Your Oncologist (Cancer Doctor) has recommended HDR Brachytherapy.

This information will tell you about this treatment, what to expect when you attend, what to expect after treatment and any possible long term side effects.

Hospital bedBrachytherapy delivers radiation into body cavities or tissues using hollow tubes known as applicators and is ideal to treat tissue that is close to the applicator. An applicator is put in place just before each treatment session. The radiation comes from a small solid radioactive source that is stored in a specialised treatment machine.

During treatment the radioactive source travels down a tube, into the applicator, delivers the radiation as per your specific patient plan and is then automatically returned to the machine. You are NOT radioactive following your HDR Brachytherapy treatment and are therefore fine to be around children and anyone who is pregnant. Brachytherapy treatments can be delivered alone or can be combined with external beam radiotherapy (EBRT). 

Brachytherapy treatment is carried out in the Brachytherapy Suite at Clatterbridge Cancer Centre: 65 Pembroke Place, Liverpool L7 8YA. Please check in on Floor 1.

You do not need to do any special preparation prior to your brachytherapy appointment; please eat and drink normally before you attend.

If possible, wear a loose skirt or dress rather than trousers. 

To make you feel more comfortable, you may want to empty your bladder beforehand.

You may drive yourself to and from the appointment, however you may prefer to have someone drop you off and pick you up. Please refer to the trust website regarding the visitor policy at the time of your appointment to check if someone can accompany you into the hospital.

You will be taken through to the Brachytherapy suite where you will be seen by the Brachytherapy Radiographers and the Oncologist. 

The whole appointment takes about 20 minutes.

The procedure is very similar to having an internal vaginal examination. You will be asked to lie on the bed and will be examined and an applicator gently placed into your vagina. Plenty of lubricant is used. The applicator needs to be firmly at the top of the vagina so you will feel some pressure. Once the applicator is in position, it will be secured to a holder attached to the bed. You will need to stay lying on your back with your legs flat and will be covered up from then until the end of the procedure. 

The radiographers will need to do treatment calculations and checks outside of the treatment room prior to administering the treatment. They do not stay in the room while you are having your treatment, but they can see and hear you all the time via a microphone and CCTV. At the start of treatment, the radioactive source moves from the machine into the applicator. You will not feel anything, but you will hear some noises from the machine. Treatment takes about 5-10 minutes.

When the treatment has finished, the radioactive source automatically returns to the machine. The applicator will be removed by a radiographer and you can leave.  

After your treatment, you may experience some side effects. These symptoms are normal and should last a few days only. However, if they continue or worsen, you should contact your GP.

These may include:

  • 'Spotting' (slight bleeding) or discharge from the vagina. These symptoms are normal. If the discharge becomes smelly, you may have an infection and may need antibiotics: see your GP.
  • Pain and/or discomfort when you empty your bladder (cystitis). It is important to drink plenty of fluids, as this will help to soothe the bladder.
  • Abdominal cramps - You can use an over-the-counter painkiller such as Paracetamol or Ibuprofen (unless you are allergic to them) to relieve the discomfort.
  • You may have the sensation of needing to empty your bowels, but then only have small movements or just pass mucus and wind. This is called tenesmus and happens as a result of irritation to the rectum.

Combination of treatments
The effects from brachytherapy alone are relatively mild. If you have also had EBRT, there are side effects relating to this which are detailed in the ‘Radiotherapy to the female pelvis’ patient information leaflet.    

Brachytherapy treats only the tissues that are close to the applicator. It is possible that scar tissue will slowly develop in these tissues. The majority of treatment-related effects appear within the 1st or 2nd year, but can start to up to 3 years later. 

The treatment can cause the vagina to narrow and shorten and become less elastic (stretchy) in comparison to before treatment. This may cause discomfort or pain during sex or an internal examination. The regular use of a vaginal dilator (dilators are tubes that are inserted into the vagina for a few minutes on a regular basis) will help to prevent vaginal narrowing and their use is recommended, even if you are sexually active. The use of dilators will be discussed and you will be offered a pack, together with additional written information.

Dryness of the vagina may also become a problem. If you are sexually active, the use of water-based lubricating gel can be helpful. 

It is important to remember that the side effects from brachytherapy differ from the side effects from external beam radiotherapy. If you are having other problems or symptoms after treatment it is unlikely that this is related to brachytherapy.

It is important to participate in your follow-up. The first appointment is usually about 6 weeks after finishing treatment.  The type of follow up may vary depending on your needs. If you do not receive an appointment either by text or post within 2 weeks of finishing treatment, please contact your Cancer Doctor’s Secretary.

The diagnosis of cancer together with the impact of treatment and any side effects can have a major impact on how you feel, which then affects how you behave. Sometimes, your relationship(s), including sexual intimacy, are affected. You might find that you lack interest in sex. Please discuss any sexual problems that arise with your Cancer Doctor /nurse specialist, as various treatments or referral to specialist teams are available to help.  

It is entirely natural to feel anxious that your cancer may return and we recognise that this can make you feel very uncertain about the future and lead to difficulties in “getting on with life”. If you find that you have long or frequent periods of low mood you should seek help from your GP. There are many ways to be helped, including but not always, a short course of anti-depressant tablets. Sometimes, more help is required to help you cope and overcome any negative feelings. Often, these feelings become more apparent once you have completed all your treatments and you are beginning to recover. You should discuss these issues with your GP or your Cancer Doctor at your follow up appointments. Referrals to specialist staff, e.g. a psychologist or sexual health practitioner alone or with your partner can be beneficial.

When to contact your CNS

It is important to remember you will still get coughs, colds, aches and pains and bowel upsets just like anyone else. Your GP will normally be happy to treat such problems. However if they are concerned about your symptoms when they see you, they can contact your CNS who can arrange a clinic appointment.

For most patients their treatment is effective and their cancer will not come back but sometimes people do have problems. We would like you to contact your CNS if you have any of the following symptoms and they persist for more than two weeks:

  • New onset of bleeding or persistent discharge from the vagina
  • Bleeding from the back passage and/or changes in bowel habit
  • Persistent abdominal bloating
  • Bleeding after sexual intercourse
  • New problems with passing water
  • New persistent aches, pains, discomfort or lumps in your tummy
  • New lower back pain
  • Unexpected weight loss without dieting or exercise
  • Persistent loss of appetite or nausea
  • New persistent breathlessness
  • New swelling of one or both legs

It is important to remember that even if you have some or all of these symptoms it does not necessarily mean the cancer has come back, but we will arrange to see you in clinic to check you over. Do remember, however, that some of these symptoms can also be caused by other conditions that are completely unrelated to womb cancer, so please do not become unduly anxious while awaiting your review.

There is an information video available on our Brachytherapy page.

There are also links to additional information leaflets:

  • Radiotherapy booklet
  • Radiotherapy to the female pelvis
  • Use of vaginal dilators when receiving radiotherapy to the pelvis

Macmillan booklets about coping and living with cancer and treatment side effects are available free of charge. These can be ordered by telephoning 0808 808 0000 or by visiting a Macmillan Information Centre (sited in the main entrances of Clatterbridge Cancer Centre - Liverpool, Clatterbridge Cancer Centre - Aintree and Clatterbridge Cancer Centre - Wirral).

Useful Contacts

The Clatterbridge Cancer Centre
Telephone 0151 556 5000

Macmillan Cancer Support 
Telephone 0808 808 0000

Cancer Information and Support at:
Clatterbridge Cancer Centre - Liverpool 0151 318 8805
Clatterbridge Cancer Centre - Wirral 0151 556 5570
Clatterbridge Cancer Centre - Aintree 0151 556 5959

Brachytherapy Clinical Specialist Radiographer
Direct dial 0151 556 5342

Gynaecological Cancer Clinical Nurse Specialist (CNS)
Direct dial 0151 556 5134 

The Clatterbridge Cancer Centre Hotline
0800 169 5555
If you are unwell during or up to 8 weeks following your cancer treatment please call The Clatterbridge Cancer Centre Hotline. Your call will be answered by a dedicated nurse advisor. This line is available 24 hours a day, 7 days a week.