Internal radiotherapy for womb cancer

Internal radiotherapy is also called brachytherapy. A radioactive metal object called a source is put inside your body. Many women only have surgery for womb cancer. But if you do need to have radiotherapy, you will probably have radiotherapy from an external machine (external beam radiotherapy) as well as internal radiotherapy.

For womb cancer, the internal radiation source goes into the vagina. This way a high dose of radiation can be given to the area of the womb. A radioactive element called caesium (pronounced seez-ee-um) is used to produce the type of radiation. Radiotherapy with caesium for womb cancer is called also intra vaginal caesium treatment. A radioactive element called iridium may be used instead of caesium.

The way you have the treatment is different, depending on whether you are having radiotherapy as your main treatment or whether you are having it after surgery. It will also vary depending on whether your hospital is using a high dose rate system or low dose rate system.

Doctors call the high dose rate treatment fast treatment. And low dose rate treatment slow treatment. They both work equally well. You will get the same total dose that your specialist has calculated you need – however it is given. The main difference is that with the fast dose rate machinery, each treatment is short but you need to have between 2 and 5 separate treatments. Because the dose rate is higher, you would receive too much radiation at once if you had it all in one go.

With the low dose rate system, you only have one treatment but it takes much longer. You usually have this as an inpatient for between 1 to 5 days.

You may have this treatment because

• You are not fit enough for surgery
• You are really against having surgery
• Your cancer has grown too far for it to be easily removed (some stage 3 or stage 4A womb cancers)

To have this type of internal radiotherapy, you may have to go into hospital for a few days for the slower low dose rate treatment. Or you may have to make several trips to the hospital to have a series of the faster high dose rate treatments.

To give you the treatment, you have plastic and metal holders (called applicators) put in place in your vagina. These contain the radioactive source, which gives off the radiation. Because you need treatment inside the womb, the doctor needs to open your cervix to put the tube inside. Widening the cervix can be a bit painful, so you have all this done in the operating theatre while you are under general anaesthetic. The diagram below shows where the applicators sit inside you. 

There is another way of giving this treatment. You may have the radiotherapy delivered from small capsules placed into your womb. Doctors call this Heymann's packing technique. 

If you are having fast (high dose rate) treatment, you will have all your radiotherapy while you are under anaesthetic. So you will wake up and it will all be finished. The only drawback is that you need several treatments and so several short anaesthetics. Once you have recovered from your anaesthetic, you will be able to go home.

If you are having slow (low dose rate) treatment, when you get back to the ward, you will either be in a room on your own or you may be with another woman having similar treatment. The source of radiation goes into the applicators after you get back to your room. This minimises the risk of exposing anyone else to radiation.

In many treatment centres, a machine called a Selectron or Curitron automatically puts the radioactive source into the tube that is already inside your womb. The machine also automatically pulls the radioactive sources back out of the tube when someone comes into your room. This means other people can come in for a short time (including your visitors) and not be exposed to any radiation at all. The machine measures the total time the radiation source is out of your body and automatically adds the time on, so you still get the exact dose you need.

The doctor will have packed the applicators into your vagina with gauze to stop them moving about. This can be uncomfortable or even a little painful. So you will have regular painkillers to help keep you comfortable. If you are uncomfortable or in pain, tell your nurse straight away. You need to be as comfortable as possible so that you will not be move around and disturb the applicators.

You will not be able to get out of bed at all in case you dislodge the applicators. You will have a catheter so you don't have to get out of bed to pass urine. You should have a call bell to hand at all times so you can ring the nurses if you need anything. If you think the applicators have moved tell the nurse or doctor straight away.

The slow treatment takes anything from 1 to 5 days. The length of time depends on the dose you need and your overall treatment plan. Your nurse will take out the applicators on the ward. You will have painkillers before this and may have gas and air to breathe when they are being removed. This helps you relax. Once the radioactive sources are out, all the radiation has gone. You are not a risk to anyone else, including children and pregnant women. You can go home that day, or the next, depending on how you feel.

If you've had surgery to try to cure womb cancer, you will have had your womb removed. So you won't be having internal radiotherapy in the same way as if it was still there. If you need radiotherapy after surgery, you may have both external radiotherapy and internal radiotherapy. Many women don't need this treatment and have surgery alone.

For internal radiotherapy after surgery, the radioactive source is inside a tube that is between 2 and 3cm across (about an inch). This is put gently into your vagina. It isn't painful so you don't need to have an anaesthetic to put it in or painkillers to take it out. The source tube is held in place either with a clamp or with a stitch or two (if you are having treatment over a few days).

Again, there are two ways of giving this treatment, depending on whether your hospital has the equipment for fast high dose rate treatment or slow low dose rate treatment. If you have the fast treatment you will have between 2 and 5 separate treatments, each taking a few minutes. If you have the slow treatment, you will have one longer treatment, lasting for anything from a few hours or up to a few days.

To have the treatment over one or more days, you will be on a ward in a single room or a room with other women having the same treatment. You will have to stay in bed and your doctor will arrange for you to have a catheter into your bladder so you don't have to get up to pass urine. Your hospital may use the Selectron or Curitron machines, which automatically pull the radioactive source back out of the tube if anyone comes into your room. As we explain above, this means other people can safely enter your room. The machine keeps a check on the total time that you have the radioactive source in place and recalculates your finish time. When the time is up, your nurse will take out the tube and you can go home.