This patient guide has been developed to answer some of the more common questions asked about radiation implant therapy.

What is intracavitary implant?

Intracavitary implant is a cancer treatment in which the radiation oncologist places radioactive sources directly into body cavities such as the vagina or uterus, using a specially designed applicator.

What are the advantages of intracavitary implant?

This enables the doctor to provide a concentrated dose of radiation to the tumor with little damage to the surrounding normal tissue.  This treatment can be used alone or in combination with external radiation or surgery to cure, control, or relieve symptoms caused by cancer.

Why must I be hospitalized?

The applicator may need to be placed under general anesthesia in some cases.  You will also be required to be at complete bed rest for 48 to 72 hours.  In addition, for the safety and protection of your family and friends, you will need to be isolated to some degree to prevent unnecessary radiation exposure.

What can I expect after my admission?

You will be admitted to a private room one day before or the morning of the procedure.  Since you will be in the hospital for several days, bring magazines, tapes, newspapers, books, hobbies or cards to distract you.  TV is available so you may want to bring a TV guide.  There is also a phone available for you to make and receive calls.

Your visitors must limit the time they spend with you to 15 minutes per person per day.  No children under the age of 18 or women who may be pregnant should visit.  This is a radiation safety measure to avoid unnecessary exposure.  Your visitors must also stand 6 feet away from the radiation source at all times.

You will be interviewed by a nurse and examined by a doctor.  Routine lab work will be done if not done prior to admission.

You will receive cleansing enemas as a precaution against displacing the applicator while trying to have a bowel movement.  You will also be placed on a low residue diet and be given the drug lomotil to prevent having a bowel movement during your stay.

You will receive a povidone-iodine douche to cleanse the vaginal tract.

A foley catheter will be inserted into the bladder prior to the implant so you will not have to use a bed pan or get up to use the bathroom.

Thirty minutes or so before you are either taken to the operating room, or the radiation oncology department for your implant, you will be given an injection of medication to help you relax.

Will the procedure hurt?

If you are taken to the OR, you will receive anesthesia.  If you are taken to the radiation oncology department, you will be awake but drowsy.  The sensation caused by the procedure is best described as "pressure" while the applicator is being placed and the vagina is being packed with gauze.  The vaginal packing is necessary to keep the system in place and to separate the bladder and the rectum from the radioactive source.  Medication is available to anyone who experiences discomfort.

What happens after the applicator is in place?

Correct placement of the applicator is verified by x-ray.  You will be required to transfer from the stretcher to the x-ray table.  Staff members will be there to assist and direct you.  After verification, you will be taken back to your room.  The radiation oncologist will come to your room later to place the radioactive material into the applicator.  The source is left in place for a specific number of hours which is carefully calculated for each individual use.  This is usually from 24-72 hours.Will my activity be limited while the applicator is in place?You will be required to maintain complete bed rest while the applicator is in place.  Avoid any sudden twisting or turning.  Doing isometric exercises, contracting and relaxing muscle groups, will help relieve cramps and stiffness.  TV, reading, phone and music will help distract you.The head of your bed may only be elevated about 30 degrees.  That's about the height of two pillows.  You may find it easier to eat if you roll onto your side, keeping your body straight.

Bathing and showering will not be permitted.  Your nurse will set you up each morning to wash your face, hands, brush your teeth and comb your hair.  

Your linens will not be changed unless absolutely necessary in order to prevent excessive movements that may dislodge your applicator.

PLEASE REMEMBER NOT TO TOUCH YOUR APPLICATOR.  If you feel it has moved or come out, ring for your nurse and inform him/her.

What safety precautions are necessary?

While your implant is in place, you will be in a private room with shielding around the bed.  Your nurse will examine the position of your applicator several times each shift.  Because he/she cares for many patients with implants, it is necessary for him/her to limit their time with you.  However, your nurse will administer safe, essential nursing care throughout your stay.

Used linen and trays will remain in plastic containers in your room until the implant is removed.  This may cause your room to look cluttered.

We realize you will be bored and lonely to some degree, so we encourage you to keep in touch with the outside world by phone.  Remember, it is for a short period of time and try to stay in a positive frame of mind.

What happens when the applicator is removed?

At the end of the prescribed time, your doctor will remove the radiation source from your applicator and it will be taken away.  The vaginal packing and applicator as well as the foley catheter is then removed.  The procedure is relatively short and you may have medication prior to it if you wish.

It is important for you to know that there is no residual radiation left after the implant is removed.  You are not radioactive.  You will be given another enema to start your bowels working again and another vaginal douche to cleanse the vaginal tract.

Someone will help you up and assist you while you walk in case you get lightheaded after being in bed for this time period.  You may go home as soon as this is completed.

 

What should I do when I'm home?

  • There may be light spotting and discharge for several days or weeks after the implant.  Heavy bleeding, foul smelling discharge or a fever should be reported. 
  • Do not use tampons, use peripads (sanitary napkins) instead.
  • Shower in place of baths.
  • Irrigate your perineum, using your peri bottle and warm soapy water, after each bowel movement.
  • If heavy discharge is bothersome, you may douche using 1 teaspoon of white vinegar in 1 quart
  • Fatigue may persist for a few days.  Get plenty of sleep at night and engage in moderate exercise to regain strength.
  • Normal bowel routines may take several days to return.

To treat constipation, drink at least 8-10 glasses of fluid a day.  Eat a high residue diet -- fruits, vegetables, bran, prune juice, etc., and use a stool softener if necessary.

  • To treat diarrhea, eat a low residue diet -- white bread, cooked fruits and vegetables, pasta, rice, etc., and use immodium as directed if necessary.     
  • Urinary tract discomfort, burning and frequency, are expected.  Drink plenty of fluids and report any foul smelling urine.
  • Sexual intercourse may be resumed in 2 to 3 weeks.  Your vagina may be dry so use plenty of water-based lubricant such as KY Jelly.
  • If you are not sexually active, we will provide a vaginal dilator for you to use after one month follow-up.  It is important to keep the walls of the vagina open.  Lying on your back with your knees bent, insert the well-lubricated rounded tip of the dilator into the vagina for 5-10 minutes, three times a week.  Even with dilatation, the walls of the vagina shorten and close somewhat.  Without it, the walls will seal off and prevent examination.