Radiotherapy uses x-rays to kill cancer cells or injure them so they cannot multiply. The radiation can be targeted at cancer sites in your body. Treatment is carefully planned to do as little harm as possible to your healthy body tissues.
Radiotherapy combined with low-dose chemotherapy (known as chemoradiation) is the current treatment of choice if the cancer is larger than a certain size, involves parts of the vagina or tissues outside the cervix, or involves the lymph nodes (as seen on CT, MRI or PET scan, or when found at surgery).
It is accepted practice worldwide to combine daily radiotherapy treatments (which take about five minutes) with low-dose chemotherapy once a week for four to six weeks. This is because research has found that women with invasive cervical cancer have better survival rates when they are given both treatments simultaneously, compared to radiation alone.
Less commonly, radiotherapy may be used after surgery.
Both external radiotherapy and internally placed radiotherapy (called brachytherapy) are used to treat cervical cancer.
In external radiotherapy, x-rays from a large machine called a linear accelerator are directed at the cervix and any other parts of your pelvis (and sometimes lower abdomen) that need to be treated.
You will probably have radiotherapy treatment from Monday to Friday for four to six weeks as an outpatient. The actual treatment only takes a few minutes each time. Radiotherapy treatment starts with an extended medical assessment, usually by a team of doctors who specialise in cancer diagnosis, treatment and follow-up. They are called radiation oncologists, and they will work together with a medical oncologist (who specialises in chemotherapy) to plan and organise your treatment. You will need to see both types of specialist for discussion before the details of the treatment can be finalised. Your consent will be taken. You may need time to understand these processes.
Radiation treatment is administered by a group of technical specialists called radiation therapists. You will meet them when the treatment is being planned at a separate appointment called ‘simulation’ or ‘planning’. Initially you will have a CT scan, where you will lie either on your back or on your stomach on a special couch. The doctor may need to place some material that can be seen on the scan inside the vagina, together with a tampon. This is only done for the CT scan. This appointment allows for accurate planning of where your treatment needs to be given.
Blood tests are performed to make sure you are not anaemic (have a low red blood cell count). If you are anaemic, a blood transfusion may be recommended.
During the treatment, you will lie on a table under the radiotherapy machine. Once the machine is turned on, you will be alone in the room, but you will still be able to talk to the radiation therapist through an intercom.
External radiotherapy does not make you radioactive. The treatment is painless when it is given. You will not hear, see or feel the x-rays.
Internal radiotherapy (brachytherapy)
Brachytherapy is a form of radiotherapy. It is delivered into or very close to the cancer from inside the body. Your radiation oncologist will discuss the method to be used with you before you begin treatment.
Brachytherapy is usually given after a course of external radiotherapy with weekly chemotherapy. This is because most cervical cancers become smaller during this treatment and this allows the brachytherapy to be more effective. Brachytherapy involves placing implants with a radiation source inside the cervix and vagina, as close to the cancer as possible. This gives adequate radiation to the tumour while minimising the dose (and side effects) to nearby organs, such as the bowel and bladder. Most patients will have three to five treatments.
The implants are inserted for a short time while you are under a general anaesthetic. The radiation source is placed into the implant for only a few minutes. The implant and the radiation source are removed before you wake up. Because the radiation source is removed, there is no radiation risk to other people around you. You will usually go home on the same day.
Less commonly, brachytherapy is given over 48–72 hours. You will go into hospital as an inpatient and have a general or spinal anaesthetic. The implant will be placed in your cervix and vagina and left in place for up to 72 hours. The brachytherapy will be given during this period. You may be in a room of your own. Your nurses will be able to enter the room to respond to your needs by pressing a button which withdraws the radiation temporarily. Nurses will explain how your visitors can protect themselves from radiation. After the treatment is complete, the implant will be removed. You will no longer be radioactive and you can go home.