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Cervical Cancer

External 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 'Internal radiotherapy'), and often as a combination of the two. It may be given if the cancer is not curable with surgery alone or if there is a high risk that the cancer may come back. It may be combined with chemotherapy.

External radiotherapy is usually given once a day, Monday to Friday, at a hospital outpatient clinic, a course of treatment lasts between five to eight weeks.

Patients attend a radiotherapy planning session before treatment begins so that the area to be treated can be marked out using small tattoos or indelible ink marks on the skin. Most women we interviewed found this procedure straightforward, apart from one who had found it distressing.

 

She describes her radiotherapy planning.

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Age at interview: 41
Sex: Female
Age at diagnosis: 39
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Yeah that initial appointment is, you go in what they call a simulator, this pretend machine and they use like a camera thing to see exactly where your, where my cervix would have been because that's the centre they were trying to aim for and so they did that. And they took some images I believe and then marked me, it's like very, one little pin prick of a tattoo. So I've got three ink marks, permanent marks. One's right on the top, if you're lying down, like sort of on top of your pelvis and then the other two are at the side. Because what would happen is the machine will do, give you one, one boost from overhead and then it would be turned round to the side and going from one to the other side, through. And so I have three marks, one on the front of me and one on either side on my thigh. And the idea of that is when you actually go for the treatment then you're lined up in exactly the same position every time you have your treatment and the lasers on the camera line up with the little tattoos on your body.
 

She explains why she found her radiotherapy planning upsetting.

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Age at interview: 42
Sex: Female
Age at diagnosis: 36
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The radiotherapy planning wasn't nice at all, I didn't feel the staff were very friendly, they weren't very nice, they were horrible to me. And I was there for about 3, 3' hours, I remember, the whole afternoon. I'd asked if my daughter could come through and watch, I said "She's a St. John Ambulance member and she'll sit quietly and she's almost a grown up girl." And no she had to wait outside. So I was sort of thinking this is uncomfortable and they want me to keep still and they keep measuring things and doing things and it was a very high bed and it was a long time and I was also worried about [my daughter] being outside because although she was sort of grown-up and sensible I just felt it was unfair to leave her there and I wanted to say "Look Mum's alright." So I came out of there finally and I said "Look [daughter's name]," I said " we can't go anywhere, the day is all messed up and I feel really sorry and everybody was just horrible to me." I said "I'm going home now." And they said "Oh you can't, you've got to go back downstairs to the radiotherapy department and you've got to see one of the doctors there and he's got the paperwork." So I went down and I sat and waited.

Many said that their radiotherapy was painless and straightforward. Several described suffering side effects after about two or three weeks of treatment. Some had more, or more severe, side effects than others. Many experienced at least some of the following' exhaustion, weakness, diarrhoea, sickness, a weak bladder and cystitis.

 

She describes her external radiotherapy.

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Age at interview: 35
Sex: Female
Age at diagnosis: 34
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But yeah the radiotherapy actually only lasts for about perhaps four minutes because what they do is do it on these exact spots. I had it there at the sides and at the front and underneath, all around that kind of area. Perhaps for a minute at a time and [the nurses would] go away behind a screen sort of thing. You were in this room on your own and then they'd turn the machine off, they'd come back, move the machine so they knew where to do it again the next time, get the exact measurements and sort of set it on again for thirty seconds to a minute or whatever it was. And then they'd go away, come back again, that would be about four times. And you would obviously take your clothes off while you were having the treatment. So sort of measuring up depending on who you got can be a five-minute thing or a fifteen-minute things. So, but that's, its, radiotherapy in itself its not much to worry about its just the side effects really.
 

She describes the side effects she experienced during her external radiotherapy.

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Age at interview: 46
Sex: Female
Age at diagnosis: 36
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But after the first sort of 10 sessions things started to go down downhill pretty rapidly, I was getting very tired. I was getting slightly, slightly sore, not completely sore but just very, very slightly. I wasn't getting any sickness as I said before so I was pleased about that. So there were pros and cons. I mean some people get things in varying degrees and that was okay. Towards the end I suppose of the third week, going into the fourth week, that's when it really started to kick in. I was really, really feeling tired, I was getting extremely sore, I was getting very, very irritable, extremely irritable because at that stage although I could still do things for myself. I could still get myself up and get dressed and ready and so on, I had to get up earlier because it was taking longer. I wasn't sleeping well, my sleep patterns went all over the shop. I was finding that sometimes I couldn't sleep at all and other times it wasn't like going to sleep, it was almost like passing out, but I was feeling tired at strange times of the day. 
 

She explains that the diarrhoea she suffered during external radiotherapy was worth it if it...

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Age at interview: 41
Sex: Female
Age at diagnosis: 39
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Yes I mean I'd been warned of this one as well, they said 'You will probably get diarrhoea with it because again the area that's being treated, you know although its getting in there and if there's any cancerous cells it will do them good and get rid of those. Its also gonna go to the bowel because that's also in the same area. So,' he said 'I'll be very surprised if you didn't you know suffer from diarrhoea.' But again the medication sorted it out, it wasn't bad. It doesn't matter really in the end, if its gonna do you good You know if its getting rid of cancer, six weeks of diarrhoea is nothing.

 

She suffered severe bowel problems and sickness during her radiotherapy for advanced cancer.

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Age at interview: 36
Sex: Female
Age at diagnosis: 27
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And I was taken in every day for three weeks to have 50, no 30 seconds on each side and a minute just on the top, which doesn't sound very much and it doesn't really affect you in the first couple of weeks. And at the beginning I thought this is easy, I don't know what people are talking about; it doesn't make you ill. And then on the final week of radiation, I'd lost so much weight and I was really sick, I had constant diarrhoea and I was in a lot of pain from those two symptoms basically. And I remember thinking if only I could eat something and keep it down. I couldn't even keep a glass of water down at this point. And when I was going for the radiation every day the nurses said to me if I lost any more weight they couldn't perform the radiation because they just couldn't line me up with the beams of light on either side of the room because my weight had gone down. And at this point also I had arrows drawn all over my body relating to different parts because they were unsure how far it had spread, they decided to treat me from just above my abdomen, to quite low on my legs to try and cover the whole area. So this is why I was getting other symptoms too because it was destroying part of my bowel so this was affecting my toilet habits really badly.

One woman whose skin was red and sore from her radiotherapy described this as burned (this is unusual nowadays) and discussed how it contributed to her exhaustion. Another mentioned that she had soreness in the area she had radiotherapy which disappeared two weeks after her treatment finished. A third experienced blistering on her bottom.

 

She describes the exhaustion, diarrhoea and sore skin she experienced during her external...

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Age at interview: 31
Sex: Female
Age at diagnosis: 30
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It was after I think three weeks of radio that when it start. First my tummy and my back start getting like burned, very dark. It was like a square on my tummy and a square on my back. That's where the radiations were so it was like a burn. And the radiologist told me not to wash with any shower cream or anything, just water. And I was feeling tired all the time really, really tired and I remember that I was waiting in this room and we were all looking very tired. 

And this girl she came all lively, it was her first day and I look at her and say oh yeah just wait another few weeks and you're gonna be the same as us. It was like we were zombies you know. We didin't talk, we just sat there looking at each other. And we saw each other every day but we didn't strike conversation because everyone was so tired. 

So we were just sitting there looking. And at this point I had started having diarrhoea quite badly. I used to go to toilet maybe six, seven, eight, nine times a day. And it was really bothering me because it was like I had to travel to the hospital and at this point I was going by minicab provided by the hospital because I couldn't travel on public transport. So the doctor arranged for me to have someone to pick me up in the morning for my treatment and bring me back after the treatment. And I was going oh my gosh what if I need to go to the toilet and I'm in a car, what am I going to do? But luckily that never happened. And I was very, very tired, very sore because my tummy and my back were burned. I used to put E45 cream, it didn't help at all.

Long-term side effects and recovery

Most found that their sickness, exhaustion and bladder problems ended a few weeks after treatment but many had felt tired, and a few had bladder problems, for several months afterwards.

A woman whose skin had been red and sore said it had healed after a few weeks but had left marks on her body. Another had a weaker immune system and a painful hip five years after treatment. A third needed an operation to remove fluid from her uterus which is very unusual.

Many women had experienced long-term problems with their bowel. Some found their constipation or diarrhoea ended a few months after treatment, others had these side effects for several years. Most said their constipation or diarrhoea had become less frequent over time or was controlled with medication. One woman in her thirties describes how she still experiences problems with her bowel nine years after her treatment and she explains how she has learnt to live with it.

 

She explains how she has learnt to cope with long term bowel problems following radiotherapy.

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Age at interview: 36
Sex: Female
Age at diagnosis: 27
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In the beginning I was afraid to [go out] because of my bowel and I would always be looking where the nearest toilet was or if I'd be on a course for a day I would think I can't go because what if I have to run out of the course. But I've actually learnt to live with that and I do tell most people so it's not sort of an issue and if I'm out for the day. I think psychologically I can cope with it a lot better now so physically it doesn't affect me so badly for some reason. So that would be the only thing that would be a long term effect on me I think but its something that I have dealt with and can deal with and it doesn't affect anything I do anymore. And nothing else is affected, I can do anything.

Mentally it was easy when I was with my husband because I thought he understands, he knows. But when I was going into a new relationship it was something that I thought someone's not going to like me because of this. But its actually amazing how people understand. My new boyfriend hasn't got a problem with it at all. And he will be in the car with me and spot the toilets for me if I need to go so he's very supportive. I think its something again you've got to talk about. If you don't tell your friends and you don't admit that you've got a problem then you probably have a problem yourself mentally because dealing with that is quite hard if you don't admit it. And I think probably I could wear one of those medi alert bracelets if I needed to for shops and things but I don't want to do that, I don't want to be treated as an invalid, I want to be a normal person and if you need to there's always ways basically.

Radiotherapy causes the ovaries to stop working, leading to an early menopause. Most of the women interviewed had taken HRT (hormone replacement therapy). Many said it had helped to control their menopausal symptoms, apart from one who had difficulty finding a suitable type of HRT, and this had considerably affected her daily life for a couple of years.

 

She experienced problems getting the right dosage of hormone replacement therapy for her...

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Age at interview: 53
Sex: Female
Age at diagnosis: 42
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They tried the different type of hormone replacement therapy and they never managed to get the right amount. Because I had so much trouble finding the right hormone level and eventually because of all this bleeding I start being anaemic and I was always tired. And possibly sort of also my brain balance went. I felt sort of weaker, not well, completely, I had a real problems, mental problems. I was crying in the street with no reason whatsoever. And this has been the worst part of my therapy which wasn't the cancer therapy it was afterwards, trying to sort of get me back to my periods and because I was only 43 so they thought well we can carry on for another 10 years if possible. But that was the worst time of my life, literally I cracked up. Eventually one day I had an appointment with the doctor that was specifically for the hormone replacement and I went there, I threw the tablets on the table and I said "I don't want to take them any more," and again I did probably a horrible scene in front of this person but it was my way of reacting and my way of saying that's enough, I don't want. And in fact it took about six months for my body to get rid of all the, probably chemicals. But after that that was it, I've never been happier because my periods stopped and that was, I had no side effects. Actually while I was taking the hormone replacement therapy I had hot flushes and all this sort of thing. Afterwards that was it, nothing. I was ever so pleasant.

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Last reviewed July 2017.

Last updated July 2017.

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