This information explains what you can expect from internal radiotherapy - also known as high dose rate (HDR) Brachytherapy for cancer.
We hope it answers some of the questions you may have. Please tell us if there is anything you don’t understand. We are here to take care of you and we don’t mind how many questions you ask.
What is Brachytherapy?
Brachytherapy is a type of radiotherapy, which is given internally (inside the body).
Brachytherapy can be used as the main treatment or as part of a combination of treatments which may include surgery, external beam radiotherapy and chemotherapy.
Where will I have the treatment?
If you are having the treatment as a day case then you will be admitted to Day Case Ward 4 at the Freeman Hospital. If you are having the treatment as an inpatient then you will be admitted to Ward 34 or 35 at NCCC. This type of treatment is
usually given on a Thursday morning. Your oncologist or specialist nurse will tell you whether you will need to come as an inpatient or a day case.
What happens when I am admitted for treatment?
- On admission one of the nurses will explain the process, offering you the opportunity to ask any questions. You will
also be assessed by an anaesthetist.
- If you are admitted to Ward 34 or 35, then you will also be seen by the ward doctor who will ask you questions and
- You will have a blood sample taken and may have an ECG test (a heart tracing). You may need to go for an x-ray and see the anaesthetist. This is to check how fit you are for treatment.
- Please bring with you any medication that you are taking and show this to the doctor or nurse on the ward.
- You may be given some white stockings to wear before you go to theatre. This is to reduce the risk of blood clots
developing in your legs.
Can I eat and drink?
Your treatment will be in the morning so you will not be able to eat or drink after midnight on the previous night.
What happens in theatre?
Your anaesthetist will decide which type of anaesthetic is the most appropriate one for you. You may have a general anaesthetic where you are asleep or a spinal anaesthetic. A spinal anaesthetic involves putting anaesthetic into the spine so that you will not be able to feel anything from the waist down while you undergo the treatment.
When you are in theatre the oncologist will examine you and insert a tube called an applicator into your vagina and cervix.
The applicator will be secured with gauze packing and elastic bandages around your thighs. As you will be unable to pass water normally while the applicator is in place, a catheter will be placed into your bladder to drain the urine away.
As soon as everything is in position and you are comfortable you will be taken from theatre to the radiotherapy department on a trolley.
What happens in the Radiotherapy Department?
In the radiotherapy department you will have an MRI (Magnetic Resonance Imaging) scan to plan your treatment. There may be a short wait whilst your treatment is planned. After this you will be taken into the brachytherapy room to have your treatment. In this room the applicator is connected to a machine (called a micro-selectron) using long thin tubes. The machine will then deliver treatment to you internally via the tubes.
The whole process of going to theatre, planning your treatment and having the treatment usually takes about two to three hours. MRI planning can take up to half an hour. The actual treatment time is only about ten minutes.
How does the treatment feel?
During the treatment you will remain lying flat on the treatment trolley. You will be alone in the room during treatment. You will be monitored all the time on close circuit TV. At any time you will be able to call a nurse into the room. If you have had an anaesthetic into your spine you will not feel any sensation from your waist downwards.
If you have had a general anaesthetic you may feel some backache or discomfort from the vaginal packing when you wake
up. The ward doctor will give you some medication to help the pain.
What happens when the treatment finishes?
The machine switches off automatically when the treatment has finished. The oncologist will remove the vaginal packing, the
applicator and the catheter in the treatment room. This only takes a few minutes. You will then be taken back to day case theatre ward or the inpatient ward on the trolley. You will then be given something to eat and drink.
If you are having your treatment as a day case, the nursing staff will make sure you are well enough to go home before you are discharged.
What happens next?
You will be sent an appointment to see your oncologist in an out patient clinic about six to eight weeks after your treatment finishes. After this you will be seen at regular intervals for up to five years (approximately every three months for the first two years then at every six months for the next three years).
What are the possible side effects?
For most women these effects are short term, but occasionally some women may develop long term bowel, bladder or vaginal problems. Your oncologist will discuss this with you before treatment.
- Bowel: The treatment may cause diarrhoea. Changing your diet or taking medication can help this. We also advise that you drink lots of fluids. Your specialist nurse or oncologist can advise you.
- Bladder: The treatment may cause some irritation when passing urine. You can help this by drinking plenty of fluids. You may need some medication if it does not get better or if your urine is cloudy or smelly. Your specialist nurse or oncologist can advise you.
- Pain/discomfort: You may get experience some cramp or pain in the abdomen. Taking mild painkillers and warm baths can often help with this. If you have any pain after you leave hospital please contact your GP. You may have some vaginal irritation or soreness. Regular bathing or using a lubricant such as KY jelly or Replens can relieve this.
Do not use any other creams as these may make the soreness worse.
- Fatigue: You may feel very tired. This is quite normal and we advise you to rest during the day as often as you need.
• Vaginal discharge/bleeding. You may have a bloody or brown discharge following the treatment, this is normal. If the discharge is smelly or pale green report it to your GP as this may mean you have an infection. To reduce the risk of infection bathe yourself daily, wear cotton underwear and avoid wearing tight trousers or tights.
- Vaginal scarring: Your specialist nurse or oncologist will speak to you about this and give you information about using vaginal dilators. If you wish they will also discuss any possible difficulties you may have with sexual intercourse.
- Feelings: Reactions following treatment differ from person to person. These emotions are part of the process that people go through in trying to come to terms with their illness. You can contact your specialist nurse if you would like someone to talk to or the other sources of information listed. Please speak to your specialist nurse or oncologist about any concerns you may have in relation to the procedure or any side effects you experience from treatment.