Radiotherapy treats cancer by using high-energy rays which destroy the cancer cells, while doing as little harm as possible to normal cells. Radiotherapy for cancer of the cervix can be given externally or internally, and often as a combination of the two.

Radiotherapy is usually given if the cancer has spread beyond the cervix and is not curable with surgery alone. Radiotherapy may also be used after surgery if there is a high risk that the cancer may come back. It is often given in combination with chemotherapy.

Your cancer specialist (clinical oncologist), who plans your treatment, will be able to discuss any concerns you may have.

Planning is a very important part of radiotherapy, and makes sure that it is as effective as possible. It may take a few visits. On your first visit to the radiotherapy department, you will be asked to have a CT scan or lie under a machine called a simulator, which takes x-rays of the area to be treated. The treatment is planned by a cancer specialist (clinical oncologist). Marks will be made on your skin to show the radiographer (the person who gives you your treatment) where the rays are to be directed.

Before the x-rays and scans are taken, a tampon may be inserted into your vagina and a liquid which shows up on x-ray may be passed into your rectum. This makes sure that the clearest possible pictures are taken.

External radiotherapy is normally given as an outpatient, as a series of short daily treatments in the hospital radiotherapy department. High-energy x-rays are directed from a machine at the area of the cancer. The treatments are usually given from Monday to Friday, with a rest at the weekend. The number of treatments will depend on the type and size of the cancer, but the whole course of treatment for early cancer will usually last a few weeks. Your doctor or radiographer will discuss the treatment and possible side effects with you.

Before each session of radiotherapy, the radiographer will position you carefully on the couch and make sure that you are comfortable. During your treatment you will be left alone in the room, but you will be able to talk to the radiographer who will be watching you carefully from the next room.

Radiotherapy is not painful but you do have to lie still for a few minutes while your treatment is being given. The treatment will not make you radioactive and it is perfectly safe for you to be with other people, including children, after your treatment.

You will have regular blood tests during your radiotherapy treatment and you may need a blood transfusion if you become anaemic.

Internal radiotherapy (also called brachytherapy) gives radiation directly to the cervix and the area close by. To do this, tubes which give the radiation are placed into your vagina, close to the cervix. A machine, usually a selectron, feeds small radioactive metal balls into the tubes. The tubes are usually left in place for one or two days. The radioactive balls (sources) can be withdrawn into the machine when people come into the room. This is to keep the dose of radioactivity to visitors and nurses as low as possible.

With internal radiotherapy, visitors are usually restricted and children are not encouraged to visit. While the selectron tubes are in place you will be asked to stay in bed to make sure that they stay in the right position. For the same reason, your urine will be drained away through a small tube (catheter) which is passed into the bladder.

The safety measures and visiting restrictions might make you feel very isolated, frightened and depressed at a time when you might want people around you. If you have these feelings, it is important that you let the staff looking after you know. It might also be helpful to take in plenty of reading material and things to keep you occupied while you are in isolation. You only need to be in isolation while the tubes are in place. Once they are removed the radioactivity disappears and it is perfectly safe to be with other people.

The tubes will be removed by one of the doctors or nurses and this can be a bit uncomfortable. Painkillers will be given before they are removed. Sometimes sedation or gas and air (entonox) may be given to make it easier for you.

In some radiotherapy departments an implant containing a higher dose of radioactivity (microselectron) is used and this is only in place for a few minutes. These shorter treatments may need to be repeated several times, a few days apart, and may be given as an inpatient or outpatient. This treatment does not need a tube (catheter) in the bladder to drain the urine, but a catheter may be needed when x-ray pictures are taken during the planning of the treatment.

It is not unusual to have slight vaginal bleeding or discharge once the radiotherapy treatment has ended. If it continues for more than a couple of weeks or becomes heavy it is 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. These side effects can be mild or more troublesome depending on the strength of the radiotherapy dose and the length of your treatment. The cancer specialist will be able to advise you what to expect.

Most of these side effects can be treated with medicines. Your cancer specialist will be able to help you. Any side effects should gradually disappear once your treatment is over.

We have information about the early and late effects of pelvic radiotherapy in women, and ways of dealing with them.

Diarrhoea or nausea

It is important that you drink plenty of fluids and eat as healthily as possible during your treatment. If your diarrhoea is not controlled with medicines, let your doctor or nurse know. You may feel sick during treatment, but this is not common. If you don’t feel like eating, you can have nutritious high-calorie drinks instead of meals. The drinks are available from most chemists and can be prescribed by your GP. Our eating well section has some helpful tips on eating well when you feel ill.

Sore skin

Your skin may get sore in the area being treated. Perfumed soaps, creams or deodorants may irritate the skin and should not be used during the treatment. Your radiographer or nurse can advise you on skin care during this time.

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

The menopausal side effects can be reduced by taking HRT (hormone replacement treatment) as tablets or skin patches. These can be prescribed by your gynaecologist during the radiotherapy treatment or shortly after it has ended.

Tiredness

Radiotherapy can make you very tired. It is important to get as much rest as you can, especially if you have to travel a long way for treatment each day.

Radiotherapy to the pelvic area can sometimes lead to long-term side effects, but these are not common. Ways of dealing with the long term effects of radiotherapy are discussed in our section on pelvic radiotherapy in women.

Effects on the bowel or bladder

In a small number of women, the bowel or bladder may be permanently affected by the radiotherapy. If this happens the increased bowel motions and diarrhoea may continue, or you 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 cause blood in the urine or bowel movements. These effects can take many months or 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.

Effects on the vagina

Radiotherapy can make the tissue in the vagina lose some of its elasticity (stretchiness), which may make it narrower and shorter. This can make sexual intercourse difficult and painful. Using vaginal dilators can help to keep the vagina supple. Hormone creams can also be helpful. Radiotherapy can cause small fragile blood vessels to develop in the vagina, which can lead to slight vaginal bleeding (particularly after sex). Let your doctor or nurse know if this happens and they can check that everything is ok for you.

Swelling of the legs (lymphoedema)

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