Radiotherapy

The aim of radiotherapy is to kill cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body. cells or stop them dividing. Radiotherapy uses high-energy radiation to stop cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body. cells from growing. The radiation damages DNAThe building blocks of the genes in almost all living organisms - spelt out in full as deoxyribonucleic acid., the geneticRelating to the genes, the basic units of genetic material. instructions that cells need to reproduce.

Because cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body. cells divide more rapidly than normal cells, the radiation affects them more than it affects normal cells.

When treating cervical cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body., radiotherapy is usually accompanied by chemotherapyThe use of chemical substances to treat disease, particularly cancer., given at the same time. The combined treatment is called chemoradiotherapyTreatment of cancer with both chemotherapy and radiation therapy.. Chemoradiotherapy is now considered the best treatment for advanced cervical cancers up to stage 4a.

Learn more about chemoradiotherapy.

Radiotherapy for cervical cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body. usually involves external and internal radiotherapy. A normal course of treatment might include a few weeks of outpatient external radiotherapy, followed a week or so later by a few days in hospital having internal radiotherapy.

External radiotherapy

During external radiotherapy a machine directs high-energy X-rays into the site of your cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body. from outside your body. The X-rays used are 500-1000 times more powerful than ordinary X-rays.

The radiographer positions you on a special couch and you lie still for a few minutes while the machine gives the treatment. Each individual treatment lasts a few minutes. You will not feel any pain or discomfort while you are being treated.

You will normally have external radiotherapy as an outpatient - that is, there is usually no need to stay in the hospital overnight.

Most people have daily treatments from Monday to Friday each week for three to five weeks.

External radiotherapy does not make you radioactive - it is safe for you to be with other people immediately after treatment.

The simulator allows your specialist to get an accurate picture of where the cells are that need to be treated

Treatment planning

Before you start your radiotherapy treatment, your specialist will need to make a treatment plan. A machine called a simulator will be used to target your treatment to kill cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body. cells with as little damage as possible to healthy cells.

The simulator allows your specialist to get an accurate picture of where the cells are that need to be treated.

One or more marks will be made on your skin. These will be used to position the radiotherapy machine accurately when you are being treated.

I had five weeks of chemotherapyThe use of chemical substances to treat disease, particularly cancer., and 28 sessions of radiotherapy. I then had 20 hours of brachytherapyA type of radiotherapy where radioactive pellets or wires are inserted into the tumour., which was to provide a direct hit of radiotherapy internally using metal rods inserted through my vagina.

Fiona

Internal radiotherapy

With internal radiotherapy a source of radiation is put inside your body, close to the site of the tumour. This kind of radiotherapy is sometimes called brachytherapyA type of radiotherapy where radioactive pellets or wires are inserted into the tumour..

In the case of cervical cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body., this means putting the source in your uterus next to your cervixAny neck-like structure; most commonly refers to the neck of the uterus..

The advantage of this kind of radiotherapy is that the treatment can be targeted very accurately at the cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body. cells.

Internal radiotherapy is given in one of two ways:

  • Low-dose therapy - you have long treatments with a fairly weak source of radiation
  • High-dose therapy - you have short treatments with a strong source of radiation.

The total amount of radiation you receive is the same for both types of treatment.

Low-dose therapy

In low-dose therapy, plastic capsules called applicators are put next to your cervixAny neck-like structure; most commonly refers to the neck of the uterus. and uterus via your vagina. These are connected by tubes to a machine that contains balls of radioactive material. The machine feeds the balls into the applicators to start your treatment.

The balls can be withdrawn into the machine for short periods so that people can come into the room and visit you without being exposed to radiation.

If you have this kind of internal radiotherapy, you will usually stay in hospital for about five days. Because the radiation can affect others, you will normally be away from other people while you are being treated.

High-dose therapy

High-dose therapy is similar to low-dose therapy, with a machine feeding radioactive material into applicators. Because the source material is much more radioactive, you only need to be treated for ten or fifteen minutes at a time.

You will usually have up to five treatments with this kind of internal radiotherapy, with several days between each treatment. You will be able to go home between treatments, and you may be treated as an outpatient in some cases, where there is no need for overnight stays in hospital.

Side-effects of radiotherapy

Radiotherapy is given to kill cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body. cells, but unfortunately it is not possible to avoid some damage to healthy cells at the same time. The damage to other cells causes a number of side-effects.

Some side-effects will go away after the therapy has ended; others are permanent. How bad these side-effects are will depend on:

  • How long your radiotherapy lasts
  • How strong the doses are
  • Your particular reaction to the treatment.

Short-term side-effects

  • Fatigue - a general feeling of tiredness is very common in radiotherapy
  • Skin sensitivity or soreness - it is quite common for your skin to be made sore in the place where you are being treated
  • Bladder irritation - this is sometimes called radiation cystitis. You may feel as if you need to urinate all the time, and urination may be painful. It can help to drink plenty of water
  • Diarrhoea - it is quite common for pelvicRelating to the pelvis. radiotherapy to cause diarrhoeaWhen bowel evacuation happens more often than usual, or where the faeces are abnormally liquid.. Your doctor may give you medicine to control it
  • Vaginal bleeding and soreness - this is a frequent side effect of internal radiotherapy, but should not last more than a few days.

Long-term side-effects

Early menopauseThe time of a woman’s life when her ovaries stop releasing an egg (ovum) on a monthly cycle.

One of the main long-term permanent side-effects of radiotherapy for cervical cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body. is damage to your ovaries. The radiotherapy stops your ovaries from working, and so brings on the menopauseThe time of a woman’s life when her ovaries stop releasing an egg (ovum) on a monthly cycle.. This normally happens about three months after treatment.

The effects of this early menopauseThe time of a woman’s life when her ovaries stop releasing an egg (ovum) on a monthly cycle. are often more severe than those of a natural menopauseThe time of a woman’s life when her ovaries stop releasing an egg (ovum) on a monthly cycle.. Hormone therapy can be used to make the transition easier.

Vaginal changes

Radiotherapy has the effect of making tissues in the area of treatment less elastic. This can make your vagina shorter and narrower, and so make sexual intercourse difficult.

Your gynaecologist may be able to give you creams and dilators to help with this.

Swollen legs (lymphoedemaA build-up of fluid in an area of the body due to a reduction in the drainage of lymphatic fluid, a fluid derived from the blood.)

In a few people, radiotherapy affects the lymph glands in the pelvis, stopping them working properly. This can lead to a build up of fluid in your legs, making them swell.

If you do get lymphoedemaA build-up of fluid in an area of the body due to a reduction in the drainage of lymphatic fluid, a fluid derived from the blood., your doctor will be able to help you manage it with compression bandages, exercises and massage routines.

What questions should I ask my doctor about radiotherapy?

When you see your cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body. specialist you may find it helpful to have a list of questions to ask about your treatment. You might want to ask:

  • Why do you recommend that I have radiotherapy?
  • If I have the treatment will it cure my cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body.?
  • Is there a choice of treatments?
  • How long will the treatment take?
  • Should I have chemotherapyThe use of chemical substances to treat disease, particularly cancer. as well?
  • What are the possible short-term side-effects?
  • What are the possible long-term side-effects?
  • What are the chances I will have long-term side-effects?
  • How long will it take me to get back to normal?
  • Will I need hormone replacement therapyThe administration of female hormones in cases where they are not sufficiently produced by the body. Abbreviated to HRT.?