Intracavitary Radiation with Anesthesia - Patient Guide
This handout is about a type of radiation therapy called Intracavitary Radiation (ICR). It will tell you what ICR is and how to prepare for this type of treatment. Please underline anything you do not understand. Also, write down any questions you have. When you come for a visit about ICR, bring this handout and your questions. Your doctor or nurse will answer your questions.
What is ICR?
ICR also is called brachytherapy. ICR carries a high dose of radiation to a small area within the uterus, cervix, or vagina. Small, hollow instruments are put into place by your doctor. A tiny, radioactive source, attached to a wire, is threaded through the instruments. The wire is left in place for a short period, most often 5-20 minutes. The wire then moves out of the instruments and goes back into its storage container. The doctor gently removes the instruments. The treatment is over.
ICR is done in the Radiation Oncology Department. Most patients getting ICR have 5 treatments. The treatments are scheduled 1-2 times per week. Each ICR treatment takes 2 to 3 hours from start to finish. ICR is considered a surgical procedure. It is done under anesthesia. Anesthesia is given by doctors and nurses. Medicines used in general anesthesia help patients fall deeply asleep and remain comfortable.
What do ICR instruments look like?
The drawing to the right shows some of the commonly used instruments for ICR. It also shows where the instruments are placed in the body. The instruments vary in size and shape. Your doctor will choose the ones that are right for you.
How do I get ready for ICR?
Getting ready for the first ICR treatment requires a number of tasks. These tasks are done in a pre-procedure visit that takes 2-4 hours to complete. First, you will have a complete medical history and physical exam from the radiation doctor. This exam must be done within 30 days of the first ICR treatment. Second, all of your current medicines must be reviewed. The review includes the names, the doses, and the number of times taken per day. Some patients need lab work, an EKG, or a chest x-ray. You must also visit the Anesthesia Screening Clinic. In this clinic, your records are reviewed to prepare for the anesthesia. You will be asked about your prior experiences with anesthesia. Please note, patients who get anesthesia are not allowed to drive for 24 hours. On the day of your ICR procedure, a friend or family member will need to drive you home. You should not drive or make important decisions until the next day.
What happens on the day of the ICR treatment?
On the day of the treatment, do not eat or drink anything after midnight. This is a standard requirement for patients receiving anesthesia. If you do eat or drink something after midnight, your treatment may be canceled. This is for your safety. If you normally take medicines in the morning, be sure to ask the nurses in the Anesthesia Screening Clinic which ones you should take on the morning of the treatment. These medicines should be taken with a sip of water.
Please plan ahead.
- Arrive at least 60 minutes before your scheduled ICR treatment time.
- Come in either through the Hospital or Clinic entrance.
- Bring your parking stub with you.
Once in the hospital, head toward the Town Square Reception area.
- Get your parking stub stamped.
- Register at one of the Registration desks.
- If needed, get lab work done at the Outpatient Lab.
After you have done these steps, report to ____________________________________________
In the pre-procedure area, you will change into a hospital gown. An identification bracelet will be placed on your wrist. Shortly before your treatment is scheduled to begin, you will be brought down to the Radiation Oncology department by an escort. You will be on a cart. A member of the anesthesia team will talk to you. A small intravenous (IV) needle will be put into a vein in your hand or arm. This IV will be used for medicines and fluids. You may be asked to walk into the treatment room. You will be asked to position yourself on a narrow treatment table. We will help you with this if it is hard for you. After you are on the treatment table, the anesthesia team will give you medicines to put you to sleep. Once you are deeply asleep, the radiation doctor will begin getting you ready for the ICR treatment.
The ICR Treatment
1. Loose cotton stockings will be put on your legs to keep them warm. Compression leggings that inflate and deflate will also be put on your lower legs. These are used to promote blood flow. During the treatment, you will lie on your back. Your legs will be put up into leg rests. You will remain in this position until the treatment is over.
2. The radiation doctor will do a pelvic exam to see how things look. Your skin will be cleaned with antiseptic solution. A small tube (Foley catheter) will be put into your bladder to collect urine. This tube is removed before you go home. The instruments used for the ICR are put into place by the radiation doctor. The placement of the instruments is checked with ultrasound and X-ray. When an ultrasound is done, a cool gel is put on your lower abdomen. This helps the doctor see your inner body parts. A small amount of barium liquid is put into your rectum. This helps the radiation doctor keep the radiation away from your rectum.
3. Once the instruments are in place, the radiation treatment is planned. Radiation treatment planning is done by the medical physicist. He or she uses a prescription written by the radiation doctor. A computer software program is used to develop the treatment plan. Once the treatment plan is completed, it is checked and approved by the radiation doctor.
4. After the treatment plan is approved, the treatment is almost ready to begin. The radiation that is used for ICR comes from a tiny piece of radioactive material. This material is about the size of a piece of pencil lead. It is attached to a wire and kept inside a lead-lined storage container located in the treatment room.
5. Right before the treatment starts, the radiation doctor connects one end of 1-3 thin hollow cables to the storage container. The other ends of the cables are attached to the ends of the ICR instruments. The treatment is ready to begin. During the treatment, the radioactive material moves out of the storage container and into the ICR instruments. The radioactive material stays in the instruments until the prescribed dose of radiation is given. The period of time that the radioactive material is in the instruments varies from 5-20 minutes.
6. After the radiation dose has been given, the radioactive material returns to the storage container. It does not remain in your body or in the instruments. The treatment portion of the procedure is now over. All of the ICR instruments are removed, your legs are lowered back onto the table, and you are “brought out of” the anesthesia. You are moved to the post-anesthesia care unit and checked for about an hour. After you are more awake, you are moved to the discharge unit. This total recovery period can last from 2-3 hours.
7. Once you are fully awake, you will be given something to eat and drink. Family members or friends can visit. You will be prepared for discharge. The radiation doctor may wish to talk to you or you may wish to talk to the radiation doctor. You may remember bits and pieces of the procedure, or you may remember nothing at all. Because of the medicine given for anesthesia, you should not drive, drink alcohol, use dangerous equipment, or make any major decisions for 24 hours.
What can I expect after ICR?
1. You may have some minor vaginal bleeding or discharge for the first 24 hours. It should not be more than a normal menstrual period. You may want to bring a sanitary pad; we DO NOT recommend the use of tampons.
2. Please do not douche during the time you are getting ICR treatments. Douching can disrupt the body’s natural chemical balance.
3. You may have some vaginal cramping (similar to menstrual cramps) after the procedure. This should stop by the end of the day. Ibuprofen (Advil® or Motrin® IB) or naproxen (Naprosyn® or Aleve®) may be helpful. Take it according to the directions on the bottle.
4. You may have some irritation or burning when you urinate. This can be related to the catheter that was put in. You should drink 8-12 glasses of fluids each day for the next 1-2 days. Let us know if these symptoms do not go away.
5. Your next bowel movement may look white or gray in color. This is from the barium that was put into your rectum.
6. Your memory of the treatment may be fuzzy. This is a short-term side effect of the anesthesia medicines.
7. After your treatment, you may resume your normal diet.
8. You are not radioactive after this treatment.
9. You will be given a vaginal dilator at one of your visits. How it is used will be explained to you. You will need to use it because the ICR treatments cause the vagina to narrow and shorten. Your radiation doctor will tell you how long you will need to use it.
10. It is safe to have sexual intercourse between treatments.
11. Call the Radiotherapy doctor at (608) 263-8500 for any of these symptoms.
- Fever above 100ºF.
- Pain that is not relieved with medicine.
- Bleeding more than a normal menstrual period.
- Burning with urination or blood in the urine lasting more than 24 hours.
Your radiation doctor is _____________________________ Phone Number ________________
The Spanish version of this Health Facts for You is #7145.
The information provided should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Any duplication or distribution of the information contained herein is strictly prohibited.
Last Updated: 12/10/2012
Copyright © 03/09/2010 University of Wisconsin Hospitals and Clinics Authority. All rights reserved. Produced by the Department of Nursing. HF#4392
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