My Doctor Mentioned Radiation Treatment But I Don’t Get What That Means

What happens after surgery?

The need for more treatment is determined by the stage of the cancer. This stage can only be determined by looking at the uterus and lymph nodes under the microscope. Radiation is a treatment that is given to a particular part of the body in order to kill cancer cells. These cells can be microscopic cells; in this case, radiation is used as an “extra” treatment to prevent recurrence. Radiation can also be used to treat recurrent disease if it is localized to one area of the body. It is given by a specialized physician known as a radiation oncologist.

There are different kinds of radiation. Radiation is most commonly given via a machine called a linear accelerator. These are large machines that look a little like a CAT scan machine. There is a bed for the patient to lie on and the radiation is delivered from the machine to the patient. Radiation can be given externally to treat the entire pelvic area (called whole pelvic radiation) and can also be given as an implant. An example of this is vaginal radiation, also called vaginal brachytherapy.In this case iridium is often used to localize the radiation to the top of the vagina.

When you first go to the radiation oncologist, the doc-tor will take a thorough history of your health and the treatment to date for your cancer. He or she will review your pathology and any x-rays that you may have had. The radiation oncologist will also perform a physical examination. In the case of endometrial cancer, the radiation oncologist will be checking to be sure you have completely healed from your hysterectomy. This examination will also include a pelvic examination to be sure that the top of your vagina, called the vaginal “cuff,” has completely healed.

Your doctor may recommend an aggressive radiation treatment plan if he or she believes you to be at risk for recurrence in the pelvis. Factors such as the tumor grade (grade 2 or 3) and deep involvement of the myometrium may play into this perceived increased risk. If recommended, it is called whole pelvic radiation. After your examination, your radiation oncologist will schedule you for a “simulation.” This means that the radiation team will obtain x-rays of you, usually a CT scan of your pelvis, to assess the area of treatment (called a “field”).

They will also be looking to see where normal structures, such as bowel and bladder, are located. This will allow them to map out your radiation treatment to maximize the dose to the area to be treated while minimizing the dose to the normal bowel and bladder, which are also in the pelvis. There are physicists in the radiation oncology department who help to plan the radiation fields.

Some radiation oncologists will put tattoos on your body to mark out the areas to be radiated. These tattoos are very small blue dots that are not noticeable but will allow the technician to position you in the correct position under the radiation machine every time you come in to be treated.

Whole pelvic radiation is usually started between 4–8 weeks after your surgery, though it is sometimes delayed for a variety of reasons. Once it is started, it is important to finish the treatment without delays if possible. The treatment is given daily for 5–6 weeks, but not on the weekends. Each treatment takes a very short time (less than 30 minutes). You can expect to come to radiation oncology, check in, and then wait for your appointment. You undress, put on a gown, and are positioned on the machine. The treatment is given; then you dress and go home. The entire visit should not take more than two hours each day.

While you are being treated with whole pelvic radiation therapy, you may experience some side effects. These usually do not start until 10–14 days into your treatment and may include diarrhea and fatigue. Most of the side effects can be managed with over-the-counter medications. Long-term side effects of radiation include problems with your bowel and bladder and swelling in your legs. Fortunately these side effects are infrequent.

Another form of radiation is delivered to the vagina, and is called vaginal brachytherapy. Your radiation oncologist will check to make sure that the top of the vagina is completely healed and that there is no evidence of early disease recurrence. Then he or she will fit you with a vaginal “cylinder,” which is a thin metal tube like a tampon that fits into the vagina. The vaginal treatments are given with an isotope called iridium in most cases. Usually, three treatments are given. Each treatment takes 10 minutes and the treatments can be given weekly.

Your doctor may recommend that you have vaginal brachytherapy only. The treatment is intended to decrease the risk of endometrial cancer coming back at the top of the vagina, which is one of the most common places for endometrial cancer to recur. In addition, your doctor may recommend this treatment if you have invasion of your cancer into the muscle of the uterus. One of the most important side effects is vaginal stenosis, or closure.

This can be avoided if you are sexually active or if you use a vaginal dilator at least once per week. For others, your doctor may recommend that you have both vaginal brachytherapy and whole pelvic radiation. In this case, you may have the vaginal brachytherapy done before or during the whole pelvic radiation treatment.

An alternative to traditional whole pelvic or vaginal radiation is called intensity modulated radiation therapy (IMRT). This is a form of external radiation, but allows for precise planning of radiation treatment, with an aim to spare normal tissue as much as possible.

Each treatment is delivered in multiple segments, which maximizes the treatment dose to the area of the tumor and then minimizes the radiation dose as treatment fields approach normal tissue. By varying the intensity of each dose of radiation, it can allow for the maximal treatment effect at the least risk to non-cancerous tissue.

Your radiation oncologist will likely continue to follow you after your treatment is completed. He or she will want to know about any problems you may be having with your bladder or bowel. Rarely, women can have radiation-related bowel problems, especially rectal bleeding, also called radiation proctitis. Also rare are radiation bladder problems, called radiation cystitis.

These problems can be diagnosed and treated with proctoscopy in the case of the rectum or cystoscopy for the bladder. Women who have had pelvic lymph node dissections and then had whole pelvic radiation are at higher risk for having swelling in their lower extremities. This can be treated with pressure stockings and by keeping the legs elevated when possible. In extreme cases lymphedema pumps and physical therapy can be used.

Beyond radiation, your doctor may recommend chemo-therapy, particularly if you have positive lymph nodes, or if you have uterine serous papillary carcinoma. The optimal treatment for endometrial cancer following surgery is not known and many clinical trials are being done to answer important questions about the value of radiation and chemotherapy and to understand how to combine them. You may consider being treated on one of these clinical trials. One good place to get information about clinical trials you might be eligible for is the NCI’s website www.clinicaltrials.gov.

I really recommend second opinions for additional treatment decisions. There are so many different approaches plus possible clinical trials available. It is a huge decision and the final say is your own. At the very least, become friends with the leading cancer center websites and also the American Cancer Society and National Cancer Institute sites. Read every-thing you can find. No one will look out for your well-being as conscientiously as you.