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Internal radiotherapy (brachytherapy)

Internal radiotherapy for cervical cancer means giving radiotherapy to the cancer from inside the body. It is also called brachytherapy.

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 as an inpatient.

The treatment gives a high dose of radiation to the cancer but very little to surrounding tissues. It can shrink the cancer, relieve symptoms and help you feel more comfortable. It might slow the growth of the cancer and it can reduce pain.

Treatment as an inpatient

You usually have 4 treatments. You may have 2 treatments on the same day.

Before treatment

You go into hospital before your brachytherapy. You are taken to theatre and have an anaesthetic. The anaesthetic may be an injection into your spine (epidural) so you are numb below the waist. Or you have a general anaesthetic, which puts you to sleep.

The doctor puts the applicators into the vagina and cervix. The applicators are made up of tubes and, or needles. Gauze is placed inside the vagina to hold the applicators in place. A tube (catheter) is placed in your bladder.

Once the applicators are in place, you are unable to get out of bed and need to remain lying flat. Below is a photograph of how the applicators are placed.

Diagram showing the positon of the applicators for internal radiotherapy

 You have a CT and, or MRI scan to check the position of the applicators. Below is a photograph of a CT scanner.

Photo of a CT scanner

The nurses on the ward make sure you are comfortable. You can have pain relief if you need it. You remain on the ward while the treatment team produce a treatment plan. This should be ready within a few hours.

During treatment

Once the plan is ready you come down from the ward to the brachytherapy room. The radiographers connect the applicators to the machine. During the treatment, they leave the room and watch you from outside on a CCTV screen.

Afterwards the radiographers disconnect the applicators from the machine and take you back to the ward. This happens for either 3 or 4 days, depending on what the doctor has prescribed. You might have 2 treatments in a day.

Before each treatment you have a CT scan so the radiographers can check that the applicators have not moved.

It can be difficult staying flat throughout the treatment, however the nurses make sure you are as comfortable as possible. You are free to have visitors during ward visiting hours as you are not radioactive.

After treatment

After the last treatment, a member of the brachytherapy team removes the applicators and catheter. This is done without anaesthetic but is quick. You have pain medicine beforehand and gas and air is available. You might be able to go home either that same day or the following day.

Treatment as an outpatient

You will usually have brachytherapy after having a hysterectomy and chemoradiotherapy. You usually have 2 treatments on separate days, which can last between 10 to 15 minutes.

This treatment involves placing a tube inside the vagina. This is taken out once the treatment is over. You are only radioactive when the treatment machine is switched on. So afterwards you are safe to be around everyone, including children.

The treatment is given by a special brachytherapy machine which is kept in a purpose built room. The machine contains a small radioactive pellet which leaves the machine and enters the tube. Once inside it releases radiation. You won’t feel the radiotherapy but the tube can feel uncomfortable.

Before treatment

Your doctor or therapy radiographer examines you to check what size applicator they can use for the treatment. The applicator is a tube which comes in different sizes. They put the tube in your vagina and hold it in place with a clamp. They use a gel to help put the applicator in so it’s as comfortable as possible. 

You then have a CT scan which takes a short time. Your radiographers wait outside while this happens. Below is a photograph of a CT scanner.

Photo of a CT scanner

Your radiographers remove the applicator after the scan and you are free to go home.

Your radiographers and doctors create your radiotherapy plan. They make sure that the area of the cancer will receive a high dose and surrounding areas receive a low dose. This reduces the side effects you might get during and after treatment. 

During treatment

You usually come back for treatment within a week. You stay in the same position as you were for the CT scan. Your radiographers put in the applicator and connect it to the brachytherapy machine. They then leave the room but can still see you on a CCTV screen during treatment.

After treatment

Your radiographers remove the applicator once treatment has finished. You are then free to go home. The process is the same every time.

Side effects

Radiotherapy for cervical cancer can cause side effects. These side effects include diarrhoea and bladder infections.

Let the radiographers know if you have any problems while having treatment or afterwards. They can give you advice or refer you to a doctor.

Last reviewed: 
02 Apr 2020
Next review due: 
02 Apr 2020
  • Cervical cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow up
    C Marth and others
    Annals of Oncology, 2017. Volume 28, Supplement 4

  • Radiotherapy in Practice - Brachytherapy
    P Hoskin and C Coyle
    Oxford University Press, 2011

  • Cancer: Principles and Practice of Oncology (11th edition)
    VT DeVita , TS Lawrence, SA Rosenberg
    Wolters Kleuwer, 2019

  • Cancer and its Management (7th edition)
    J Tobias and D Hochhauser
    Wiley Blackwell, 2015

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