In-patient brachytherapy for gynaecological cancer. Cancer Services Information for patients

Transcription

1 In-patient brachytherapy for gynaecological cancer Cancer Services Information for patients i

2 Introduction This booklet provides information about brachytherapy (a type of internal radiotherapy). We hope it will answer some of your questions about treatment. If you would like more information or have any further questions please ask. What is brachytherapy? Brachytherapy is internal radiotherapy and is used to treat cancer of the cervix (neck of the womb). Giving the radiotherapy from the inside allows a high dose of radiation to be directed to the cervix without passing through the surrounding tissue. Brachytherapy is given through an applicator (hollow tube) which is placed into your vagina and womb whilst you are under general anaesthetic in the operating theatre. It is given approximately five to fourteen days after you have finished your external beam radiotherapy and chemotherapy. What happens before I come into hospital for treatment? You will have an MRI scan about seven to fourteen days before your brachytherapy treatment. A few days before you are due for your treatment, usually a Thursday afternoon, you will be asked to visit Ward 39 in the Osborne Building for a pre-assessment appointment. You will see a nurse who will go through the admission and discharge process with you and can answer any questions you may have regarding treatment. You will have blood tests taken. The visit will last approximately one hour and you will be able to go home afterwards. It is recommended that you bring a friend or relative to help listen and take in some of the information for you. 2

3 How is the treatment given? Your brachytherapy treatment is usually given on a Tuesday and Wednesday. Please call Ward 39 on around 11am on the Monday to check a bed is available for your admission. You will then be asked to come to the ward at 4pm on the Monday. You must visit the MRI department to fill in a patient safety questionnaire before coming to Ward 39. On the evening of your admission you will be given some laxatives to help empty your bowel. On the morning of your surgery you will have an enema to empty your bowel completely. This will reduce the chances of you having a bowel movement during treatment. You will need to have nothing to eat or drink from midnight the night before your surgery. On Tuesday morning the anaesthetist will see you before your operation and will ask questions regarding previous surgery and any allergies. In theatre you will be given a general anaesthetic (you will be asleep) and the applicators will be inserted into your vagina and womb. Treatment is given through these applicators. When the applicators are in place gauze will be inserted into the vagina to push the bowel away from the treatment area to help reduce the side effects from the treatment and also to help keep the applicators in place. While in theatre you will have a catheter inserted into your bladder as you will not be able to get up to go the toilet while the applicators are in place. The catheter will be removed at the end of your treatment. 3

4 What happens after the applicators have been inserted? You will need to lie on your back for the remainder of your time on the ward, whilst the applicators are in place. If you have any concerns about lying on your back for long periods, please mention them at your pre-assessment visit. The applicators can cause back pain while they are in place. You can be given painrelieving injections to help with this pain. It is important to let the nurses know if you are in pain. When you have woken up from the anaesthetic you will be taken to the CT scanner room in the Radiotherapy Department where you will have a scan to check the position of the applicators. After your CT scan you will be taken to the MRI scanner. Both the CT and MRI scan will help us to plan your brachytherapy treatment. After the MRI scan you will be taken to Ward 39 so you can rest. In the meantime, the radiotherapy team will work on a brachytherapy plan for you, and you can expect to have your first treatment between 4pm and 6pm. For the treatment you will be taken back down to the Radiotherapy Department. When the machine has been programmed, the applicators will be connected to the long plastic tubes through which the treatment will be administered. Treatment time is between ten and twenty minutes and is completely painless. When the treatment is in progress there is radiation in the room, so the radiographers will leave the room and will observe you via cameras. When the treatment has finished you will return to the ward. There will be two more treatments on the following day (Wednesday), one in the morning and one in the afternoon. Before each treatment you will have a CT scan to check the position of the tubes. Occasionally patients require a blood transfusion. If necessary this will discussed with you by your consultant. 4

5 Are there any instructions when I go back to the ward? You must not turn on your side, sit up or lift your bottom off the bed as this could move the applicators. You can move your legs and will be encouraged to do so to help your circulation. Every hour you should take several deep breaths to help prevent chest problems that can occur from lying flat. Your urine will drain into the collecting bag. You do not need to try to pass urine. It is advisable to eat small amounts and drink lots of fluid. We recommend you bring snacks with you that are easy to eat lying down and a sports bottle for ease of drinking whilst lying down. What happens after my last treatment? You will be given a pain-relieving injection and a muscle relaxant 20 minutes before your last treatment. After the last treatment the urinary catheter will be removed. The applicators will also be removed: you will be awake for this procedure. When the applicators have been removed you will be able to sit up. A nurse will help you the first time you get out of bed as you may feel a little light-headed or dizzy after lying down for so long. This feeling will soon go away. You may be able to go home the day your treatment finishes if you have passed urine following removal of the catheter and you do not have any heavy vaginal blood loss. Some patients stay in for a further night. On discharge you will be given some pain relief to take home. We recommend you take this regularly to help your recovery and mobility. You will need someone to collect you from hospital and stay with you for the night following your discharge. 5

6 Are there any side effects? It is normal to have some side effects from the treatment. These usually settle within four to six weeks of finishing the brachytherapy. Possible side effects include: Vaginal discharge / bleeding The treatment causes some swelling to the lining of the vagina and you may notice a bloody or brown discharge. A slight discharge is normal. If you have a smelly or pale green discharge you should tell your doctor as it could mean you have an infection. It will help to reduce the risk of infection if you: inform your doctor as soon as possible if you have a lot of bleeding wear pants with cotton gussets avoid wearing tights or tight clothing wash the area gently every day, but do not have hot baths. Cystitis The bladder is close to the treated area. You may feel a burning sensation when passing urine. Drinking plenty of fluids helps to dilute the urine and flush the bladder through. You should inform your doctor if: your urine is cloudy or smelly you feel hot and feverish These symptoms may mean you have a urine infection and may require antibiotics. 6

7 Are there any side effects? (continued) Diarrhoea The bowel lies close behind the vagina. The treatment causes some inflammation to the lining of your bowel and this may give you mild diarrhoea. Drinking plenty of fluids (two to three litres or four to five pints) will help replace fluid lost by frequent bowel motions. Fatigue Many people feel tired following treatment, particularly for the first one to two weeks. It can take many weeks to builds up your energy again. It is advisable to gradually increase the exercises you take and rest when you feel tired. Perforation of the uterus When the applicators are inserted it is possible to perforate (make a small hole) in your womb. If this occurs it will show up on the CT scan and appropriate treatment will be given by your consultant. Pain The position of the applicators may cause some women to have discomfort or cramping pains for a few days after treatment. Take the pain relief given to you by the ward and take warm baths. Nausea If you experience any nauseous feelings please inform a nurse on the ward. 7

8 Long-term side effects These occur months or years after finishing radiotherapy. There may be some permanent changes in the tissues in the treated area. For most patients these do not cause significant problems. Vaginal scarring and dryness The lining of your vagina is very delicate. While it is healing after the treatment some scarring takes place. This means that bands of fibrous tissue (called adhesions) may form in your vagina making intercourse and internal examinations difficult. You can help to reduce this by using vaginal dilators which will be given to you on completion of your treatment if you have not been given them already. Going to the toilet more often There may be an increase in how frequently you need to empty your bladder. You may need to open your bowels more often and more urgently. These symptoms can usually be controlled by your diet In a very small percentage of patients there is a risk of more serious damage to the bladder, bowel and vagina leading to narrowing or formation of a small hole. This may mean that an operation is needed to correct the problem. 8

9 Key appointment dates to remember MRI (during external radiotherapy):.. Pre-assessment appointment:... Admission date:... MRI questionnaire completion (day of admission):... Brachytherapy treatment dates:..... Follow-up appointments You will receive an appointment six weeks after finishing your brachytherapy. This will be in the Oncology Clinic. If in the meantime you have any problems or questions please contact: Gynaecology Oncology Nurse Specialists (key workers)

10 Questions 10

11 11

12 If you would like this information in another language or format, please contact the service equality manager on Oncology Patient Information In-patient brachytherapy for gynaecological cancer Edition 2. August For Review: August CAN