Internal (Intracavitary) radiotherapy (often called brachytherapy) gives radiation treatment directly to a particular part of the body. In women it is used for treating cancer of the cervix, womb (uterus) or vagina. It can be used on its own or combined with external radiotherapy. A piece of radioactive material, known as a source, is put close to the area of the cancer. The advantage of internal radiotherapy is that it gives a high dose of radiotherapy directly to the tumour, but a low dose to normal tissues.

The source is placed inside applicators (hollow plastic or metal tubes) which are positioned at the top of the vagina. (Sometimes only one tube is used). This keeps the source in place. The applicators are placed inside the vagina while you are under a general anaesthetic or sedation in the operating room. At the same time, a flexible tube called a urinary catheter may be put into your bladder to drain off urine. This means that during your treatment you won’t have to move around to pass urine (which could dislodge the applicators).

Once the applicators are in place, an x-ray will be taken to check that they are in the correct position. Sometimes the radioactive source is put into the applicators while you are in the operating room, but more commonly it will be put in place once you are back on the ward in your own room. The applicators are kept in place by a pack (cotton/gauze padding) inside your vagina. This can be uncomfortable but you can have regular painkillers to ease any discomfort.

Once the source is in place you have to stay in bed, so that the applicators don’t move out of position. If you need anything, you can call a member of staff by using the buzzer by your bed. If the source does move out of position, you should call the staff on the ward straight away.

Many women find the prospect of this treatment quite worrying. It’s important to talk things through with your specialist so that you understand as much as you need to about what your treatment involves. Some hospitals have specialist nurses who are trained to give advice and support to women having treatment for gynaecological cancer. Ask your specialist what help is available in your hospital.

In many hospitals a machine called a Selectron, or similar name, is used to put the radioactive material into the applicators. The machine is attached by tubes to the applicators. When the machine is switched on, it passes small radioactive balls into the applicators. If the machine is switched off, the radioactive balls are pulled back inside the machine. The machine is kept switched on throughout treatment, except when someone needs to go into your room. It can then be turned off, to reduce their exposure to the rays.

However, safety measures and visiting restrictions are still necessary. The time you spend on the machine varies, but it’s usually between 12–48 hours.

Sometimes a machine called a Microselectron is used for internal radiotherapy. It gives the radiotherapy more quickly, so the treatments last for only a few minutes and you can go home the same day.

Once the complete radiation dose has been given, the source and the applicators will be removed. This is usually done in your own room on the ward (rather than in an operating theatre). As it can be a little uncomfortable, you will be offered some painkillers beforehand. Sometimes a few breaths of the gas Entonox will help you to relax. Staff on the ward will check that all the applicators and sources have been removed. Your catheter may be removed at the same time.

Your specialist may suggest that you use vaginal douches for a few days after the applicator has been removed to keep your vagina clean. Vaginal douches are a way of ‘rinsing’ the vagina to keep it clean. Your nurse will tell you more about this.

You will probably be able to go home the same day, or the following day. Once the radioactive sources are removed, all traces of radioactivity immediately disappear.

Many women are given both internal and external radiotherapy to ensure the cancer is treated in the most effective way.

It is not unusual to have slight bleeding or discharge once the radiotherapy treatment has ended. If it continues or becomes heavy, it’s important to let your doctor or nurse know.

Radiotherapy to the pelvic area can cause side effects such as tiredness, diarrhoea and a burning sensation when passing urine (cystitis). These side effects can be mild or more troublesome depending on the strength of the radiotherapy dose and the length of your treatment. Your specialist will be able to advise you what to expect.

Most of these side effects can be treated with medicines, which your oncologist can give to you. Any side effects should gradually disappear once your treatment is over.

It’s important that you drink plenty of fluids and have a healthy diet during your treatment. If you have diarrhoea you can ask your doctor to prescribe anti-diarrhoea medicines. You may feel sick, but this isn't common. If you don't feel like eating, you can replace meals with nutritious high-calorie drinks, which are available from most chemists and can be prescribed by your GP. Our section on eating well has some helpful tips on eating when you are feeling ill.

Menopause

Unfortunately, radiotherapy for cancer of the cervix affects the ovaries, and brings on the menopause, usually about three months after the treatment starts. This means that your periods will stop and you will have menopausal side effects such as hot flushes, dry skin and possibly loss of concentration. Some women become less interested in sex and notice that their vagina is dry.

You can be protected from menopausal side effects by taking HRT (hormone replacement therapy) as tablets or skin patches. Your gynaecologist may suggest you start on these during the radiotherapy treatment or shortly after it has ended. It’s important to discuss the possible effects of menopause with your specialist so that you can be given appropriate advice and support. An organisation called The Daisy Network can help women who have experienced premature menopause.

Sometimes radiotherapy causes a narrowing of the vagina, which can make sex uncomfortable.

This can be distressing but there are things that can be done to help. See our sections sexuality and fertility for advice on how to deal with the effects on your sex life and fertility.

Radiotherapy to the pelvic area can sometimes cause long-term side effects (sometimes called 'late effects'). However, improvements in treatment planning have made these much less likely.

In a small number of people, the bowel or bladder may be permanently affected by the radiotherapy. If this happens the increased bowel motions and diarrhoea may continue, or the person may need to pass urine more often than before. The blood vessels in the bowel and bladder can become more fragile after radiotherapy treatment and this can make blood appear in the urine or bowel movements. This can take many months or even years to occur.

If you notice any bleeding it is important to let your doctor know so that tests can be done and appropriate treatment given.

Our section on pelvic radiotherapy in women has information on coping with these side effects.

Some people also find that radiotherapy affects the lymph glands in the pelvic area and can cause swelling of the legs. This is known as lymphoedema. It is more likely if you have had surgery as well as radiotherapy.

These can be used to treat a number of types of tumours including those in the mouth, lip, cervix and breast. Very thin radioactive needles, wires or tubes are inserted while you are under general anaesthetic in the operating room.

An x-ray may be taken to ensure that the needles are in the correct position. You will be in a room on your own, and the safety measures will be used until the wires are removed – usually after 3–8 days. Sometimes the wires are removed under a general anaesthetic.

Wires in the mouth can be uncomfortable, and can make eating and talking difficult. You will need to have a soft or liquid diet while they are in place. Your nurse will show you how to keep your mouth clean, using regular mouthwashes. If eating is a problem you may be fed through a thin tube (a nasogastric or NG tube), passed up your nose and down into your stomach.

The wires are removed once the correct dose of radiation has been given. This may be after two days if the treatment is given as a booster following external treatment or up to one week if it is the only type of radiotherapy treatment being given.

Once the wires have been removed, the area will feel sore for up to two or three weeks afterwards. Your specialist will prescribe painkillers that you can take regularly until this improves.

After caesium brachytherapy there is a slight risk of infection, but this is very rare. If you develop a high temperature or heavy bleeding after your treatment, contact your specialist as soon as possible. You will be prescribed antibiotics to treat the infection.

Brachytherapy using radioactive seed implants is sometimes used to treat small tumours of the prostate gland.

Brachytherapy is available in some hospitals in the UK. It is carried out under a general anaesthetic, or sometimes a spinal anaesthetic. Small radioactive metal seeds are placed into the tumour within the prostate gland, and they release small doses of radiation very slowly over a period of time. The seeds are not removed, but stay in the prostate tissue. The radioactivity gradually fades away over approximately a year. The radiation affects only the area a few millimetres around the seeds, so there is no danger of it affecting other people.

Side effects

It is fairly common to feel some soreness and bruising after the seeds are implanted. Your doctor can prescribe painkillers to help.

Some men get blood in their urine, which is quite normal. If you notice a lot of blood you should let your doctor know. It can help to drink plenty of fluids to flush through any blood.

It may be painful to pass urine for a time, or you may need to pass urine more frequently, or have a weaker stream. Up to one in seven men will have difficulty passing urine after brachytherapy. Some men will need to have a catheter inserted for a while. Occasionally the tube that drains urine from the bladder (urethra) will narrow some time later. If this happens, the urethra can often be stretched.

Brachytherapy treatment may cause impotence, and some men may become infertile after treatment.

It’s important to discuss this with your specialist who can advise you about the likely impact of brachytherapy on your sex-life and fertility, and suggest ways of coping.

Our section on early (localised) prostate cancer explains this treatment in more detail. See also our information about the possible late effects of pelvic radiotherapy.