Feedback We appreciate and encourage feedback. If you need advice or are concerned about any aspect of care or treatment please speak to a member of staff or contact the Patient Advice and Liaison Service (PALS): Freephone (City Hospital Campus): 0800 052 1195 Freephone (QMC Campus): 0800 183 0204 From a mobile or abroad: 0115 924 9924 ext 65412 or 62301 E-mail: pals@nuh.nhs.uk Letter: NUH NHS Trust, c/o PALS, Freepost NEA 14614, Nottingham NG7 1BR www.nuh.nhs.uk Internal radiotherapy (HDR Brachytherapy) for cervical cancer Information for patients Radiotherapy Department If you require a full list of references for this leaflet please email patientinformation@nuh.nhs.uk or phone 0115 924 9924 ext 67184. The Trust endeavours to ensure that the information given here is accurate and impartial. High Dose Rate microselectron This document can be provided in different languages and formats. For more information please contact: The Nottingham Radiotherapy Centre City Campus Hucknall Road, Nottingham Tel: 0115 962 7976 Jo Creelman, Lesley Smith. Radiotherapy Department October 2016. All rights reserved. Nottingham University Hospitals NHS Trust. Review October 2018. Ref: 1266/v3/1016/AS. Public information
Introduction This booklet provides information about brachytherapy (internal radiotherapy). We hope it will answer some of your questions about the treatment. If you would like more information or have any further questions please ask the radiographer looking after you. If you are satisfied that you have received enough information about your cancer, the benefits and risks of any treatments, or no treatment and you decide to have brachytherapy you will be asked to sign a consent form. What is brachytherapy? Brachytherapy 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 it passing through the surrounding tissue. Internal radiotherapy is given through an applicator which is placed inside your vagina whilst you are under anaesthetic. The treatment is given after you have finished your external beam radiotherapy and chemotherapy. How can brachytherapy help? Brachytherapy may be offered to you with chemotherapy and external beam radiotherapy for curing or controlling cancer of the cervix. How is the treatment given? Brachytherapy is given by a machine called High Dose Rate microselectron. The treatment is carried out in the south radiotherapy department. You will need to stay in hospital. You will have three internal treatments. The first treatment is given on a Thursday. You stay overnight on the ward and have the second and third treatment the following day, after the treatment is given you go home - you will be discharged later that day, or the following morning. 2 Carers UK Provides information and advice on carers rights. Can put people in contact with support groups for carers locally. Tel: 020 73784999 NHS Direct 24 hour nurse-led helpline, providing information and advice about health, illness and health services. Tel: 0845 4647 Macmillan Cancer Support Provides practical, medical, emotional and financial support Freephone: 0808 808 2020, Monday to Friday, 9am to 10pm Textphone: 0808 808 0121 Cancer Counselling Trust Offers confidential telephone counselling to individuals, couples or families affected by cancer across the UK. Tel: 020 7704 1137 Useful websites www.jostrust.org.uk www.cancerresearch.org.uk www.macmillan.org.uk www.daisynetwork.org.uk www.infertilitynetwork.uk www.maggiescentres.org www.mariecurie.org.uk www.nhsdirect.nhs.uk www.eastmidlandscancernetwork.nhs.uk 11
Useful organisations NOTTGOSH (Nottingham Gynaeoncology Self Help Group) A friendly informal support group for gynaeoncology patients and their carers. Social evenings and speakers. Meetings are last Tuesday of alternate months, 7pm to 9pm at City Hospital Campus. Tel: Sue Mills on 0115 969 1169 ext 56162. Jo s Trust Provides information and support to women with cervical cancer, their families and friends. Helpline is staffed by trained volunteers. Tel: 0808 802 8000 days/times may vary. Gynae C Provides information and emotional support via a telephone help-line, E-mail, letter and website for women with gynaecological cancers, their partners, families and friends. Tel: 01793 491116 Daisy Network Offers online support and information for women who have experienced an early menopause. Infertility Network UK Provides information, support and telephone counselling about infertility issues. Tel: 0800 008 7464 What happens before the treatment? The anaesthetist sees you before your admission to hospital and any tests that are necessary to check your general health are organised. You need to have a MRI scan a few days before your brachytherapy. This type of scan uses a magnet to get detailed pictures of your cervix. The MRI pictures are used with radiotherapy scan pictures to plan your treatment. You must not have anything to eat after 2am and only clear fluids up until 6am the day of the procedure. You come into Fraser ward at 16:00 on:... Please bring any tablets or medicines that you are taking. What happens in theatre? Once you are under anaesthetic the oncologist places the applicator in position. Gauze is packed around the applicator to stop it moving. A thin, flexible tube (catheter) is put into your bladder and this drains urine into a bag while the applicator is inside. The procedure takes about twenty minutes in theatre. You go into recovery to wake up and then to radiotherapy for a CT planning scan. Cancer Recovery Foundation Aims to help people prevent and survive cancer through education or by direct assistance. Programmes include Family Emergency Service Fund which provides direct financial assistance for families in need. Tel: 020 8249 6054 Citizens Advice Bureau Offers free, confidential, impartial and independent practical advice on a variety of issues including financial, legal, housing and employment. Contact details for your local office can be found in the phone book. 10 Cervical applicator 3
How is the treatment planned? A radiotherapy CT scan is done to plan your treatment. You come to the radiotherapy department from theatre on a trolley. After your CT scan you go back to your ward while the planning is done. On your return to the ward you can eat and drink freely as long as you don t sit up. What happens during the first treatment? The radiographers make you comfortable on the treatment bed. A radiographer connects the applicator to the treatment machine with flexible tubes and sets the dose to be given. The treatment machine is called the Microselectron. The machine makes clicking noises when it is working. A small radioactive pellet passes in to the applicator to deliver the treatment. The treatment is not painful. The radiographers will leave the room to switch the machine on. You will be on your own for the treatment. We do not wish to cause offence or distress when we ask family or friends to remain in the waiting area. This is to limit exposure to radiation. How long will the treatment take? The treatment usually takes about 15 minutes. The treatment time is worked out for each person. The radiographers will tell you the exact time before your treatment starts. The radiographers can see you on closed-circuit television. You must lie still on the treatment bed so that the applicator doesn t move. You stay overnight on the ward with the applicator inside. There is a pay to view TV and telephone or you can bring in your own mobile devices. You can call a nurse at any time. What happens after the treatment? You will receive a follow up appointment six weeks after finishing your brachytherapy. This will be in the Radiotherapy clinic. What should I do if I m worried? Most women who have this type of radiotherapy make a very good recovery and are able to continue with all their normal activities. If you develop new symptoms after your treatment is over or if you are concerned that the immediate side effects are not clearing up, please use the following numbers. Radiotherapy Information and Support 0115 962 7976 Gynaecology Specialist Nurses 0115 969 1169 ext 53238 / ext 56162 King s Mill Hospital 01623 622515 ext 3073 Macmillan Cancer Information Centre 0115 840 2650 Student radiographers We are a teaching hospital and we sometimes have male and female students observing in the treatment room. Please tell the radiographers if you prefer not to have an observer with you. Data Protection Act 1998 The hospital trust is responsible for maintaining the confidentiality of any information we hold on you. If you have any questions or concerns about this please ask the radiographer looking after you. 4 9
Are there any long term side effects? 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. Dilators Dilators are smooth, plastic tubes which can be put into your vagina to gently stretch the tissues They come in different sizes so a small one can be used to start with The dilator is left in position for a few minutes each day You may be given a set of dilators and some lubricating jelly when you have finished your treatment. There is an instruction leaflet with them A Radiographer will show you the dilators and explain how to use them If you are at all worried about using the dilators we can ask the district nurse to come to your home and help you. There are some gentle exercises you can do in bed so you don t lie completely still all the time. There is an information leaflet which you might find helpful. Please contact the physiotherapy department if you have any questions or would like more information. What happens during the second and third treatment? On Friday morning, you come to the radiotherapy department from the ward on a trolley. After your scan you go to the ward while the planning is done. The second treatment is given in the same way as the first one but the treatment time might be slightly different. The radiographers will tell you the exact time before your treatment starts. The third treatment is given six hours later. The applicator and catheter are taken out on the ward after the third treatment is finished. You may experience some discomfort during this. A sedative, and pain-killer can help to ease it. You can go home after passing urine without the catheter. You will not be radioactive. If you do not have a sexual relationship at the moment it s still important to use the dilators. The doctor will need to do internal examinations as part of your check up in clinic. This may be uncomfortable if the vagina has become very narrow. If you are sexually active it is safe for you start having intercourse again as soon as you feel comfortable to do so. Some women experience bleeding after sex for the first few months after treatment. We advise using a lubricant such as KY jelly for vaginal dryness. 8 5
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. 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 own doctor as it could mean you have an infection. It will help to cut down the risk of infection if you: wear pants with cotton gussets avoid wearing tights wash the genital area daily 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 see your own doctor if: your urine is cloudy or smelly you feel hot and feverish These signs may mean you have a urine infection. Your doctor can test your urine and treat you with tablets if you have an infection. Pain The position of the applicator may cause some women to have discomfort or cramping pains for a few days after treatment. You will be given painkillers to take home with you. You may find warm baths soothing. If the painkillers do not help you should see your own doctor. Fatigue Many people feel tired following treatment, particularly for the first one to two weeks. It can take many weeks to build up your energy again: Rest when you feel tired Gradually increase the exercise you take and the tasks you do Balance periods of activity with short rests Vary your activities to stimulate your interest Use your energy to do things that you enjoy Return to work when you feel ready Loss of appetite It s common to lose your appetite when you are recovering from treatment: Don t worry if you can t eat proper meals Eat small snacks as often as you can Choose foods that you enjoy Buy foods that are easy to prepare or ready prepared Diarrhoea The bowel lies close behind the vagina. The treatment causes some inflammation to the lining of your bowel and this may give you diarrhoea. Drinking plenty of fluids (two to three pints a day) will help replace fluid lost by frequent bowel motions. You will be given some tablets to take home to control the diarrhoea. 6 7