Cervical cancer

Welcome to Cancer Care Services at the Royal Brisbane and Women’s Hospital. You are here today to begin your journey through radiation therapy to the pelvis.

A radiation therapist will greet you in the waiting area and bring you through to one of our radiation planning rooms. Your radiation planning session is a critical component of your radiation treatment.

You will be required to remove clothing from your lower body, as well as your shoes, in our change room before we begin.

The staff will start with you in a sitting position on the CT bed. We use a laser system to ensure you are straight and level when lying down. The usual treatment position is with your legs slightly apart in foot stocks and your hands on your chest.

Do your best to remain as relaxed as possible during the simulation process. When you are tense or stressed, your body position changes compared to when you are relaxed. It is important that we can position you exactly the same each day for treatment as you were during your planning session.

We will move you around until we achieve the ideal treatment position. Please allow us to make these movements for you.

In some circumstances, we may create a personalized mold for you called a vac bag. It is a beanbag that we mold to cast a defined impression of your pelvis, back, and legs. We mold the bag around you, then remove all the air, which locks your shape into the bag. This is not required for all pelvis treatments.

We will place non‑permanent pen marks on your pelvis that are used to set your position each day. Stickers are placed on these marks so they can be seen on your CT scan.

We will then move you into the CT scanner. It is important to stay as relaxed and still as possible, and breathe normally throughout the scan. It only takes a few minutes.

Once the scan is finished, we will return to the room, remove you from the CT scanner, and record on paper and with photos all aspects of your planning session.

The final requirement of your planning session is giving you permanent marks. You will usually receive three of these. We clean the area first, then apply a small drop of ink onto your skin. We then use a very fine needle to give you a small tattoo. They are quite painless and so small that they will be hard for you to find. These marks are very important, as we use them to direct the radiation each day.

At the end of your planning session, a radiation therapist will walk you back to the waiting area to book your first treatment appointment. You will leave today with your first appointment date and time on your appointment card, which you need to bring with you each day.

For further information regarding your treatment, please refer to other videos in this education series or speak with any member of our Cancer Care team.

Welcome to Cancer Care Services at the Royal Brisbane and Women’s Hospital.

You are here today to begin your course of radiation treatment.

You will be treated on one of our five treatment units. This is pre-determined by your radiation oncologist depending on your individual clinical circumstances.

You will likely be treated in the same room each day while on treatment. However, you may be treated in the other identical treatment rooms from time to time.

Once our treatment room is ready, we will guide you into the room.

Each day, we are required to ask you your full name, date of birth, and the area of your body you are having treated.

We have music playing in the room, but if you prefer no music or your own music played, please let us know.

We start by sitting you on the treatment couch and then carefully lay you down.

The radiation therapist will now reproduce your position from your simulation session. Do your best to remain as relaxed as possible during the treatment process.

When you are tense and stressed, you may hold your body in a different position to when you are relaxed.

We will then secure your mask in place.

As we raise the treatment couch, we dim our lights and use lasers to reproduce your position.

Our adjustments to your position are very small. Do your best not to help, and allow us to perform movements for you unless asked.

If it feels too tight or uncomfortable in any areas, let the team know.

Once happy with your position, we will advise you that we will exit the room.

This will also be signified by an audible indicator.

It is your job to remain as relaxed and still as possible, as any movements you make will require us to restart the setup.

You may be in the room by yourself for up to 15 minutes daily, but this will vary from day to day depending on many factors.

From outside the room, we take a series of images that we use to accurately target your treatment site.

We may re-enter the room to adjust your position physically or by moving the bed from outside.

We are now ready to commence your radiation treatment.

Whether you are treated on a linear accelerator or TomoTherapy therapy, radiation is delivered with the same intent, just with a different approach.

Both machines will make different noises during the delivery of the radiation, and as the machine rotates around you.

You will receive the same amount of radiation daily, as prescribed by your oncologist.

You will not feel anything during the treatment.

Be sure to breathe normally at all times.

We are watching you on closed circuit cameras from outside the room while delivering your treatment. If you need us for any reason, carefully wave your hand, and we will come in to help you out.

Once completed, we immediately return to the treatment room. Remove your mask and bring the bed down please stay still until you are told it is safe.

Your treatment is now complete.

You can dress yourself and head home.

You should not have experienced any pain or sensation from the radiation delivery, and it’s safe to be out in public, as you are not radioactive.

It is important to discuss with the treatment team any concerns or issues you may have during the course of your treatment.

You will have been given your next day’s appointment time and your estimated finish date for treatment.

For further information regarding your treatment, nursing care, or support services, please refer to other videos in this education series, or feel free to speak with any member of our cancer care team.

Radiotherapy or radiation therapy kills cancer cells using high energy X-rays that are generated electrically.

The radiation is directed to the specific area of your body that requires treatment.

Radiation therapy is normally given daily, but can be delivered as a single treatment or over a period of up to six weeks

Treatment each day can take from ten minutes to up to an hour, depending on what area of your body is receiving the treatment.

There are two different ways that radiation therapy can be given, externally and internally.

The most common method is delivered externally using machines called linear accelerators. These machines are like X-ray machines on steroids.

In our department, we also have TomoTherapy machines, and we have a specialised technique called total body irradiation for bone marrow transplant patients.

All radiation therapy machines target the radiation into the specific area being treated in your body.

With external radiation therapy as soon as the machines are turned off the radiation is no longer being produced.

You are not radioactive, so it’s safe to shower, use shared bathrooms, kiss, hug, have protected sex.

It didn’t really feel like anything. It was kind of like an MRI, if you have one of those before. I just laid there with my eyes closed, chilled out. It smelt kind of weird, and it’s hard to explain kind of like a metallic smell.

Radiation therapists are the people who in conjunction with the radiation oncologist, design and deliver your radiation therapy treatment.

Our department is located on level three of the Cancer Care Precinct within the Joyce Tweddell building of the RBWH.

The Sony You Can Centre, located on level six of our building, is a purpose built recreational space for AYA patients.

So if you feel like taking a break away from the waiting areas or wards, there is a space specifically designed for our young people.

Radiation therapy is designed personally for you.

A radiation oncologist worked with a team of specialists across the entire health service to provide you with recommendations regarding the best treatment for you.

As your radiation treatment is custom designed, you will be seen in the radiotherapy department a few weeks before your treatment starts.

At this appointment, a CT scan of the area of your body is a must, and sometimes personalised equipment is created for you to help you stay still and make your treatment precise.

It is very important for you to be as comfortable as possible, and therefore, if it isn’t, please let us know.

So I had full body irradiation. So I was put on a bed lying flat, and I had, they made a cast of my body and I was wrapped in that, and had a lot of sand bags put on top of me.

I don’t know the technical names because I do not care to know. First lot of treatment, a face cast was used with a vacbag behind me just to make sure that I’m held nice and secure in place. And for the second lot of treatment, none of that was used and the machine rather spun around me, which provided me with a little bit more ease.

So the linear accelerator, which is the radiation machine and I had a mask made. So this one here, which is my little face and my favorite piece of equipment used was the speaker. So you can use that to like, play your own music. Which was really awesome.

Just like an x ray, you should not feel anything when you’re having your treatment.

The way radiation works, it also affects the cells around the area of the body being treated.

You may experience some side effects after your first week of treatment.

Your radiation oncologist will discuss your potential side effects before your treatment starts.

Side effects experienced are usually dependent on where you’re having treatment.

If you begin to experience any of them, make sure to tell the radiation oncologist, radiation therapists or the nursing team within your centre.

With the first intensive radiation therapy I experienced very intense side effects, muscle pain. It burnt the inside of my throat and I couldn’t swallow. But as I was getting ready for a transplant, that was all to be expected and kind of, you know, exacerbated by other chemotherapy treatments.

With the second lot of treatment that I had that was daily for a month, the side effects were a lot less, you know, that was just a bit of tiredness, fatigue and joint pain, but no severe burns or discomfort when swallowing was experienced.

Just the soreness of where the radiation was targeted towards me, which in my case was my chest, and that was really it. There’s no other side effects, which was great.

So my side effects were I was sick after every single treatment. And because I was getting it on my head as well, I lost my hair.

So going into it, I kind of just accepted the fact that my body may not react nicely to treatment, so I didn’t put any pressure on myself to uphold my lifestyle. And looking back like, I’m really glad I did that because I was really fatigued throughout the whole thing. I would say, if you’re getting it five days a week to maybe plan for weekends, maybe a Sunday, because I was still quite tired on a Saturday. And I think like really just like think about your body and if you wake up feeling ready for it and energised, then organise something then, but yeah, just listen to your body.

So during radiation, I made sure to go at my own pace. I made sure that any activities that were planned with me and my friends or family were less high energy and more socializing and just chilling.

I just kept it at one day at a time often to prepare yourself mentally and emotionally for the next session. I also tried to bribe myself with fun activities, lunches, coffees, anything that would work.

I kind of just had to power through it, realise that this is really going to help you in the future and that a small like couple of hours of uncomfortableness is going to result in you being able to hopefully be happy and healthy for a long time in the future.

I’d probably tell myself, you don’t need to be so strong, you know you can let yourself take it all in. Tt’s not a scary time, it’s something that you need to get better.

Just to look again, pay attention to your body, do whatever makes you happy, comfortable and gets you through it, whatever that is. I had Maccas after every single treatment, just do whatever works for you. Yeah, and this don’t put pressure on yourself. It’s a lot to go through. So mindfulness, self-care, eat whatever food you want, do whatever you can to get through.

I think for me, it, you know, I would tell myself that it’s so important to understand that it will pass. You know, the treatment cycle will finish, you know, your body will slowly recover. And even in the worst parts of it, you can get through by looking at the fact that you will be healthy and stronger again. And those feelings and smells and senses they will stop.

For more information about radiation therapy, please visit the Cancer Council website.

For more information about adolescent and young adult support services, please visit these websites.

My name is KK. I’m from Malaysia. I came to Australia when I was 20 years old. Corelle. So I’m an Aboriginal woman from Cape York.

Uh, I was diagnosed with cervi- cervical cancer IIIc I. I was diagnosed with, cervical cancer stage IIIc I. When I heard about brachytherapy, I think I went down a,

internet, tunnel. So, was quite scared and, did my own research initially and on the internet, there’s a fair bit of, I think misinformation or

scary, scary information and it’s… And there’s an American side of brachytherapy and an Australian side of brachytherapy. I was just more curious about, like, the aspects of what sort of

brachytherapy and how long the brachytherapy’s gonna last. I actually got myself into a bit of a panic, but, through, you know, support and questioning I found out that it wasn’t as

scary as it w- what I thought it to be. Brachytherapy is a crucial part of the curative treatment for cervix cancer. We have to place some type
of applicator, or in some cases multiple applicators, through the vagina, through the cervix, and then int- placed into the uterus.

And then we’re able to place our radiation source inside these applicators to give the treatment. So therefore the radiation is focused and

concentrated on the actual cervix itself and the cancer. The treatment is delivered by a machine which looks like a little robot that sits by the side of the bed.

The machine will need to be connected to the applicators that are in you. With these applicators in place, it means

that you are going to have to be confined to bed for the duration of the treatment, which may be

one, two, or sometimes even three days. On the day that you are admitted to hospital for your brachytherapy, firstly you

will come to the operating theater and have the applicators put in under an anesthetic. There are various types of anesthetics that can be offered on the

will come to the operating theater and have the applicators put in under an anesthetic. There are various types of anesthetics that can be offered on the

day. We will tailor the anesthetic to you as an individual according to your medical needs and also your preferences.

The most common type of anesthetic we offer is an epidural anesthetic. This is where we place a very fine plastic

catheter into your back, and when we infuse local anesthetic through that catheter, it provides numbness to the lower part of your body.

This will keep you comfortable during the insertion of the applicators and afterwards as well. To do this, we do it in a sterile fashion.

We clean your back, and then we numb the skin with a small injection and place the catheter itself. Often, you will also be offered

either some sedation or a general anesthetic as well. This is where you’re right off to sleep. The epidural itself though needs to be placed either while you’re awake or under a

very light sedation so that you can tell us what’s going on when we put it in. I was really curious what’s an epidural, so I went on TikTok and, like,

I… Yeah, so, it was just worried and scared but eventually, it was more of a curiosity. I was quite anxious, to be honest. I had a bad experience, with

my son over 23 years ago, so I c- I’ve carried that epidural experience through with me. So I did speak to the nurses about, and the care team about

my, I guess my anxiety around doing an epidural. It, it worked. It definitely works. So, I never had kids, so I never had epidural

before. So, yeah, it was just, the doctor kind of prepped you by, like, showing you what you need to do and then, like,

before you knew it, the needle was already in. And then, like, it happened so quick for me. I was really lucky because they had it in one go and then, like, yeah.

So, like, it felt a bit funny actually after they’d gone in. Like, there was a bit of an electric shock and a slight burning sensation as it

So, like, it felt a bit funny actually after they’d gone in. Like, there was a bit of an electric shock and a slight burning sensation as it

touches. Like, I felt my leg were a bit, like, weird, when it first went in. But the doctor already, like, told you what

to expect before it happens, so I think the mental prepping helped a lot. And then, like, it was nothing unusual.

Like, and eventually, like, it was in and I didn’t feel anything at all. Once you’re comfortable and safe, you’ll be able to go down to the radiation

oncology area to check the position of the applicators and to make sure that you’re ready to commence your treatment.

You’ll have an epidural pump connected to your epidural catheter, and that will have a button that you can press.

You’ll be able to press it every 20 to 30 minutes, and it does have a lock on it so

you can’t overdose yourself. With the epidural you did have to press a couple of times, but it was more so just a preventative before pain

set in. I used it, like, once through the procedure ’cause I wanted to practice on it. And towards the end because I was so afraid of the kinda, like,

you can’t overdose yourself. With the epidural you did have to press a couple of times, but it was more so just a preventative before pain

set in. I used it, like, once through the procedure ’cause I wanted to practice on it. And towards the end because I was so afraid of the kinda, like,

removal of the apparatus, I pressed it a couple of times just to make sure that I don’t feel pain.

Retrospective, it was unnecessary. Like, I think the dose given to me was enough, and then I was also given those

ibuprofen and paracetamol. You won’t be radioactive when all of this is removed. And really, you’re not radioactive for this treatment except

for the time when you’re connected to the machine and when the machine is delivering the actual treatment itself. We place a catheter, which is a tube that goes into your

bladder, and so therefore your urine will just drain into a bag by the side of the bed while you’re

confined to bed for the treatment. For, for your bowels, we do actually have you on a special diet before you come into hospital, which should

reduce your need to open your bowels while you’re confined to bed. We do have medication, so if you feel the urge to go, we can give

you medication to try and slow it down.Sometimes none of that works, and you, you know, you pass a bit of wind, and sometimes your

bowels open as well. That’s okay. Um, that won’t affect the treatment, but if it happens, it happens. I never had any hospital stays before.

Get checked on by nurses like a couple of hours, and you get fed like, meals every now and then. You get checked your blood pressure, and then like,

the machine buzz off every hour. Downloaded lots of videos and I- and everything on my phone. I had a book. I needed someone to talk to.

I could FaceTime my daughter, and my grandkids FaceTime me. So it was just having connection with the outside world.

I had food and snacks, and not having a cappuccino every morning was I knew that was gonna be a bit crazy for me.

But so I’ve got my own sachets in. Yeah, but you have a TV in the room, and yeah, most of the time it’s… it was just

resting, relaxing, and, and, and yeah, taking care of yourself. Yeah. Each day during your admission, you will be seen by the APMS team, or the

Acute Pain Management Service team. This team is an anesthetist and some nursing staff. They will check on you every day to make sure that your pain relief is working as

intended and to troubleshoot any issues that you may have while you’re here with us. The APMS team will ensure that you have things if you’re feeling sick

or, nauseous or if you’re having trouble with sleeping. So we’ll make sure that there’s extra medications that you can ask for if you need

them. If you experience any issues with pain relief, either in the evenings or overnight, there is an anesthetic doctor on 24 hours a day in this hospital, and they’re able

to come and see you and check your pain relief and troubleshoot any issues that may come up. The removal was quite straightforward. Didn’t hurt. They came out.

Um, it’s… I guess the aftereffects after they’re gone, so getting up and being able to walk was… You know, you’d been lying down for two days, so your legs are a little bit, you

know, still numb from the epidural. Um, but it was, I would say, painful the first 24 hours, just mainly staying on top of the Panadol and Nurofen when I

went home and not trying to do too much. So because brachytherapy allows us to give a very concentrated and high dose of radiation just

localized to the cancer itself, it’s a key part of achieving a cure when we’re treating gynae cancers, particularly cervix cancer.

Now I’m just happy to be alive, and I’m still able to move. So yeah, I’m just keen to be back to the norm and

change a few aspects of my life, to just keep continuing on being healthy and positive, and yeah. So that’s one of my big things, is to try and get back into comps.

Well, I’ve set a goal for N- late November. I’m doing my first fitness comp in, couple of weeks, so I’ve had about six weeks prep to try and get ready.

Please do it because, like, it’s your… it’s the last stretch of the treatment, and you, you can do it. Like, just trust in yourself and, like, hopefully you’ll be cured from the

cancer on the road to recovery, so do it. Don’t be afraid.

Hello, and welcome to Cancer Care Services.

You’re here to begin your journey for the treatment of your cancer.

On your first visit, the doctor will review any relevant tests and scans, and discuss your diagnosis with you and what the best treatment options are.

You will need to bring any scans you have had to this appointment.

You will need to have a recent blood test before having your chemotherapy each time. This can be done at Sullivan and Nicolaides, QML, or your local hospital on the day prior to coming for treatment.

If you need to have your blood collected on the day of your doctor’s appointment, this will need to occur one to two hours prior to your appointment for the results to be ready for the doctor to review.

It is best to speak with the nurse or doctor regarding the best process for blood collection at your treating unit.

Once your blood results are available, the doctor can review them to determine if your treatment can go ahead.

Your doctor will discuss the results with you at your appointment and check that you are well before treatment can go ahead.

If everything is OK, the doctor will prescribe the chemotherapy orders.

The chemotherapy order is delivered to the pharmacist to check in clinic, and then again in pharmacy.

At most facilities in Metro North, the chemotherapy is ordered and delivered to the pharmacy from an
external company pre-made.

Some chemotherapy is very expensive, or has a short stability and needs to be made up on the day of treatment. This varies at different facilities and can take some time, as there are a number of checks that need to occur to ensure the right treatment is being made to the right patient.

These checks also occur for the pre-made treatments, as there is a requirement for two pharmacists to be available to perform the checks.

After you have finished with the doctor, you will be called in for your treatment appointment.

Depending on the number of patients attending on the day, or if there are any emergent treatments, there may be a delay between the doctor’s appointment and the treatment appointment.

Every attempt is taken to minimize this delay.

If you are a new patient, you will be taken through to have your one-on-one education session prior to your treatment to ensure you understand everything about your treatment, any side effects, and how to manage them. This is a great time to ask questions and discuss any concerns you have with your nurse.

When you are ready, the nurse will take you to the treatment chair or bed and set you up for treatment.

This will mean putting a drip in your arm, or if you have a device, connecting the fluid lines.

The nurse will take your temperature and perform an assessment to make sure you are OK for treatment.

Usually you will have some drugs to help stop nausea before your chemotherapy. Most of the time, these are given through your drip. But sometimes these are oral medications.

When the chemotherapy is ready, the nurse will put on a special gown, gloves, goggles, and mask before they give you the chemotherapy. This is to protect the nurse from exposure to the drugs.

The chemotherapy is good to treat someone with cancer, however, it can cause cancer or affect fertility if the nurse is exposed.

The protective equipment might look a bit scary, but it’s necessary to protect the nurses. And other precautions are taken to protect visitors and the public.

Before the chemotherapy is given, two nurses are required to check the drugs and will ask you your name and date of birth and check your identification band prior to giving you the treatment. This is necessary to ensure the right patient gets the right treatment.

When the chemotherapy is running, it is important to let the nurses know if there is any stinging or burning at the drip site, or if you feel anything out of the ordinary, as this might be a sign of a reaction. This can occur from time to time depending on the drums you are having, so please let the nurses know immediately if this happens to you.

When the chemotherapy is completed, the nurses will put on their protective clothing again to disconnect you and dispose of the equipment in a special bin.

It is important that you collect any medications the doctor has ordered for you to take home. These are usually tablets and stop you feeling sick after the chemotherapy, or may be a part of your chemotherapy treatment. The pharmacist will explain how and when to take them.

You will also need to ensure you have your appointment and blood tests slip for your next treatment before you leave. Or at some facilities, it may be necessary to post your appointment to you. Speak to your nurse before you leave.

If you have any difficulties in the days after your treatment, please contact your treating area during business hours.

Or if it is more urgent or out of hours, go to your nearest emergency department.

For further information regarding your treatment, please refer to other videos and resources on the Patient Portal, or speak with any member of our Cancer Care team.