Treating Endometrial Cancer With Radiation Therapy
- Radiation therapy is a highly effective, generally well-tolerated option for endometrial cancer treatment. It is crucial for curing the disease and can help reduce recurrence risk.
- Radiation is a primary method for treating this cancer. It’s often used after surgery, but can be given on its own or combined with chemotherapy, depending on the cancer stage and clinical setting.
- Radiation treatment options include brachytherapy (internal radiation) and external beam radiation therapy. They can be administered individually for treatment, or both may be recommended for some patients.
- Short-term side effects may include vaginal irritation, dryness, bleeding, bowel or rectal irritation, skin changes, and fatigue.
- Long-term effects could involve vaginal stenosis (narrowing), lymphedema, and, in some cases, premature menopause due to ovarian radiation exposure.
It is often used after surgery to ensure doctors catch all of the cancer but it can also be used alone or in combination with chemotherapy, depending on how far the cancer has spread.
Read MoreThe Benefits of Radiation for Endometrial Cancer
Radiation uses high-energy particles or waves, such as X-rays or gamma rays, to target and destroy cancer cells in the uterus. By damaging the DNA of these cells, the radiation eventually kills them which halts the spread of the cancer.Doctors may recommend radiation therapy on its own or in conjunction with other treatments because it is has been shown to help prevent the cancer from returning.
“There are some features of the cancer that make you high risk for recurrence. And what that means essentially is the doctor could be scared that maybe even just a single cancer cell escape the uterus and could eventually grow back with time. And if that’s the situation, your doctor might recommend radiation treatment,” Dr. Chase.
The National Comprehensive Cancer Network (NCCN), an alliance of more than 30 top cancer treatment centers, recommends using radiation in endometrial cancer based on factors including:
- Cancer stage
- Tumor grade
- Patient age
- Presence of risk factors
The timing, type, and dose or radiation depends on the specific cancer case.
For example, if cancer is in the earlier stages, doctors typically use radiation after surgery to make sure they wipe out as many cancer cells as possible. Studies suggest that it cuts the chance of the cancer coming back. This kind of therapy can sometimes help you stay cancer free for longer.
When the cancer is in a more advanced stage, radiation may be used in conjunction with chemotherapy to help ease cancer symptoms and improve quality of life. It may also extend survival, especially in high-risk patients.
For patients who aren’t good candidates for surgery, radiation therapy might be considered as a primary treatment option.
“If the cancer has time to spread to the lymph nodes or the lungs or the bone, your chance of a cure is much lower and you’re more than likely going to need more treatment like chemotherapy or radiation,” Dr. Chase says.
In general, radiation therapy is a very effective and well-tolerated treatment.
What are the Types of Radiation?
Doctors use different forms of radiation to treat endometrial cancer, these include:
Brachytherapy
- This is often referred to as internal radiation therapy, where radioactive sources are placed directly into the area that requires treatment to allow for very precise delivery of radiation. This minimizes the exposure of radiation to other tissues nearby which helps to lower the risk of side effects.
- In endometrial cancer, brachytherapy involves placing a radioactive source into the vagina to target an area known as the vaginal cuff — a common site of endometrial cancer recurrence. Doctors fit a cylinder into the vagina and connected to a radioactive source.
- Brachytherapy may be administered after surgery or external beam radiation. It generally requires only 2-3 treatments in total when given in high dosage.
External Beam Radiation Therapy
- External beam radiation is delivered by a large machine called a linear accelerator that targets cancer cell DNA with high-energy X-rays.
- The therapy has a high precision which avoids high doses of radiation leaking into areas like the kidneys and bowel that are not likely to have disease involvement. This helps preserves healthy tissue and lessens the risk of side effects.
- Usually given after surgery, external beam radiation helps prevent disease from coming back. It is usually focused on the entire pelvic region to help target any area the cancer may be residing, including the lymph nodes.
- In more advanced cancers, the treatment is sometimes offered along with chemotherapy.
- It can also be used to help treat symptoms related to the disease, like pain or vaginal bleeding, in a palliative setting.
- Treatment is usually five days a week, for 4-6 weeks.
Dr. Jennifer Mueller, a surgeon and gynecologic oncologist with Memorial Sloan Kettering Cancer Center in New York, tells SurvivorNet that there is a strong argument for using radiation if there is a real chance your cancer may come back after previous treatment — and even if your doctor is confident they have removed all of the cancer.
“So it’s usually the lymph node status in combination with uterine risk factors that help us next steps in therapy,” she says. “If that is the case, then usually chemotherapy or what we call systemic therapies or what we recommend and that can be done alone or in combination with radiation therapy.”
Related: Immunotherapy, PARP Inhibitor Drug Combination For Advanced Endometrial Cancer
What are the Side Effects of Radiation?
Short Term side effects following radiation therapy may include:
- Irritation to the vagina
- Vaginal dryness
- Vaginal bleeding
- Irritation of the bowel or rectum that can lead to loose stools or diarrhea
- Skin darkening and irritation
- Fatigue
In the long term, patients should be aware of the following side effects:
- Vaginal dryness
- The buildup of scar tissue in the vaginal that can lead to vaginal stenosis (or narrowing of the vagina)
- Lymphedema or fluid buildup in the legs if pelvic lymph nodes were treated
- In younger patients, if ovaries receive a high enough dose of radiation, they may experience premature menopause.
- Urinary incontinence or leakage
- Sexual dysfunction
While undergoing treatment, your doctor will keep an eye out for any potential side effects and will talk to you about how best to manage or prevent them from occurring.
Pelvic floor exercises post-radiation therapy for endometrial cancer are essential in strengthening weakened pelvic muscles, helping to manage urinary incontinence and improve sexual function. These exercises enhance quality of life by reducing side effects and increasing patients’ control over their bodies. Discussing these exercises with your care team can provide guidance on effective techniques and incorporate them into your recovery plan.
It’s also important to drink plenty of fluids to prevent dehydration, get plenty of sleep to counteract fatigue, and use skin lotion to ease skin irritation.
Talk to your care team about the importance of managing side effects after radiation therapy.
Related: Get Your Health Questions Answered With SurvivorNet’s AI ‘My Health Questions’
Questions to Ask Your Doctor
- What are the expected benefits of radiation therapy for my stage of endometrial cancer?
- Can you explain the type of radiation therapy you recommend for my treatment plan?
- What side effects should I anticipate from radiation therapy, and how can we manage them effectively?
- How does radiation therapy fit into my overall treatment plan, especially in conjunction with surgery or chemotherapy?
- Are there any long-term effects of radiation therapy I should be aware of, and how can I minimize them?
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