Cervical Cancer
Internal radiotherapy for cervical cancer
Radiotherapy uses high-energy X-rays to destroy cancer cells while harming normal cells as little as possible. Radiotherapy for cancer of the cervix can be given externally or internally (see also ‘External radiotherapy’) and is often given as a combination of the two.
It may also be combined with chemotherapy (chemoradiotherapy).
Internal radiotherapy (sometimes called brachytherapy) for cervical cancer is usually given after external radiotherapy or after chemoradiotherapy. It is sometimes given after surgery.
Treatment may be given as low, high, or pulsed dose rate radiotherapy (see Macmillan Cancer Support for more information about dose rates; 'Resources and Information').
Internal radiotherapy treatment for cervical cancer is given while under local or general anaesthetic. Applicators, which look like rods (sometimes called ovoids or tubes) are placed in the cervix and vagina. Once the applicators are in place, the planned dose and rate of radioactive material (called a source) is sent into the applicators by a machine controlled by a radiographer.
Internal radiotherapy is given in two main ways:
- intrauterine brachytherapy: when a hysterectomy has not been done, applicators are passed through the cervix and into the womb (uterus) while under a general or spinal anaesthetic (typically given as an inpatient treatment)
- vaginal brachytherapy: when a hysterectomy has been done, applicators are placed into the vagina, usually without anaesthetic (typically given as an outpatient treatment)
High dose rate therapy is the most common way that brachytherapy is given to the cervix. It is usually given over a course of 2 or more sessions as an outpatient but may also be given in hospital as an inpatient.
All the women we interviewed were treated as inpatients. On 2 occasions, the clinicians had difficulty inserting the rods into the vagina, but most women said they did not have this issue. Some women described feeling pain or discomfort when they woke from their anaesthetic after intrauterine brachytherapy, but pain relief was available.
She describes feeling discomfort when she woke from her anaesthetic after the rods had been inserted in to her vagina.
She describes feeling discomfort when she woke from her anaesthetic after the rods had been inserted in to her vagina.
And that's quite uncomfortable because I came out of the general anaesthetic and I remember I was like, and I've never had, for all of the other operations I'd had for my biopsies and all of the other things I'd kept saying no to any pain relief afterwards and I came round from this and they said "Do you want some pain relief?" "yes," so they gave me diamorphine and they gave me some more. But it's a funny sort of, it's not pain as in cutting yourself or anything it's just a deep sense of uncomfortableness It just feels like something is there that's not supposed to be there. But it's more uncomfortable than having a sort of, I don't know having a too tight shoe or something do you know what I mean. It's just very odd. And I think you've got all that pressure on you as well because you've got all that packing inside of you which is sort of pressing on your bladder and you're catheterised because obviously you're having to, you've got all these rods inside you so you can't move. And they also give you pills to constipate you because you're not going to be able to get up to go to the loo.
When treatment began, a few said that they initially felt panic, but were comforted by knowing that they could attract the nurses' attention on the CCTV screen if they needed to.
Many found their treatment difficult and uncomfortable because they had to lie still for a long time, or they had sickness, and had found it painful or uncomfortable (see below and interview 09).
Others found it less painful; one woman who was treated for 19 hours explained that she did not feel distressed during that time. Some said they could not sleep during their treatment, despite being given sleeping pills, because they were afraid of dislodging the rods in the vagina. One described how she coped.
She explains that she felt happy during internal radiotherapy.
She explains that she felt happy during internal radiotherapy.
Describes the pain she experienced during internal radiotherapy and how she coped.
Describes the pain she experienced during internal radiotherapy and how she coped.
you are really very cut off. And when the nurses do, they come in and they do have to try and turn you, to rub you because otherwise you get bed sores and even trying to turn you over a little bit is absolutely excruciating. You have this, I don't know what size it was but it felt gigantic inside of me. But there was also a part of me which was saying well just go through it, just get on with it. It's not the end of the world, you're going to come out of it in X amount of time. It's painful now but just get on with it. And I think that's really why I was watching the clock so much, because every second that I watched it, was another second gone.
After treatment is finished, the rods are removed using entenex (gas and air). Most people we spoke with said they found this process uncomfortable but not painful. Many described feeling very weak; several had a sore back and felt exhausted, and a few people lost weight.
A few also recalled having cystitis for a couple of days while others had constipation, diarrhoea and sickness for a short while.
One woman said she felt very emotional the day after her treatment.
She comments that she did not feel any pain when the rods were removed from her vagina after internal radiotherapy.
She comments that she did not feel any pain when the rods were removed from her vagina after internal radiotherapy.
And I was there all night with the tubes and at seven o'clock in the morning they came, they switched the machine off. They came in the middle of the night to see if I was OK but they had to switch the machine off to come in the room. So at seven o'clock they came, they switched the machine off and they say 'OK we're gonna take the,' they call the rods 'we're gonna take the rods out.' And they asked me if I want like anaesthetic by injection or the gas. I said OK I'll have the gas. And it was not painful at all to take, because I was using the gas it was not painful. I just felt, because the tubes were, they had some case around like a bandage and they had to pull it so I could feel it coming off, but it was not painful. And I saw the tubes were quite long this, this long but they were very thin and long and after that I asked them 'Can I get up?' And they say 'Yes, you can get up, you can have a shower, you can do whatever you want.' And I was OK.
She had been worried about having the rods removed after internal radiotherapy but it had not been painful.
She had been worried about having the rods removed after internal radiotherapy but it had not been painful.
And at the end of the five days when they came to take the tubes out they had warned me that the pellets are timed to a certain extent an exact life, each radiation or radian pellet has got a shelf life basically, so they'd worked out to the second what time they had to come out and it was six o'clock on the Friday morning. So the whole night before I didn't sleep, panicking when these tubes were gonna come out. And the nurse had to come in the night before and hold my hand and talked to me. We became very friendly, and said to me what was gonna happen and how it was gonna happen and that they would give me medication to relieve the pain. So at six o'clock in the morning I was given the pethidine to take away the pain and then two nurses came in to take out the tubes. Two came out really easily. The third one had real trouble to take out. And although it wasn't painful it was just really uncomfortable and then all the packing came out as well, which was an awful lot.
After radiotherapy, women are usually encouraged to use a 'douche' to keep their vagina free from infection, and, if they are not sexually active, a dilator to prevent the vagina from narrowing. Most women who used a 'douche' or a dilator found them easy to use.
She describes her experience of using a douche after internal radiotherapy.
She describes her experience of using a douche after internal radiotherapy.
Recovery time from treatment varied. One woman returned to work after 2 weeks and others returned to work after 3 months.
Most women we interviewed also had external radiotherapy, and the combination of these 2radiotherapy treatments led to some long-term side effects (see 'External radiotherapy').
She describes her recovery from radiotherapy.
She describes her recovery from radiotherapy.
We have not yet been able to interview anyone who has had vaginal brachytherapy for cervical cancer. If you have had this type of treatment and you would like us to include your story on this website, please email us at hexi@phc.ox.ac.uk for more information.
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