In this post, I will be discussing radiation therapy for uterine cancer and some important statistics you need to know. This was recommended to me as part of my treatment plan, but I declined it for many reasons I will go into here.
Please be aware that radiation therapy may be necessary for certain situations and can be helpful. I am not opposed to radiation and I am not encouraging anyone to make the same decisions I did with regard to care. We are all different and it is up to you to get all the facts you need to make an informed decision before jumping into a treatment plan.
It is important to ask lots of questions in your appointments. I don’t advise anyone to blindly follow along with what the doctors are telling you. You have to be your own advocate in today’s medical world. Take charge of your healing journey right from the start.
Make sure to read to the end for a pro-tip on what you can do to help reduce the side effects of radiation treatments and CT scans!
WHAT IS RADIATION THERAPY?
Radiation therapy (radiotherapy) uses high dose radiation to shrink tumors and kill cancer cells. When the cancer cell is exposed to high dose radiation, it damages the DNA causing the cell to stop dividing or die. Radiation has a delayed effect so the cancer cells do not die right away. However, the effect can last a long time continuing to kill cancer cells for weeks and months after treatment ends.
It is important to note that radiation is a local treatment. It can only kill cancer cells where the radiation dose is being delivered.
DIFFERENT TYPES OF RADIATION FOR UTERINE CANCER
- EXTERNAL BEAM RADIATION
This treatment is given with a large machine that aims the radiation beam over the pelvis and/or lower abdomen to eliminate any cancer cells that may remain in the area after surgery. Using 3-D imaging from your CT, Petscan or MRI they can target exactly where to place the radiation from different angles if there is an actual tumor, sparing other organs and tissues. The machine, called a linear accelerator, does not touch your body, but rotates around your body.
This therapy is usually recommended for those with spread of the cancer beyond the uterus or who are at high risk for recurrence. It is sometimes directed over a large area to “clean up” any remaining cancer cells that may be in the area. It can also be used for women who can’t have surgery due to other health problems. This form of radiation is what they recommended for me.
Typically the treatments are 5 days a week over the course of several weeks. This allows them to use smaller doses of radiation and reduce the side effects.
- INTENSITY MODULATED RADIATION THERAPY (IMRT)
This is where the radiation dose is divided by a computer into many “mini-beams” of differing strengths. In this way the doctor can tailor the treatment based on the tumor size, shape, and location. Often times uterine cancer has spread very close to important organs, the bladder, colon, rectum and intestines especially. This form of therapy is used to better protect the healthy tissues in the area. Make sure to ask about this if you are going to be undergoing radiation therapy.
- INTRAVAGINAL BRACHYTHERAPY
Endometrial cancer often recurs at the vaginal cuff. This form of radiation involves placing radioactive material in the vagina and leaving it there for 20-30 minutes. An applicator is inserted into the vagina and the small radioactive “seeds” (made of metal) are inserted through the tube to deliver the radiation right at the vaginal cuff. This is done on an outpatient basis in the doctor’s office. Typically it is 3-6 treatments done over 1-2 weeks.
- STEREOTACTIC BODY RADIATION THERAPY (SBRT)
This form of radiation is a non-invasive alternative to surgery. It is used to shrink small tumors, especially metastatic tumors in different parts of the body such as a lymph node or lung and hopefully prevent spread of the cancer. It can also be used for inoperable tumors.
This treatment uses radiation beams of different strengths that are aimed at the tumor from different angles. It requires imaging and planning sessions to obtain very accurate mapping of the tumor so they can precisely guide the stereotactic beams directly into the tumor and spare the nearby healthy tissues.
It is different from traditional radiotherapy, which uses lower doses of radiation and tries to get most of the radiation dose into a tumor, but there is still some radiation exposure to surrounding tissues. Traditional radiation is also used to cover large areas all at once like the pelvis and lower abdomen.
SBRT is a relatively safe, minimally invasive procedure. The main side effect is fatigue. However, other side effects may occur based on the location of the radiation. See the list of common side effects of radiation below.
For some women, both traditional and SBRT radiation are used to treat a resistant tumor.
Stereotactic radiosurgery is a novel treatment modality in gynecologic oncology. Its use has been reported for inoperable primary tumors, recurrent tumors in or near irradiated fields, and isolated pelvic nodal metastases. Read More
There are other modes of delivering radiation therapy, but these are the most common ones for uterine cancer.
7 IMPORTANT THINGS TO KNOW ABOUT RADIATION THERAPY
1. Radiation therapy is typically used for patients with higher grades and stages of uterine cancer or who have had a recurrence. For lower grades and stages of uterine cancer, vaginal brachytherapy may be all that is recommended after surgery.
2. After surgery you will need to heal for about 4-6 weeks before beginning radiation therapy.
3. The doctors will discuss the options with you and then there is a series of appointments for planning and marking with temporary tattoos so you are positioned exactly the same for each treatment. For SBRT they will make a mold for you to lay in each time to get exact positioning.
4. Advanced imaging with either CT, PetScan or MRI will be done to plan the radiation therapy.
5. The American Society for Radiation Oncology recommends radiation therapy (either vaginal or external beam) to reduce the risk of recurrence. They also recommend intensity modulated radiation therapy (IMRT) be used if external beam radiation therapy is delivered to reduce the acute and late toxicities.
6. If your blood sugar (glucose) is high at the time of radiation, cancer cells may be desensitized to the radiation, which leads to more aggressive mutations. Also, if your insulin is high radiation may not work as well.
7. If you are young and want to have children, radiation can damage the ovaries making you infertile.
WHAT ARE THE SIDE EFFECTS?
With radiation therapy there can be acute side effects, which are immediate or shortly after treatment starts and late complications, which can occur weeks, months, or even years later.
EXTERNAL BEAM AND INTENSITY MODULATED SIDE EFFECTS
Acute Phase
- Diarrhea
- Nausea and abdominal cramping
- Frequent bowel movements and urinations
- Cystitis (inflammation and pain in the bladder and sometimes bladder infections)
- Vaginitis (inflammation, ulcers and pain in the vagina)
- Anemia
- Fatigue
- Reduced white blood cell and platelet counts
- Disrupted sleep
- Skin burns (like having a bad sunburn)
Late Complications
- Ulcers (skin, mouth)
- Lymphedema
- Swelling in the lower part of the body
- Cancer (yes, radiation can cause cancer!)
- Bowel obstruction
- Damage to and weakening of bones (sometimes even fractures)
BRACHYTHERAPY SIDE EFFECTS
- Vaginal dryness
- Urinary tract infections
- Scar tissue formation and sometimes even narrowing of the vagina called stenosis
- Painful intercourse
SBRT SIDE EFFECTS
- Fatigue – this is very common and can be quite profound for some women
- Nausea and vomiting
- Swelling at the site of the radiation
- Itchiness
- Redness like a sunburn at the site of the radiation
- Other side effects depending on the organs nearby that my be affected
HOW EFFECTIVE IS RADIATION THERAPY FOR UTERINE CANCER?
1. In this STUDY they looked at 736 women with more advanced forms of uterine cancer. The women were randomly assigned to receive a combination of chemotherapy and radiation therapy, also called chemoradiotherapy or chemotherapy alone.
RESULTS
- There were no statistical differences in 5 year recurrence free survival between the two groups.
- The chemoradiotherapy group had less local recurrences, but more distant recurrences than the chemo group alone.
- Acute and late complications were more common in the chemoradiotherapy group.
- For some people traveling to a radiation treatment center 5 days a week for several weeks or months can be a huge burden.
2. In this STUDY, they looked at 383 women with stage 1A, grades 1-3 endometrial carcinoma and 330 women with stage 1B, grades 1-2 endometrial carcinoma.
RESULTS
- For the women with stage 1A cancer who received radiation therapy, there was an overall reduced 5 year survival compared to those who had not received radiation!
- For the women with stage 1B cancer, there was no statistically significant difference found in 5 year survival between those treated with radiation versus those not treated.
In conclusion, radiotherapy may not improve 5-year overall survival for patients with primary stage IA, grade I–III or stage IB, grade I–II uterine endometrial carcinoma.
3. In another STUDY 715 women with stage 1 uterine cancer were treated with surgery alone or surgery and radiation therapy.
RESULTS
- The recurrence rate was only 4% for those with radiation vs. 14% for those with surgery alone.
- Although the recurrence rate was lower, the overall survival of those treated with a combination of surgery and radiation was only 81% vs. 85% for those with surgery alone!
- The women undergoing radiation had more side effects than the women treated with surgery alone.
The doctors concluded that radiation therapy did not improve survival.
When I first met with my gynecologic surgeon to go over my biopsy results after surgery it was recommended that I undergo radiation therapy as part of my treatment plan. When I asked about the statistics, the doctor told me that, based on scientific studies, radiation does not improve overall survival, but can help reduce local recurrence of the cancer. When I learned that, I decided not to do the radiation therapy and risk the side effects when it wouldn’t help me live longer.
WHEN RADIATION THERAPY CAN BE BENEFICIAL FOR UTERINE CANCER
In some cases where women have metastases in the bone, bladder, or other organs radiation therapy can be effective at shrinking tumors and relieving pain and other symptoms. It can buy more time while other treatments are tried.
I know of one woman who had severe bleeding from her bladder secondary to a recurrence of the cancer there and it was treated with radiation stopping the bleeding and putting her into remission.
I know another woman who had a metastasis in one of her pelvic bones causing severe pain. She underwent radiation therapy to relieve pain and it also obliterated the tumor. She then went on to do naturopathic treatments and has remained in remission for years.
IN CONCLUSION
Don’t be afraid to ask questions before diving into radiation treatments. Make sure you have all the facts you need to make an informed decision and know what side effects you may encounter. Make sure you are comfortable with your plan because that can make all the difference.
Trusting in your doctors and the treatment plan and feeling good about it all is a big part of the healing process and can make treatments more effective. This is called the Placebo Effect.
There is also a Nocebo Effect. This is where the treatments may not work or you may have bad side effects if you are not happy with the plan, don’t believe in it, or are fearful of getting all the side effects. I kept this in mind when making my decisions about treatments.
ONE THING YOU CAN DO TODAY TO HEAL YOUR BODY
Today I want to encourage you to start taking MELATONIN if possible.
Melatonin, like Vitamin D, is an extremely important supplement for cancer patients. Although many people think of melatonin as a sleep aid, that is only one very minor role that melatonin plays in the body.
Here are 7 things that Melatonin has been shown scientifically to do
- Significant inhibition of cancer growth of many different cancers and stages of cancer.
- Prevent tumor spread
- Protection from ionizing radiation and drug toxicities including chemotherapy
- When used with chemo or radiation it has been shown to improve outcomes and survival.
- Detoxification of free radicals in the body that are often created from toxic chemo drugs and radiation, but can be caused by all kinds of things.
- Protects healthy cells from damage
- It can prevent angiogenesis (new blood vessel formation by the tumor)
These are not all of the things that melatonin can do, but some very important ones when you have cancer! I started with a small dose to see how I would tolerate this supplement and worked my way up. Higher doses are better when it comes to cancer.
Most people tolerate melatonin very well. I was even able to take it during the day without problems falling asleep, but everyone is different. For that reason, I suggest you take it before bed.
For CT scans and radiation treatments it is often recommended by naturopathic doctors to take 300mg of Melatonin prior to treatment to prevent toxicity of the radiation. Please make sure to discuss this with your naturopathic doctor before doing this.
I currently take 120mg of Melatonin every night. If you could only take or afford a few supplements this would be one of them along with Vitamin D!
Here is the melatonin supplement I use. Melatonin
Jesus said to her, daughter, go in peace and be healed of your affliction. Your faith has made you well. Mark 5:34