Undergoing Intravaginal Brachytherapy
Date:January 2024
Review: January 2026
Ref: B- 211/MR/Undergoing Intravaginal Brachytherapy v4
PDF: Undergoing intravaginal Brachytherapy v4.pdf [pdf] 136KB
Introduction
This leaflet is designed to give you the information that you will need before having a course of ‘Intravaginal Brachytherapy’ treatment for gynaecological cancer.
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 the case of intravaginal brachytherapy, it is achieved by insertion of an applicator inside the vagina.
Brachytherapy treatment can be used after surgery and external beam radiotherapy. It may also be used if surgery alone is the primary treatment of choice.
Why has this treatment been advised?
If you have had external beam radiotherapy previously, then intravaginal brachytherapy is given to deliver targeted radiation dose from inside, to the top of vagina. This is to reduce the risk of cancer coming back in this area in the future. Not all the treatment dose required can be given with the external radiotherapy.
If you have had surgery alone, having a course of brachytherapy treatment to the top of the vagina will also lower the chances of cancer coming back in that area in the future.
Prior to the treatment, you will have consultation with the Oncologist, where the intravaginal brachytherapy treatment and procedure relevant to you will be explained. The number of treatments needed do vary, so we will inform you of this. We will also need your consent to give the treatment, which means signing a consent form, ensuring you are fully informed of the proposed treatment plan.
If you have any questions about the brachytherapy treatment after this consultation, please do not hesitate to discuss them with the Liaison or Brachytherapy Radiographer. View our contact details.
When will I have the Brachytherapy?
We aim to start the vaginal brachytherapy in the week following the completion of pelvic external beam radiotherapy. It will depend on your treatment finish date.
If you have been having external beam radiotherapy at Plymouth, you will have a medical review during your radiotherapy treatment where we will explain the procedure to you, ensure you have all the information, ask for your written consent and the dates of procedure will be confirmed in a letter. You will need to attend for two treatments, usually given on Tuesdays or Fridays.
If you have had surgery only at Plymouth, time is needed for healing prior to starting vaginal brachytherapy treatment. Your Oncologist will discuss the appropriate timeframe for start of treatment and usually three sessions of intravaginal brachytherapy given once a week over three weeks are used. You may start on a Tuesday or a Friday and will be weekly thereafter.
The brachytherapy team will contact you by phone to discuss your start date and subsequent appointments when your referral has been received.
For patients having external beam radiotherapy or have had surgery alone in another hospital
If intravaginal brachytherapy has been recommended by your local Oncologist, then you will be referred to the Oncology team at University Hospital Plymouth for this treatment. Once the referral is received, the Brachytherapy team will contact you regarding your treatment dates and schedule.
You will need to have consultation with Oncologist at Plymouth prior to starting brachytherapy treatment. Usually, we would do it on the same day as the first intravaginal brachytherapy procedure. We appreciate you may have a considerable distance to travel, and it would avoid a separate visit.
Patients having had only surgery will need to attend for three sessions of intravaginal brachytherapy, a week apart.
Patients having had surgery followed by external beam radiotherapy will attend for brachytherapy usually in the week following completion of external radiotherapy and will have two sessions of intravaginal brachytherapy over one week.
Where are we?
We are located in the Plymouth Oncology Centre at Derriford Hospital (Level 2). We have a separate entrance, and the Oncology Centre is situated at the back of the Hospital. Using the Oncology entrance on Level 2, with direct access is advised as it is easier than entering via level 6 Main Entrance. The closest car park is “C”, located near the Derriford Health and Leisure centre. Please report to reception on arrival.
How long will I be in the hospital?
The intravaginal brachytherapy is given as an outpatient treatment, and you can expect to be in the department approximately 3 hours for the first attendance with subsequent visits shorter at approximately 30-45 minutes.
There is no prior preparation for you to do and you can eat and drink normally on the day of your appointments. Do take your usual medications as prescribed.
We advise that you do not drive after brachytherapy and that you are accompanied home. Getting public transport is also not advised. Please let us know if this is difficult for you.
What to bring with you?
We have limited space in the suite so please bring essential personal belongings only. You will keep your belongings with you during your time with us. A carer or family member/friend can attend with you but will be asked to wait in the waiting room during the procedure.
Consent Consultation
The Oncologist will explain the procedure and brachytherapy treatment that is advised for you. Possible side-effects will be explained in detail. Please ask if you have any concerns or questions about the procedure or treatment. Sometimes it is helpful to write down any questions you may have prior to your appointment. We will ask you to sign the consent form if you agree to proceed. If you are coming from another hospital the consultation will take place on arrival, prior to preparation or treatment.
Examination and preparation procedure (First visit)
It will take place in the Bluebell suite procedure room with the Oncologist and brachytherapy staff. We realise this will be an anxious time for many patients, however we will explain everything to you as we go along and are here to support you in any way possible.
We will ask that you put a hospital gown on and remove any clothing below the waist. You may be given pain relief tablets if required. The Oncologist will discuss it with you. Then we will ask you to lie on your back on a couch with two pillows for the duration of your time with us. The Oncologist will do internal vaginal examination using a speculum with your legs bent or lifted up in supports. The examination would help to ensure adequate healing of vaginal wound after surgery and also to choose the right size of brachytherapy applicator (a cylindrical tube) to be used for the procedure. It should not cause you pain but can be uncomfortable and similar to having a smear test, using a speculum to open up the vagina.
Next, the Oncologist or Radiographer will insert a urinary catheter into bladder as you will be unable to get off the couch until the treatment is finished. You will not be able to open your bowel during this time and you will be offered constipating medication if required.
The correct size brachytherapy applicator will be selected for you, and it is gently inserted inside the vagina much like inserting a tampon. The applicator is cylinder shaped and made of plastic. It is lubricated to reduce any discomfort and will be inserted slowly to reach the top of vagina.
During this time, it does help to relax as much as possible, however we do realise it may not be easy for you, we are here to help. Controlled breathing can also help with this. You can relax your legs down onto the couch once the applicator is in place.
The Oncologist or Radiographer will then connect the brachytherapy applicator to a clamp placed on the couch so that the applicator does not move out of place. It is not painful. You may have some pen marks put onto your skin for reference and these will wash off.
During the procedure we always respect your privacy and dignity at all times, covering you wherever possible. However, during the procedure, scan, and treatment it will be necessary to uncover you for a short while.
The following diagrams show the female anatomy and demonstrates the type of cylinder applicator that is inserted into the vagina during the procedure and for each treatment.
Once the applicator is in position, we will move you on the couch to do a planning CT scan of your pelvis. It allows us to check that the applicator is in the correct place and helps to calculate the radiotherapy dose to surrounding organs, if needed. It is only done on the first visit. The CT scan takes about 15 minutes.
Treatment procedure
Brachytherapy Radiographers will deliver your treatment. Prior to delivering the treatment there will be a short time gap when the dose and machine is checked.
Laying on the couch you will be wheeled into the treatment room. The brachytherapy machine is small, is not enclosed and will not touch you. It is at the foot of the couch and during the treatment you will not feel anything.
We ask that you lie still, and the radiographer will connect the vaginal brachytherapy applicator to the machine. It is done by using hollow tubing that connects to brachytherapy machine at one end and to the vaginal brachytherapy applicator at the other end.
Once connected, the radiographers will leave the room to deliver the treatment. No one else can be in the room with you during this time. We have a CCTV camera to observe you at all times during the treatment. Please wave your hand if you require assistance and we can interrupt the treatment to come into the room.
When the treatment is being delivered, a very small sized radioactive source will travel from the machine, down the tube to the inside of the vaginal brachytherapy applicator to deliver the specified dose of radiotherapy. It will then retract back into the machine when treatment is complete. The treatment can take between 2 to 15 minutes to deliver, and then the radiographers will re-enter the room to disconnect you from the machine tubing.
After the treatment
After completion of treatment, you will be wheeled back to Bluebell Suite so that the vaginal applicator and urinary catheter can be removed by the Brachytherapy Radiographer. It takes a few minutes only. The applicator and catheter are easily removed. When it is all done, you will be able to sit up and get dressed. We will ask you to pass urine prior to going home to ensure bladder function is not affected by the catheterisation. Details of any subsequent appointments will be given to you before going home.
Going home
It is essential that a responsible adult accompanies you home after the treatment and you should also not drive on the day.
Subsequent treatments
These will be shorter visits. The procedure is more straightforward. The Brachytherapy staff will ask you to empty your bladder just prior to entering the treatment room and walk you into the room. Neither urinary catheter nor CT scan is required for subsequent treatments.
After undressing and putting a gown on, we will ask you to lie on the couch as before, bending your knees up. The correct size vaginal applicator used for you on the first treatment will be gently inserted into the vagina with lubricant and fixed into position as before. This will usually be done by a Brachytherapy Radiographer.
Please let us know of any concerns following the first treatment so we can give you any advice if needed.
The treatment procedure will be same as the first treatment. On completion, the radiographers will re-enter the room, the applicator will be gently removed and once you are dressed you can go home.
Side effects after Intravaginal Brachytherapy
Bladder
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 and it is important to drink plenty of water at home.
Occasionally, a bladder infection can develop and if any persistent discomfort on passing urine occurs, you should contact your GP (family doctor), or Brachytherapy Radiographer for advice.
Vaginal soreness or bleeding/discharge
You may feel sore in the vaginal area following the treatment for a few days. You can take simple analgesics like paracetamol or Ibuprofen if you are not sensitive to these drugs. It is possible to have some vaginal bleeding/spotting or discharge following the treatment for a few days. Contact your GP or Brachytherapy Radiographer if it worsens or becomes odorous / uncomfortable.
Avoid sexual activity that involves penetration for about 6 weeks following completion of vaginal brachytherapy.
To reduce the risk of vaginal infection, bathe regularly, wear cotton underwear and avoid wearing tight fitting trousers or tights.
Bowel
You may experience loose stools or diarrhoea. Please let us know if this happens as you may need to take some medication. Drink plenty of fluids. If you have been advised to alter your diet, please continue to do so.
Tiredness
It is normal for this treatment to make you feel tired, so rest as you feel you need to.
Long term side-effects
The most common side-effect is to the vagina. The long term effects of radiotherapy can result in dryness of the vagina and narrowing or shrinkage of vagina. It can become less stretchy than normal vaginal tissue. If the vagina is dry, sexual intercourse can become difficult or uncomfortable and you may need to use lubricating jelly. These can be obtained via over-the-counter pharmacy or on prescription. Avoid using oil-based lubricants as it can irritate the vaginal walls.
As part of your follow up after treatment it is necessary to examine you internally. You will be given the option of using vaginal dilators to reduce the risk of vaginal narrowing or shrinkage. It will be discussed with you in detail by one of your Gynae Specialist Nurses when you attend for follow up appointment in oncology clinic 6-8 weeks after completing the treatment. It is particularly appropriate if you have not returned to intercourse 6 weeks after treatment or if you are not in a relationship.
Vaginal Bleeding
Occasionally any scarred areas in the vagina have fine surface blood vessels which may result in spotting of blood after internal vaginal examination and also after intercourse or use of vaginal dilators. Inform your GP or Gynae Specialist Nurse of any heavy or unexplained vaginal bleeding.
Bowel/bladder
In patients requiring only vaginal brachytherapy after surgery, the long-term side-effects on bowel and bladder function are rare.
There is approximately 5% risk of more complicated side-effects related to bowel or bladder function due to the combined external beam pelvic radiotherapy and vaginal brachytherapy treatments.
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 patients may notice increased urinary frequency or urinary control may be affected.
Feelings
Many patients find this a very stressful and anxious time. Reactions differ following treatment and you may feel low, anxious, and tired or depressed. During your treatment, please let us know if you are struggling in any way. There are people willing and able to help you at this time and if you have any worries or questions, please let us know. It may also be helpful to discuss your feelings with your GP or your cancer nurse specialist.
Support
In addition to the professionals, you have seen during your treatment, there is a support centre in Derriford Hospital called ‘The Mustard Tree’ Macmillan Centre. Help and support can be accessed during and after your treatment has finished. Support can help your emotions feel more manageable and help you focus on positive elements of your life.
Follow up
You will be reviewed in the Oncology Clinic 6-8 weeks following completion of your treatment. The appointment will be sent to you. 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. If you were referred from another hospital, your follow-up will be back with the team that saw you originally.
Useful telephone numbers
Liaison Radiographer & Brachytherapy Radiographer, Plymouth Oncology Centre, Radiotherapy, Level 2.
Tel: (01752) 437032
The Macmillan Support Centre (Mustard Tree). Derriford Hospital, Level 3.
Tel: (01752) 430060
Gynaecological Cancer nurse specialists, Derriford Hospital, (01752 437296).
Online sources of further information and support.
