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Patient information - Cervical cancer - Brachytherapy

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This treatment involves two types of radiotherapy:

  • Brachytherapy (internal radiotherapy treatment)
  • External beam radiotherapy (EBRT).
What is Radiation Therapy (Radiotherapy)?

Radiotherapy is the use of high energy x-rays to treat cancer. Radiotherapy is sometimes called external beam radiotherapy (EBRT) and is delivered by a linear accelerator (radiotherapy treatment machine). Your treatment is individualised and carefully planned by your doctor and radiation therapists. Brachytherapy uses a radioactive source to deliver radiation internally.

To deliver the dose into your cervix, applicators (or tubes that transport the radioactive source) need to be inserted through your vagina into your cervix and uterus, which is performed under anaesthesia.

What is the aim of treatment?

Radiotherapy is given to destroy cancer cells in your cervix.

What does Brachytherapy involve?

Brachytherapy to the cervix is given in 3­-5 treatments, which take place 1-­2 times a week for 2­-3 weeks.
Each treatment can take up to a whole day to plan and deliver. Most patients will be admitted to hospital and discharged on the same day. Some people may need to be admitted to hospital the night before your brachytherapy procedure.
Patients are not allowed to drive for 24 hours after this procedure because of the anaesthetic. Please ensure someone is available to drive you home.
Your brachytherapy treatments may start during your external beam radiotherapy or once it has finished. 
Note: It is also important that you do NOT receive chemotherapy or external beam radiotherapy on the same day as your brachytherapy.

During treatment

When you are having brachytherapy treatment, you will be on your own in the treatment room. The radiation therapists can see and hear you at all times via cameras in the treatment room. 
If you become concerned or feel unwell in any way, raise your hand or call out. The radiation therapists will interrupt the treatment and attend to you. 
You won’t feel anything but may hear some whirring or clicking noises.

Emergency

IMMEDIATELY go to your nearest hospital Emergency Department, or contact your doctor or nurse if you: 

Emergency contact details

Ask your doctor or nurse from your treating team who to contact if you have a problem
  • develop a temperature of 38ºC or higher
  • develop chills, sweats, shivers or shakes 
  • develop uncontrolled bleeding
  • develop severe abdominal pain.
Daytime:
Night/weekend:
Other instructions:
Before radiotherapy begins and during treatment, if you are pregnant or feel that there is any chance that you may be pregnant it is important to discuss this with your doctor.
Do not try to get pregnant during this treatment. Ask your doctor or nurse about what type of contraception you should use.

Some cancer treatments can reduce your fertility. This can make it difficult or impossible to get pregnant.

Talk to your doctor or nurse before you start any treatment. Depending on your situation there may be fertility sparing options available to you.

Tell your doctor, nurse or radiation therapist if you:

  • develop changes to your bowel or bladder habits
  • develop any changes to your skin
  • feel unwell in any way.

At home it is important to:

  • take your medications as prescribed by your doctor.

What does brachytherapy treatment involve?

Before treatment:
  • You will be given instructions on preparing your bowel prior to the procedure.
  • Your anaesthetist will advise you about when to stop eating and drinking before your treatment.
On the day of treatment you will:
  • Be given an anaesthetic and a catheter will be inserted into your bladder to drain the urine as you are not allowed to get out of bed or move around once the applicators have been inserted.
  • You will have access to pain relief for the length of the procedure.
  • If your insertion has been performed in theatre you will be taken to the Radiation Therapy Department for your simulation, planning and treatment.

Simulation/planning

  • At your simulation appointment the radiation therapists will do a planning CT or MRI scan of your pelvis. This will be used by the radiation team to carefully check the position of the applicators and plan your treatment.
  • The radiation therapist, medical physicist and radiation oncologist will plan your treatment using the CT/MRI scans. This process will take approximately 1­2 hours. During this time you will be taken to the nurse's bay to rest.

Note: It is important to remember that moving, sitting up and walking around is not possible while you have the applicators inserted.

During treatment

  • A radiation therapist, medical physicist, radiation oncologist and nurse will all be involved in the delivery of your brachytherapy treatment.
  • To deliver your treatment, the applicators that were inserted will be connected via cables to a machine called a remote after loader that houses the radiation source.
  • The radiation source is programmed to travel up and down the channels in the applicators, stopping at pre­-planned points to deliver your treatment.
  • It will take approximately 15­-30 minutes to deliver your treatment and you will need to remain still laying in your bed the whole time.
  • Once treatment is completed the applicators are removed by the radiation oncologist and you will be observed. Once you feel well enough and can pass urine you will be discharged and allowed to go home.

Quitting smoking

  • It is never too late to quit smoking. Quitting smoking is one of the best things you can do to help your treatment work better.
  • There are many effective tools to improve your chances of quitting.
  • Talk to your treating team for more information and referral to a smoking cessation support service.

Staying active

  • Research shows that exercise, no matter how small, has many benefits for people during and after cancer treatment.
  • Talk to your doctor before starting an exercise program. Your doctor can advise whether you need a modified exercise program.

Cancer treatments can cause damage to normal cells in your body, which can cause side effects. Everyone gets different side effects, and some people will have more problems than others.

The table below shows some of the side effects you may get with this treatment. You are unlikely to get all of those listed and you may also get some side effects that have not been listed.

Tell your doctor or nurse about any side effects that worry you. Follow the instructions below and those given to you by your doctor or nurse.

Short term side effects: May occur during treatment or within a few weeks of finishing radiotherapy and usually settle within 4 weeks

Vaginal bleeding and pain

  • After your brachytherapy treatment, you may get:
    • a small amount of bleeding or spotting
    • pain, soreness or swelling where the applicator was located
    • cramping or swelling in your abdomen
    • a burning sensation when you urinate.
  • Tell your doctor or nurse if you get any of the symptoms listed above.
  • Contact your doctor or nurse immediately, or go to the nearest hospital Emergency Department if you have any uncontrolled pain or bleeding.

Increased risk of bleeding or infection

  • Your cancer treatment may cause your blood count to decrease.
  • This may increase your risk of bleeding, bruising and infections
  • Wash your hands often.
  • Keep a thermometer at home and take your temperature regularly, and if you feel unwell.
  • Learn how to recognise the signs of infection.
  • Limit contact with people who are sick.
  • Ask your doctor or nurse for the eviQ information - Infection during cancer treatment. 
  • Contact your doctor or nurse immediately, or go to the nearest hospital Emergency Department if you get any of the following signs or symptoms:
    • a temperature of 38°C or higher
    • chills, shivers, sweats or shakes
    • a headache or stiff neck
    • a sore throat or cough
    • uncontrolled diarrhoea
    • severe pain in your abdomen
    • shortness of breath
    • a fast heartbeat
    • feeling unwell even without a temperature.

Bowel irritation

  • During the last few weeks of treatment, you may have:
    • bowel motions (stools, poo) that are more urgent or frequent
    • a small amount of bleeding or clear discharge when passing a motion
    • a sore or irritated rectum
    • bloating, cramping or pain.
  • Take anti-diarrhoea medication as directed by your doctor.
  • Drink plenty of fluids (unless you are fluid restricted).
  • Avoid spicy foods, dairy products, high fibre foods, and coffee.
  • Ask your doctor or nurse for eviQ patient information - Diarrhoea during cancer treatment. 
  • Contact your doctor or nurse as soon as possible if your diarrhoea continues despite taking medication, or if you feel dizzy, light-headed or unwell.

Bladder problems

  • You may have
    • discomfort and burning when you urinate
    • blood in your urine.
  • You may also notice that you urinate more often.
  • Some people have less control over their bladder (incontinence) which may be temporary or ongoing.
  • Increasing your fluid intake (unless fluid restricted) and taking Ural® may provide some relief from the burning sensation when passing urine.
  • Contact your doctor or nurse immediately, or go to the nearest hospital Emergency Department if you are unable or having difficulty to pass urine, or severe discomfort.

Sexual function and vaginal changes - female

  • You may get dryness, itching or a burning sensation in the vagina.
  • This may cause pain or discomfort during sex.
  • Using a water-based lubricant may ease some discomfort.
  • To overcome vaginal dryness, you may need to use an internal moisturiser such As Replens®, Aquagel®, Vielle® or Sylk® which can be bought from your chemist.
  • Tell your doctor or nurse if you get any of these symptoms, they can help you to manage them.

Long term side effects: May develop months after radiotherapy has finished and may be permanent

Bowel changes

  • For some people, their bowel habits do not return completely back to normal after treatment has finished.
  • You may get:
    • an urgent need to open your bowels
    • pain when opening your bowels
    • a small amount of bleeding or clear discharge when passing a motion
    • diarrhoea
    • constipation
    • leakage or less control over your bowel motions (incontinence).
  • Tell your doctor or nurse if you get any of the symptoms listed above, they can help you to manage them.
  • Contact your doctor or nurse as soon as possible if you have any bleeding from your rectum.

Bladder changes

  • Radiotherapy can cause changes to the lining of your bladder in the long term which can be temporary or ongoing.
  • You may have:
    • discomfort and burning when you urinate
    • urgency or pass urine more often
    • leakage or less control over your bladder (incontinence).
  • Tell your doctor or nurse if you get any of the symptoms listed above, they can help you to manage them.
  • Contact your doctor or nurse immediately, or go to the nearest hospital Emergency Department if you are unable or having difficulty to pass urine, or severe discomfort.

Bowel blockage (bowel obstruction)

  • This treatment can affect the movement of faeces through the bowel, causing a blockage.
  • You may get:
    • abdominal pain
    • loss of appetite
    • nausea or vomiting        
    • constipation
    • watery diarrhoea.
  • Tell your doctor or nurse if you have any of the symptoms listed above.
  • Contact your doctor or nurse immediately, or go to the nearest hospital emergency department if you have uncontrolled pain, vomiting or diarrhoea.

Sexual function and vaginal changes - female

  • Treatment to the pelvis may cause vaginal changes including dryness and narrowing or shortening of the vagina (called vaginal stenosis). These changes may be temporary or ongoing.
  • It is important to keep the vagina lining as supple as possible to reduce this.
  • You can manage vaginal narrowing by having regular intercourse or using a vaginal dilator.
  • Ask your doctor or nurse for eviQ patient information - How to manage vaginal stenosis using a vaginal dilator 
  • Tell your doctor or nurse if you get any of these symptoms, they can help you to manage them or refer you to someone who can help.

Tiredness and lack of energy (fatigue)

  • Feeling tired or fatigue may continue for some time after the radiotherapy has finished.
  • Tell your doctor if you have ongoing tiredness and lack of energy.

Developing a second cancer

  • There is a very small risk that you may develop a second cancer as a result of having radiotherapy.
  • This is uncommon and may not happen until at least 10 years after treatment.
  • Talk to your doctor if you have any concerns about the benefits and risks of radiotherapy.

Will I be radioactive?

After your treatment has been given and the catheters have been removed, you will NOT be radioactive. Your bodily wastes (urine and faeces) will NOT be radioactive.

Will treatment affect my sex life?

While it is still safe for you to have sexual intercourse during your radiotherapy, the desire to have sex may decrease because you may become tired, anxious or unwell. It may help to discuss your worries with your partner and/or your radiation oncologist or nurse. A referral to a sexual counsellor may also assist.

What can you do if intercourse is painful? 

You may find you  are in too much discomfort to have sex until the tissues in your vagina have healed. This may take 4-6 weeks after your radiotherapy has finished. It may help to discuss this with your partner, radiation oncologist and/or nurse. A referral to a sexual counsellor may assist in managing this side effect. The regular use of a vaginal dilator will help with keeping the tissues in your vagina flexible and elastic. Ask for eviQ patient information - How to manage vaginal stenosis using a vaginal dilator

Do I still need to use contraception? 

Yes, you should use contraception during and after radiotherapy. Ask your doctor or nurse about what type of contraception you should use and for how long.

Will this treatment affect my fertility? 

Some cancer treatments can reduce your fertility. This can make it difficult or impossible to get pregnant. Talk to your doctor or nurse before you start any treatment. Depending on your situation there may be fertility sparing options available to you and/or your partner, discuss these with your doctor or nurse. See our patient information sheets – Fertility for women during cancer treatment.

Should I be on a special diet while having treatment? 

You may be asked to go on a special diet before your brachytherapy. You will be given instructions by your treating department. You can resume your regular eating habits after your procedure and it is important to keep your bowel movements regular by eating a balanced diet and drinking plenty of fluids.

Will I lose my hair? 

Brachytherapy will not cause you to lose any hair in the treatment area. If you do lose your hair in the treatment area this will be from your external beam radiotherapy. In most patients this is temporary but for some this may be permanent.

Can I drive during treatment? 

If you have received a general anaesthetic for your treatment, you are not allowed to drive for 24 hours. Please ensure you have someone to drive you home and discuss any concerns with your radiation oncologist.

Can I resume normal activity after the procedure? 

Avoid any heavy lifting or strenuous physical activity for the first two weeks following your treatment. Following this, you may return to your normal activities. Occasionally, vigorous activity may cause some blood in the urine. If you experience this and it continues for more than a few days, tell your doctor.

Can I have a flu or tetanus vaccination? 

It is usually safe to have vaccinations such as flu and tetanus while you are having treatment. If you are due for vaccinations talk to your radiation oncologist about the best time to have them.

Is it safe to take vitamin tablets and herbal medicines?

Before starting any medication which includes prescription, over-the-counter medicines, vitamins and alternative, natural or herbal medicines tell your doctor, radiation therapist or nurse. Some medications may interact with your treatment.

Who can I talk to if I am not coping? 

You may feel anxious or depressed during and after the treatment process. Let your treating team know and they will arrange for you to talk to someone. You can also call the Cancer Council 13 11 20 for more cancer information and support.

How do you know if the treatment is successful?

It is not possible to know if your treatment has been successful immediately after you finish treatment. Your doctor will see you during and after your treatment and will discuss your progress.

What is the follow­ up?

Once your treatment has finished, you will be advised by your doctor as to what follow up appointments are needed.

Telephone support

  • Call Cancer Council on 13 11 20 for cancer information and support

Gynaecological cancer information

General cancer information and support

Quit smoking information and support

Quitting smoking is helpful even after you have been diagnosed with cancer. The following resources provide useful information and support to help you quit smoking. Talk to your treating team about any other questions you may have.

This document is a guide only and cannot cover every possible situation. The health professionals caring for you should always consider your individual situation when making decisions about your care. Contact your cancer clinic staff or doctor if you have any questions or concerns about your treatment, or you are having problems coping with side effects. Use of this document is subject to eviQ’s disclaimer available at www.eviQ.org.au

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The currency of this information is guaranteed only up until the date of printing, for any updates please check:

https://www.eviq.org.au/pi/1319

19 Feb 2020