Intrauterine Brachytherapy
Date issued: March 2024
Review date: March 2026
Ref: B- 210/MR/Intruauterine Brachytherapy v3
PDF: Intrauterine brachytehrapy final March 2024 v3.pdf [pdf] 275KB
Intrauterine Brachytherapy treatment a guide for patients and their families
Introduction
This leaflet is designed to give you the information that you will need before having a course of cervical brachytherapy (Intrauterine) treatment for your gynaecological cancer.
Cervical (Intrauterine) brachytherapy treatment is usually given in the week following completion of a course of daily External beam Radiotherapy to the pelvis for Cancer of the Cervix or sometimes in the last week of the External Radiotherapy.
Prior to your Brachytherapy treatment, you will have a consultation with the Clinical Oncologist, where the procedure will be explained to you in more detail and relevant information given. We will also need you to give us your consent to undergo the treatment.
You will be informed how many treatments you will need and of the Brachytherapy plan for you. This will take place in the planned weekly medical reviews in the radiotherapy area. You will have these booked on your schedule of radiotherapy appointments.
If you are being referred to Plymouth for the Brachytherapy from another hospital, you will be sent an appointment to attend a Consultation in the Oncology clinic so that the treatment plan for you can be discussed by the Oncologist here. Consent for the procedure will be taken and you may need to attend a Pre-Op assessment in the same visit. You will be advised of this.
We do appreciate that you will also need to attend on that day for External Beam treatment in your local centre but due to the timing required for the brachytherapy, both are important for you to attend.
Please mention any concerns about timings of appointments here /logistics of coming to Plymouth to the Radiographers locally and they can communicate with the Plymouth team, however, the Pre-Brachytherapy Consultation does need to be face to face to ensure you are fully informed of everything.
If you have any questions about the Brachytherapy plan after this consultation, please do not hesitate to discuss them with the Liaison or Brachytherapy radiographer (please find the contact details in the back of this leaflet).
What is Brachytherapy?
Brachytherapy is a treatment designed to deliver a dose of radiation internally. A radiation source is introduced directly inside the area of the body we wish to treat. In your case this is into the uterus (Womb) and top of the vagina.
The diagram below shows the pelvis and the position of one of the applicators that may be used to treat you. It will be placed inside you so that the Brachytherapy treatment can reach the correct areas.
The diagram above is to demonstrate where the bladder and bowel are in the pelvis.
The treatment does not leave you radioactive and it is fine to be with other people during this and after the Brachytherapy is finished.
How is Brachytherapy given?
Brachytherapy is given in divided doses, so called fractions, using a very small radiation source. We have a number of options of how to give these. Your Oncologist will explain how many fractions you will need and the pattern of giving these.
You will be admitted to Brent Ward, Level 8, on the day before the procedure for some preparation before theatre the following morning.
You may need to have a chest x-ray, ECG and blood tests done on Level 6 and you will be given the forms to have these investigations if they are required.
It will also be necessary to prepare your bowels prior to theatre by initially giving you an enema or suppositories and then constipating medication will ensure your bowels do not open during the procedure or treatment.
Eating or drinking
You may be asked to go onto a low residue diet, much like the foods that you may be eating during the external treatment you have had already. This will be explained to you.
You are allowed to eat and drink until midnight before the anaesthetic. After midnight you will not be able to have anything at all, except to take any tablets you need. Please check with the doctor for advice on taking diabetic medication or Warfarin if you are on these. You will be under the care of the nursing staff on the ward and they will also advise you on what to do.
Theatre
You will be taken from Brent Ward the following morning to the theatre.
The applicators are usually inserted into place under a general anaesthetic in theatre or using a spinal/epidural. The anaesthetist will discuss the best option for you.
Your oncologist will examine you internally and a tube (Urinary catheter) will be placed into your bladder. The treatment applicators (hollow tubes) will be placed into the vagina and also into the uterus with packing gauze ribbon in the vagina used to ensure it all stays in place.
Interstitial Brachytherapy Needles
These are fine plastic tubes that are sometimes used in conjunction with other Brachytherapy applicators. The oncologist will let you know if these will be used for your treatment. The needles will be placed into the tissue area to be treated during the anaesthetic. The number of these to be used will depend on the size and area needing treatment. They will remain in place for the brachytherapy treatment and removed at the end.
During the insertion of plastic interstitial needles, there is a small risk that a needle may penetrate the bowel, urinary bladder, or may cause bleeding in the pelvis if a blood vessel is damaged. The chance of this happening is quite small. Most of such episodes would resolve by conservative management. In rare cases, surgery to open the abdomen and repair damage to the bowel or control bleeding may be required.
Recovery
A period of time will be spent in theatre recovering from the anaesthetic where you will be monitored closely and given any pain relief required to keep you comfortable. When you wake up you will be aware of the applicators between your legs.
It will be necessary to lie relatively flat on the bed/trolley to avoid the applicators moving or becoming dislodged for the whole period of time of your treatment.
Once you have recovered from the anaesthetic, you will have a CT scan of your pelvis in the Radiotherapy Department on Level 2. An MRI scan may also be done.
After the scans you will return to Brent ward and continue to be given appropriate pain relief throughout your time with us. You will remain lying in bed in the same position until the treatment plan is complete.
How we plan the treatment
This is done using the CT/MRI scan. It allows us to plan the treatment and calculate the dose of Brachytherapy treatment for you and to ensure the dose to the bladder and bowel is as low as possible.
We also check the applicators are in the best possible position to deliver the treatment to the area. This complex process of planning the treatment can take several hours to complete by the physics team and Oncologist.
Brachytherapy Treatment procedure
The porters will collect you from the ward on your hospital bed and bring you to Radiotherapy on Level 2.
The treatment team will need to check your correct ID prior to treatment and confirm you still agree to proceed. Please ask any questions at any point.
The treatment is given in a Brachytherapy treatment room. You will stay on your hospital bed for the Brachytherapy. We will need to uncover your pelvis to check the applicators are in the correct position but will cover you up as much as possible throughout.
The Radiographers will connect a plastic tube to your applicators and this is also connected to the HDR treatment unit (High Dose Rate After loader).
You should not feel anything from the treatment when it is delivered.
The radioactive source is very small and travels down the tubing from the machine and into the applicators where it lodges to give you the treatment. It returns to inside the after loader when the dose has been delivered.
The radiographers need to leave the room during the treatment. They can see you clearly at all times on a camera system. They will be checking you are doing fine but can enter the room if you should need them.
Usually, the treatment takes between 10 and 15 minutes to deliver, and once the treatment is finished, the source automatically travels back inside the machine and the radiographers will re-enter the room.
Sometimes there is a need to introduce water into the catheter balloon inside you which is easily done via the catheter tube.
If there is a build-up of gas in the lower bowel, the Oncologist may insert a thin flatus tube into the rectum (Back passage) prior to treatment delivery. This is not painful.
We will preserve your dignity at all times. The radiographers will be present in the room to chaperone you.
After the first treatment
You will return to Brent ward until the second treatment the following morning (Approx. 8.30am).
During this time the applicators will remain inside you. After the second fraction, another CT scan will be done in Radiotherapy, (approx. 9am).
When the CT scan has finished you will be taken on the trolley/bed back to the ward and have a third treatment Wednesday afternoon when the plan is ready from Physics.
On Thursday at 9am you will need another CT scan to plan a fourth fraction which is usually delivered approx. 2.30pm.
Sometimes the timings can vary of treatment and scans. This will be explained to you.
In between scans and treatment and overnight you will be cared for on the ward.
Removal of Applicators
When all your treatment is finished you will be taken to the Brachytherapy Bluebell Suite, so that the brachytherapy applicators and packing can be removed along with the catheter in your bladder. If interstitial needles have been used these will also be taken out.
You will need to bend your knees up for this for a few minutes only. We will ensure you are given adequate pain relief during the applicator removal. We have Entonox (gas and Air) you can use during this time which is short acting and helps any discomfort.
The Radiographers will support you through this.
You will be made comfortable before returning to Brent ward where any further care will be given until you are feeling well enough to return home.
If you need two insertions, you will be admitted the following week to repeat this procedure.
Going home
After having a general anaesthetic, it is essential that a responsible adult accompanies you home after the treatment and stays with you for the next 24 hours. You should also not drive a car, operate machinery, drink alcohol or sign any legally binding document for 24 hours. It is also advisable that you do not take sole responsibility for children or anyone who is in need of your care, such as the elderly for the same period of time.
You will be given an aftercare leaflet with contacts for the Brachytherapy team and instructions with who to contact if you need advice or help afterwards with any side effects. Your bowels may be constipated afterwards, and you may need laxatives for a few days to help with this. Any medications to take home will be prescribed from the ward.
Side effects after cervical Brachytherapy
You should not feel unwell after this treatment but you may notice slight discomfort the first time you pass urine after the catheter is removed. You should drink 1-2 litres a day and we need to check you can pass urine normally before you go home.
Occasionally, a bladder infection can develop and if any persistent discomfort on passing urine occurs, you should contact your GP (family doctor) or you can ring the Liaison radiographer contact on the leaflet for advice on what to do.
Vaginal bleeding/discharge
It is possible to have some vaginal bleeding or discharge following the treatment for a few days and the vagina will feel sore for a few days afterwards. Contact your GP if any discharge persists becomes smelly or pale green/yellow or you can also ring the Liaison radiographer/Brent ward for any advice. You should also contact us if you have continued bleeding/discomfort for more than a few days or blood on passing urine.
The contact numbers are at the back of this booklet.
To reduce the risk of infection, bathe regularly, wear cotton underwear and avoid wearing tight fitting trousers or tights.
Bowel
You may experience looseness or diarrhoea so continue to follow the dietary advice you have previously been given and continue taking the anti-diarrhoea medication if needed. Drink plenty of fluids. It may be best to reintroduce avoided foods slowly.
Tiredness
It is normal for this treatment to make you feel tired, so rest as you feel you need to.
Longer term side-effects
The most common side-effect is to the vagina. It can become quite dry, with narrowing and shrinkage also. The vagina can become less stretchy than normal vagina tissue. If the vagina is dry, sexual intercourse can become difficult or uncomfortable. As part of your follow up after treatment it is necessary to examine you internally fully and so keeping your vaginal tissue supple is important after treatment.
You will be given the option of using vaginal dilators to reduce the narrowing, this is particularly appropriate if you have not returned to intercourse by 6 weeks after treatment or if you are not in a relationship.
If intercourse is resumed it may be necessary to use lubricating jelly such as KY jelly or Sylk. These may be obtained over the pharmacy counter. Do not use oil-based lubricants such as baby oil or Vaseline.
You will be given a clinic appointment usually at 6-8 weeks after the treatment to discuss use of vaginal dilators.
Please feel free to contact your Gynae Specialist Nurse to discuss the dilating further.
Bleeding
Occasionally any scarred areas in the vagina have fine surface blood vessels which may result in spotting of blood after examination and also after intercourse.
Inform your GP of any heavy or unexplained bleeding or please contact us for advice.
Bowel/bladder
There is an approximate 5% risk of more complicated side-effects to the bowel or bladder due to the combined external beam and Brachytherapy treatment. These will be explained to you before the procedure. These can include some lasting alteration in bowel habit that may be controlled by altering your diet. Some people continue to pass urine more often.
Fertility
External beam radiotherapy can affect the functioning of the ovaries and the uterus, therefore usually making you sterile and unable to have children. Brachytherapy treatment, usually focusing on the uterus and top of the vagina, can also make you sterile.
Feelings
Many patients find this a very stressful and anxious time. Reactions differ following treatment and you may have low moods, feel anxious and tired or depressed.
There are people willing and able to help you at this time and if you have any worries or questions, please ask any of the people in this booklet for further advice.
It may also be helpful to discuss your feelings with your GP.
Support
In addition to the professionals you have seen during your treatment, there is a Macmillan support centre at Derriford hospital called ‘The Mustard Tree’. Help and support can be accessed during and after your treatment has finished. This is located in the oncology centre on level 3.
Please seek advice and support if you need it, this will also be available at your local cancer centre if this is not in Plymouth. Support can help your emotions feel more manageable and help you focus on positive elements of your life when your treatment finishes.
Follow up
You will be seen in the clinic following completion of your treatment by your oncologist. This appointment will be sent to you and will usually be for about 6-8 weeks after treatment. The appointment will usually consist of finding out how you are and examining you. Scans and x-rays are usually not done at this point.
Follow-up care is continued by your referral cancer centre and Oncologist so further visits to Plymouth are usually not required.
Aftercare
If you have any worries or concerns about how you are feeling after this treatment, but before the follow up, you can phone the Liaison aftercare/Brachytherapy radiographers for advice.
Useful Telephone Numbers
Liaison Radiographer & Brachytherapy Radiographer
Tel: (01752) 437032 (office hours, not weekends)
Gynaecological cancer nurse specialists, Derriford Hospital
Tel: (01752) 437296 (office hours, not weekends)
The Macmillan Support Centre (Mustard Tree) Level 3.
Tel: (01752) 430060
Brent Ward, Level 08, Derriford Hospital Tel: (01752) 792306 (out of hours and weekends)
