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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 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 (brachytherapy)

You may have internal radiotherapy you have radioactive sources placed into your vagina. It may be given as an outpatient as a short treatment every week for up to 5 weeks. Or you may have it as an inpatient treatment that takes from 12 to 24 hours. You usually have internal radiotherapy within 1 or 2 weeks of finishing external radiotherapy.

 

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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 that is similar to an X-ray machine. 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.

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 chemoradiation, 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. There is more about combination radiotherapy and chemotherapy in this section.

 

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 will have a planning CT scan. The scan shows the cancer and the structures around it.

The 360° photo is of a CT scanner. You can use the arrows to look around the room.

You lie on the scanner couch with the treatment area exposed. The radiographers will 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. We have information about radiotherapy skin markings.

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 will plan the areas that need treatment and outline 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 will explain what you will 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 from 1 minute to several 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 a few minutes. They watch you carefully through a window or on a closed circuit television screen. They may ask you to hold your breath or take shallow breaths during the treatment.

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.

 

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.

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). You 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 information 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 go into hospital on the morning of your treatment. But some units may ask you to go 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 you may have 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 a room that houses the radiotherapy machine containing the radiation source. The applicators are connected to the machine. The machine moves the radiation sources into the applicators and give the treatment. This usually takes about 10 to 15 minutes. Then the machine pulls the radiation sources back and your applicators are removed. Then, 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 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 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

The pulsed dose rate (PDR) radiotherapy system gives a dose of radiation for 10 minutes every hour for 12 to 24 hours.

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

You will also have have a tube into your bladder (a catheter) so that you don't have to get out of bed to pass urine. When you get back to the ward, you will be in a room on your own (or sometimes with one other woman having the same treatment). A member of your treatment team will connect the applicators to the machine and it gives the radiotherapy each hour. 

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 have regular painkillers to help keep you comfortable. If you are uncomfortable or in pain, tell your nurse so that your medication can be changed.

If you are having loose or frequent bowel movements, your doctor or nurse will prescribe drugs so that you don't have bowel movements during this 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.

A nurse takes the applicators out for you on the ward. You will have painkillers beforehand. You may also have 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

You can phone the Cancer Research UK nurses on freephone 0808 800 4040. The lines are open from 9am to 5pm, Monday to Friday. They will be happy to answer any questions that you have.

Our general organisations page gives details of people who can provide information about radiotherapy. Some organisations can put you in touch with a cancer support group. Our cancer and treatments reading list has information about books, leaflets and other resources about radiotherapy treatment.

If you want to find people to share experiences with online, you could use Cancer Chat, our online forum.

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Updated: 20 August 2014