Selection radiotherapy treatment to the cervix and uterus
Your doctor has recommended a course of radiotherapy as part of the treatment for your cancer. Radiotherapy is the treatment of cancer using X-rays. It is a localised treatment and the side effects you experience will depend on the area of your body being treated. There are two types of side effects - those which come on during or immediately after treatment (acute side effects) and those which can be long term (late side effects). Your doctors will have taken these into account when considering the benefits of treatment and will inform you of the side effects you are likely to get. This information sheet explains the common side effects you may experience. This does not mean that you will definitely get them. It is also possible that you may experience a side effect not mentioned here. Please discuss any concerns you may have with your doctor, specialist nurse or radiographer.
For gynaecological cancers, radiotherapy can be given externally or internally. Often a combination of the two is used.
Your doctor may recommend internal treatment after biopsy (removal of a sample of tissue for analysis), after surgery, or after external radiotherapy as a 'top-up' or 'boost'. For an information sheet on external radiotherapy see the abdomen & pelvis section. Your treatment will depend on a number of factors, in particular the type of cancer and the size of the tumour.
What is the Selectron?
The Selectron is a machine that can deliver radiotherapy internally via special tubes known as applicators. This machine automatically places small radioactive sources inside the applicators so that the radiation is concentrated within the cancer where treatment is most needed.
What does the treatment involve?
Three applicators will be inserted into the uterus & vagina under general anaesthetic. You will be admitted the day before the procedure and will not be allowed to eat or drink from midnight on the day before. In the operating theatre, the applicators are inserted into the uterus & vagina together with gauze packing to hold them in position. A gauze pack may also be inserted into your rectum. When you come out of the operating theatre, you will be taken to the radiotherapy department to have X-rays taken to check that the applicators are in the correct position. After this, the rectal pack will be removed and you will return to the ward.
A doctor or physicist will connect you to the Selectron machine later in the day and tell you how long your treatment will take. In most patients, this will be around 24 hours. The physicist or radiographer will draw marks on your thighs which will be checked periodically to make sure that the applicators remain in the correct position. In order to avoid accidental shifting of the applicators, you will have to stay in bed for the duration of the treatment. You will have a catheter inserted into the bladder so that you will not have to get up to go to the toilet. You will also receive tablets to constipate you so that you will be unlikely to want to open your bowels during your treatment.
Practise breathing deeply and coughing hourly while you are awake. This helps to keep your lungs clear and reduces the risk of a chest infection. You will also have to wear elastic support stockings to improve the circulation of your legs and reduce the risk of developing a blood clot. You should also exercise your feet and ankles to stimulate your circulation. If you are not sure how to do these exercises, please ask a nurse.
The treatment is not painful and you will be able to read, watch TV and eat and drink normally during the treatment. A portable pay phone can be brought to you if you wish to make any calls. This will also accept incoming calls.
While you are connected to the machine and treatment is in progress, there will be radioactive sources inside you. Visitors are therefore advised to wait until your treatment is finished before coming to see you. If it is important for you to have visitors, the sources can be withdrawn but this will extend your treatment time. The nurses can monitor you on a television screen and you may contact them by using the call bell provided. If you need to see a nurse, the sources can be withdrawn temporarily so that they can enter your room to attend to you. During your treatment you may hear mechanical noises coming from the Selectron machine. This is normal so do not be concerned. It can be isolating on your own in the room. Try to prepare by bringing things to occupy you whilst in bed.
When the treatment is completed, the radioactive sources are automatically withdrawn into the Selectron machine and a nurse will remove the gauze packing, applicators and catheter. This procedure will be more comfortable if you breathe some gas and air mixture (Entonox) and a nurse will show you how to do this when you first come to the ward.
You may go home once the treatment has finished. You will not be radioactive and it is quite safe for you to be with family and friends. You will also be given an out-patient appointment or one will be sent to you in the post.
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Potential acute side effects
After you have undergone treatment, you may experience some side-effects. These include diarrhoea, 'spotting' or slight bleeding and discharge from the vagina, and a burning sensation when passing water. They are simply your body's way of responding to the radiotherapy and should not last more than two to three days. However, if these symptoms persist or become worse, you should contact your hospital of GP. You should also inform your doctor if you have a temperature over 100oF (38oC) or if any discharge develops an odour.
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Potential late side effects
Your ovaries may be permanently affected by the radiotherapy resulting in the menopause. Hormone Replacement Therapy (HRT), in the form of tablets and/or cream, is available and will help to ease any symptoms. Please discuss this with your doctor or nurses as there may be additional guidance we can give you. Your vagina may also become narrow as a result of the treatment. This can be prevented if you resume intercourse as soon as you are comfortable. You may also be given dilators to prevent narrowing of your vagina. Your radiographer will discuss this with you and advise you on how to use the dilators.
Additional general information The cancerbacup booklet "Understanding radiotherapy" can usually be obtained from the racks around the centre or alternatively by phoning cancerbacup directly on 0800 181199. A copy of the information film Chemotherapy & Radiotherapy can be ordered directly by email only firstname.lastname@example.org
Further general information Your doctors and specialist nurses are in an ideal position to give you relevant information on your disease and treatment as they know your individual circumstances. Cancerbackup has a help line (0808 800 1234) and a prize winning video available in English, Italian, Urdu, Bengali, Gujarati & Hindi explaining Radiotherapy & Chemotherapy. Cancernet.co.uk has over 500 pages describing cancer, its management, practical tips and tool which patients, their carers and their doctors have found helpful during the cancer journey.