External Radiation Therapy No Benefit in Early Endometrial Cancer

A recent clinical study reported in the American Society of Clinical Oncology meeting has found that external radiation therapy done right after surgery do not show any benefit to patients in extending sutvival or reducing risk of recurrence.

This study, done on women with stage I endometrial cancer involves 906 women who are seperated into 2 study group. They were followed up for everage of 4 years and those who recieved external radiation therapy after surgery do not show any difference in overall or recurrence free survival rate.

Source

Hormone Therapy

Hormones are chemicals that occur naturally in the body and they control the growth and activity of cells. A type of female hormone known as progestins, a form of the female hormone progesterone is used in hormone therapy for uterine cancer treatment. It is often given in pill form. Hormones work by slowing the growth of uterine cancer.

Treatment with hormones are suitable for:
1) Young patients who want to have children and so do not want to undergo hysterectomy.
2) Patients not fit to undergo surgery or radiation.
3) Recurrent cases of uterine cancer
4) Advanced cases of uterine cancer (Please discuss the stage of your cancer with your doctor)

Side effects may include:
a) Fluid retention
b) Weight gain
c) Increased appetite
d) Loss of sexual desire

This treatment is condered new and does not guarantee that the cancer will not recur.

Radiation Therapy

Radiation therapy is a method of using high-energy x-ray to kill cancer cells. It destroy the ability of the cells to grow and divide. Radiation therapy is recommended when:
1) Your tumour is fast growing (advanced stage), and invades deeply into the uterus or outside the uterus or involves blood vessels.
2) It is sometimes done after hysterectomy if your doctor thinks you're at high risk of cancer recurrence.
3) Patients not fit to undergo surgery.


There are two types of radiation therapy, and the doctor may recommend you for a combination of both of these at the same time:

External Radiation
A machine outside the body is used to deliver the radiation. This is and outpatient procedure. The treatment is often for a few weeks (normally 5 to 6 weeks), 5 days per week. You would need to visit the Radiotherapy department in a hospital for this procedure and the process is similar to getting an x-ray.

Internal Radiation (Brachytherapy)
This is a method where radioactive materials are placed near the tumour inside your body to kill the cancer cells. For uterine cancer, the radioactive source goes inside into the vagina. There are two ways to give this therapy depending on whether you're receiving radiation therapy as your main therapy or after surgery, or the equipment available in the hospital: low dose treatment and high dose treatment.

Basically, there are no difference in how well the treatment works, because you will be getting the same dosage your doctor has calculated for you needs. The low dose therapy (normally called the 'slow' treatment), the radioactive pellets are usually left in place for a day at a time for between 1 to 5 days.
For the high dose therapy, each treatment is much shorter (usually less than an hour) and you need between 2 to 5 treatments, and you can return home the same day.

Brachytherapy has significantly less side effects than conventional external radiation therapy. Common side effects are bladder irritation, vaginal irritation, diarrhea, skin reactions, fatigue, hair loss and loss of appetite.

Chemotherapy

Chemotherapy is the use of medication or drugs to slow tumor growth and destroy cancer cells. Cancer fighting drugs can be given through the vein(by injection) or by-mouth (oral medication). The way chemotherapy is given depends on the type and stage of the cancer. A combination of drugs may be given to treat cancer as sometimes it is more effective than just one drug alone.

Chemotherapy is often used in conjunction with radiation therapy and surgery. It is used to treat areas inaccessible with surgery or radiation. Some of the drugs commonly used to treat uterine cancer:

1) Doxorubixin (brand name: Doxil)
2) Cyclophosphamide (Cytoxin)
3) Cisplatin (Platinol)
4) Carboplatin (Paraplatin)
5) Paclitaxel (Taxol)

Drugs used in treating cancer kills the cancer cells but also kills certain normal cells and thus causing side effects. These side effects depend on the specific drug, the length of treatment and the dosage (how much) used. Some of the common side effects of anti-cancer drugs:

a) Nausea and vomiting
b) Hair loss
c) Mouth sores
d) Fatique
e) Low blood cell counts (anemia)

Each drugs has a different side effects profile. Make sure you ask your doctor about the side effects that could occur with your medication. Fortunately, most of these side effects will go away after the chemotherapy is completed.

Surgery

Hysterectomy: Removing of the uterus by surgery.

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Removing the cancer through surgery is the most common treatment for uterine cancer. The standard therapy is hysterectomy. It is a major operation and you can't get pregnant after your uterus is removed so you should be very well informed, but surgery is usually the only way to eliminate the cancer.
The doctor will only be sure of the exact stage of your cancer after the surgery because he can have a good look at your organs only when he opens you up! During the operation, the doctor will examine the tissues of your uterus and the surrounding tissues and decide what needs to be removed. More tissues might be collected during the operation from different parts of your body to be further analyzed.


Different types of surgery:

Total Hysterectomy
Surgery to remove the uterus, including the cervix.

If the uterus and cervix is taken out through a large incision(cut) in the abdomen, it is called total abdomen hysterectomy. If it is through a small incision in the abdomen using a laparoscope, it is called a total laparoscopic hysterectomy. If it is removed through a vaginal incision, it is called a vaginal hysterectomy. The disadvantage of vaginal hysterectomy is that it is usually harder for the surgeon to see whether the cancer has spread to other parts of the body.

A laparoscopic hysterectomy is a relatively new technique that has the advantage of shortening the time for recovery after surgery (small incision/cut). Ongoing further studies are being done to determine whether it works as well as the usual operations, so make sure to ask your doctor about this option.

For Abdominal hysterectomy,
Hospital stay: 3 to 7 days
Full recovery: 4 to 6 weeks

For Laproscopic and vaginal hysterectomy,
Hospital stay: 1 to 2 days
Full recovery: 2 to 3 weeks


Bilateral salpingo-oophorectomy (BSO)
Surgery to remove both the ovaries and fallopian tubes. This procedure is usually done along with hysterectomy because cancer cells often spread to the ovaries very early in the disease.

Radical Hysterectomy
This is a surgical procedure to remove the entire uterus, cervix, parametrium (the tissues next to the uterus) and the upper part (about one inch) of the vagina. The ovaries, fallopian tubes and nearby lymph nodes may also be removed (a BSO). This procedure is used when the cancer has spread to the cervix or parametrium.

Hospital stay: 7 days
Full recovery: 4 to 6 weeks


Even after surgery, your doctor may advice other forms of therapies like chemotherapy and radiation therapy to destroy any remaining cancer cells.

What are the treatment options if I have uterine cancer?

Being diagnosed with cancer can make you anxious, but do not rush in making decisions. Ask as many questions as possible to understand more of your condition (the stage of your cancer, treatment options, etc). If you still feel unsure, get a second opinion, especially when your doctor has recommended a treatment option and you would like to have more confidence that it is the best possible course for you.

Some of these treatment options may be recommended by your doctor:
(Please understand that your doctor might recommend other plans of treatments than the ones mentioned here. You should not hesitate to ask your doctor more questions)
1) Surgery
2) Chemotherapy
3) Radiation Therapy
4) Hormone Therapy

Each of these therapies has different success rates and side effects. Therefore, some questions you might want to ask your doctor:
1) What are the treatment options available and suitable for me?
2) How is it done, how will it effect my working life in the short term, and how does it effect me in the long run?
3) What is the success rate of this procedure?
4) How long will this treatment take to determine whether it's working?
5) What are the side effects (both short term and long term) common to this treatment?
6) Any other new options available?

In the next few posts, I'll discuss each of these treatment options in details.