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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.

You have external radiotherapy in the hospital radiotherapy department, usually once a day, 5 days a week. Your first visit will be 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 takes 1 to 5 days, depending on the type of treatment. You may stay in hospital or have it as an outpatient. You usually have internal radiotherapy within 1 or 2 weeks of finishing external radiotherapy.

 

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How you have radiotherapy treatment for cervical cancer

Radiotherapy uses high energy waves to treat cancer. You can have radiotherapy for cervical cancer externally or internally. External treatment means the beams are directed at your body from a machine that is similar to an X-ray machine. 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 these treatments for early cervical cancer. Sometimes doctors use radiotherapy after surgery.

Before starting radiotherapy you will 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.

There is information on the next page about short term side effects and possible long term side effects of radiotherapy treatment for cervical cancer.

 

Radiotherapy and chemotherapy together

For the past few years, combined radiotherapy and chemotherapy (chemoradiation) is the recommended treatment for most women with a cervical cancer that is anywhere between stage 1B2 and stage 4A. That is, anything from a cancer that is just on the cervix, but bigger than 4 cm, to a cancer that has spread to other body tissues outside the womb, such as the bladder or bowel. There has been a great deal of research to show that this combination of treatment is more likely to cure a cervical cancer than radiotherapy alone. For this treatment, you have 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. There is more about combination radiotherapy and chemotherapy in this section.

 

External radiotherapy

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. There is information below on

Planning your treatment

Radiotherapy is carefully planned. At your first visit you lie under a large machine that is a specialised CT scanner. The doctor uses this machine to work out where to give your treatment to kill the most cancer cells and miss as much healthy body tissue as possible. 

Picture of a simulator machine

Sometimes during planning you have a tampon put into your vagina and some liquid that shows up on X-ray put into your back passage. This helps the doctor see the exact position of the cervix and vagina.

A pinprick tattoo is made on your skin and this is used to line up the radiotherapy machine every day when you have your treatment. Sometimes more marks are made with felt pen. If so, you must be careful not to wash them off. If they fade after a while, your radiographer will redraw them. Don't do this yourself.

Having treatment

The actual treatment only takes a few minutes. The radiographer will help position you on the couch and make sure you are comfortable.

Picture showing patient and radiographers

You will be left alone for the minute or two the machine is switched on. But the staff will be able to see you on a screen and hear you through an intercom, so call if you need them. The treatment does not hurt. You will not be able to feel it at all. You must lie very still for the few minutes it takes to treat you.

Having external radiotherapy does not make you radioactive. It is perfectly safe to be with other people, including children, throughout your treatment course.

 

Internal radiotherapy

Internal radiotherapy (also called brachytherapy) means the radiation source (the substance that gives off the radiation) is put inside your body. For cervical cancer, the source is put into the vagina, through the cervix up into the womb. This way, a high dose of radiation can be given very locally to the cervix and the lower part of the womb. You usually have your internal radiotherapy within 1 or 2 weeks of finishing your external radiotherapy. You can have this treatment in different ways. The total radiation dose will be about the same, whichever type of treatment you have. You may have your treatment

  • As an outpatient or with overnight stays - high dose rate (HDR)
  • As an inpatient - low dose rate (LDR) or pulsed dose rate (PDR)

You may have an MRI or CT scan a few days before you start internal radiotherapy to help plan your treatment.

Treatment as an outpatient

Outpatient treatment is sometimes called high dose rate treatment (HDR). The doctors use a machine that can safely deliver the radioactive source to the right place and remove it when the treatment is over. 

The machine contains a radiation source that gives off radiation quite quickly (irridium or cobalt). So it does not take as long for you to get the dose you need as it does with pulsed dose rate (PDR) treatment. Because the radiation is delivered more quickly, you have to have several short treatments, up to a week apart. If you had the total dose in one go, you would have too many side effects. You are most likely to have between 2 and 5 separate treatments (these are called fractions). There is more about possible side effects of brachytherapy for cervical cancer on the next page in this section.

You can have this treatment as an outpatient or an inpatient. This will depend on your doctor's advice and how well you are feeling once the treatment is over. You will probably be asked to come into hospital on the morning of your treatment. But some units may ask you to come in the night before. You should not eat or drink that morning, as you will be having an anaesthetic. When you are due to have the treatment, you will go down to theatre and have your anaesthetic. The anaesthetic may be an injection into your spine (epidural) which will make you feel numb below the waist. Or a general anaesthetic, which will put you to sleep.

Once you have had your anaesthetic, the doctor will put the applicators in place, passing them through your vagina and into your womb. You may have an MRI or CT scan with the applicators in place. This is so the doctor can see the tumour and areas of healthy tissue, and can give the treatment more safely.

You will then be moved to the radiotherapy room that houses the machine containing the radiation source. The applicators are then connected to the machine. The machine moves the radiation sources into the applicators and you have your treatment. This usually takes about 10 to 15 minutes. Then the machine pulls the radiation sources back and your applicators are removed. After all that, you can go back to your ward to recover. If you have had a general anaesthetic, this may all take place while you are still asleep and you will just wake up on the ward.

In some treatment units, a small plastic cuff stays in place in the opening of your cervix throughout your treatment course. This is a narrow plastic tube, through which the applicators can be guided for the next treatment. If your hospital gives the treatment this way, you may not have an anaesthetic the second time around. Once your final treatment is over, the plastic cuff is pulled out. This is quick but can be a bit painful and you may wish 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 have fully recovered from the anaesthetic. You may have some bleeding from the vagina after this treatment. But that should clear up within 48 hours. Your doctor may advise you to stay overnight. If you do go home, someone will have to take you and stay with you once you get there. If you live alone, your doctor will almost certainly want you to stay in hospital overnight. If you are having loose or frequent bowel movements your nurse will advise you about diet. And you'll need to drink plenty of fluids and make sure you get enough rest.

As an inpatient

Until recently internal radiotherapy for cervical cancer was given at a continuous low dose rate (LDR) for up to 5 days. Many radiotherapy centres have now switched to a different system using a pulsed dose rate (PDR ). This means that you receive a dose of radiation for 10 minutes every hour.

For both low dose and pulsed dose treatment you have to go into hospital for a few days. During a short anaesthetic, plastic holders (called applicators) for the radioactive source are put in place in your vagina and womb. You may have an ultrasound scan at the same time to help doctors guide the applicators into the right place. Once you are awake, you may have an MRI or CT scan to help plan your treatment with the applicators in place. This helps doctors make sure the healthy tissue near to the cervix is exposed to as little radiation as possible and reduces side effects.

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

A catheter will also be put in so you don't have to get out of bed to pass urine. When you get back to the ward, you will be put into a room on your own (or sometimes with one other woman having the same treatment). The radioactive source is put into the applicators when you get back to the ward so that you are not wheeled through the hospital exposing other people to radiation.

In some treatment centres, a machine called a Selectron or Curitron, which gives a continuous low dose rate (LDR), automatically puts the radioactive sources in. The machine also automatically pulls back the radioactive sources when someone comes into your room. It means that other people can come in for a short time (including your visitors) and not be exposed to any radiation at all. In PDR, the treatment source is Iridium 192, which is loaded by remote control in a similar way to HDR treatment.

The applicators are packed into your vagina with gauze to stop them moving about. This can be uncomfortable, if not a little painful. So you will be given regular painkillers to help keep you comfortable. If you are uncomfortable or in pain, tell your nurse so that your medication can be altered.

If you are having loose or frequent bowel movements as a side effect of external radiotherapy, your doctor will prescribe drugs so that you don't have bowel movements during the internal treatment.

You will not be able to get out of bed in case you dislodge the applicators. You should have a call bell to hand at all times so you can ring the nurses if you need anything. Your room will have a camera in so that the nurses can monitor you on a closed circuit television (CCTV) screen. If you think the applicators have moved tell the nurse or doctor straight away.

The treatment takes anything from 1 to 5 days. This depends on the dose you are being given and the overall treatment plan. The applicators are taken out on the ward. You will be given painkillers beforehand. You may be given gas and air to breathe when they are being removed as this helps to relax you. Once the radioactive sources have been removed, all the radiation has gone. You can go home that day, or the next, depending on how you are feeling.

Internal radiotherapy using needles

In some situations, for example if your cancer is more advanced, you may have hollow needles put directly into the tissue next to the cervix (interstitial brachytherapy). These are put in at the same time as the applicators into your vagina and womb. The needles and the applicators are attached to the machine that contains the radiation source. The machine can move the radiation sources into the needles and applicators at the same time. Interstitial needles can be used with both PDR and HDR.

 

Looking after yourself during radiotherapy

Some doctors may ask you to use a vaginal douche from the start of your radiotherapy. The idea is that this keeps your vagina clean and reduces infection. Although some specialists still suggest douching, it is not generally recommended now. If you have questions or concerns about douching do talk them over with your doctor or specialist nurse.

 

Finding out more about radiotherapy

Look at our radiotherapy section for more information about this type of treatment, including

If you would like more information about anything to do with radiotherapy, contact one of our cancer information nurses. They would be happy to help. Or you could contact one of the cervical cancer organisations. They often have free factsheets and booklets which they can send to you.

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Updated: 2 June 2014