prevent this, your nurse will give you vaginal dilators to use regularly after your radiotherapy treatment.