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Cervical Cancer

Internal radiotherapy for cervical cancer

Internal radiotherapy (sometimes called brachytherapy) for cervical cancer is usually given after external radiotherapy or sometimes after surgery. Treatment may be low or high dose rate radiotherapy. It is given using applicators, which look like rods (sometimes called ovoids or tubes), that are placed in the cervix and vagina under either local or general anaesthetic and radioactive material is placed inside the applicator.

Treatment time varies for each individual patient. Patients will need to stay in hospital during their treatment and will not be able to sit up in bed. “You’ll be cared for in a single room while you’re having brachytherapy. Special precautions will need to be taken to prevent other people being exposed to radioactivity while the machine is giving you your treatment" (Macmillan Cancer Support December 2015). 

High dose rate therapy is usually given over a course of two or more sessions as an outpatient.

All the women we interviewed were treated as inpatients. On two occasions, patients said that the clinicians had difficulty inserting the rods in to their vagina, but most did not. Some women described feeling pain or discomfort when they woke from their anaesthetic but pain relief was available.

 

She describes feeling discomfort when she woke from her anaesthetic after the rods had been...

She describes feeling discomfort when she woke from her anaesthetic after the rods had been...

Age at interview: 28
Sex: Female
Age at diagnosis: 27
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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 Interview 09 below). Others found it less painful; one treated for 19 hours explains 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 describes how she coped.

 

She explains that she felt happy during internal radiotherapy.

She explains that she felt happy during internal radiotherapy.

Age at interview: 31
Sex: Female
Age at diagnosis: 30
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So at five o'clock I had to be isolated for the radiations so the doctor came and she connected the machine to the tubes I had inside my vagina. They were really big. And they locked the room. They put everything near me like food, water. I had a book. There was a TV in the room because I could move my head and my arms, but not the rest of the body because if I moved I could perforate my stomach with the tubes, so I had to be quite still. They gave me sleeping pills but I was afraid to sleep and start moving around so I didn't sleep even with the sleeping pill. And there was a camera and the nurse said to me 'If you need anything just wave, we'll come straight.' And they just locked the room when I was there. And it was like, I felt strange, I did panic for a bit just what if they're not looking at the camera and something goes wrong. But I just say no I just have to relax. And I was in touch with friends and family through the phone because there was a telephone. So my sister was ringing me from Portugal and I was in very happy spirits. I was laughing at the phone and making jokes. I did talk with my son on the phone. So I was not down. I was quite happy. 
 

Describes the pain she experienced during internal radiotherapy and how she coped.

Describes the pain she experienced during internal radiotherapy and how she coped.

Age at interview: 49
Sex: Female
Age at diagnosis: 43
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I had taken some very positive things in to read, like I'd written specifically some things down on paper which I had planned to sort of say to myself when I felt it was difficult. And I did try actually to read them but I just couldn't concentrate on anything bar the pain. And I actually clock-watched. I had a watch in my hand for most of the time and I watched the counter, you know the seconds pointer go round. And to this day I can't wear a watch. 5' years on I won't wear a watch.

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 finished the rods are removed using entenex (gas and air). Most said they found this uncomfortable but not painful. Many described feeling very weak, several had a sore back and felt exhausted and a few had lost weight. A few recalled having cystitis for a couple of days, 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...

She comments that she did not feel any pain when the rods were removed from her vagina after...

Age at interview: 31
Sex: Female
Age at diagnosis: 30
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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...

She had been worried about having the rods removed after internal radiotherapy but it had not...

Age at interview: 36
Sex: Female
Age at diagnosis: 27
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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.

Age at interview: 28
Sex: Female
Age at diagnosis: 27
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A douche, I didn't know what it was either. It's a plastic, like a plastic bottle which is almost like concertinaed so that you squash it and it's got a sort of tube on the top which has got lots of little holes out of it. So you fill it up with water. I suggest sort of luke warm water because if it's freezing it would be horrible. Fill it up with water, screw the sort of pipe bit in the top, the little tube on the stop and then you just have to push it inside you and then you squeeze it and the water comes out of the little holes in the tube. And it's basically supposed to just I suppose moisturise you inside and get rid of anything that shouldn't be in there, all your dead cells. And that's twice a day you use that. And you can use it in the bath which means you don't have to use KY jelly and it's a bit more comfortable or else you could just use it and do it like that.

Recovery time from treatment varied. One woman returned to work after two weeks, others returned to work after three months. Most women we interviewed also had external radiotherapy and a combination of these two radiotherapy treatments had led to some long-term side effects (see 'External radiotherapy').

 

She describes her recovery from radiotherapy.

She describes her recovery from radiotherapy.

Age at interview: 49
Sex: Female
Age at diagnosis: 43
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I mean I wasn't really getting out and getting very much fresh air so, but once the treatment had finished and I used to set myself little targets. Particularly me and my husband would walk to the letter box and back and then, sorry not the letter box the post box and then try to walk around the block. Because we lived by the sea, my first trip down onto the beach was just fantastic. And getting better was actually quite a bit of therapy for my husband actually. As time was going on he was sort of saying things like that's fantastic, you've walked along the beach, that's brilliant. And he was saying things like "You know when you think back to 3 months ago, 6 months ago you couldn't do that." And I think that was actually quite a nice thing for him to see that I could come out of it and make progress.

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Last reviewed July 2017.
Last updated
July 2017.

 

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