Radiation Therapy for Gynecologic
Cancers
Facts
about Gynecologic Cancers
Gynecologic cancers include
cancer of the uterus, ovaries, cervix, vagina, vulva and Fallopian
tubes.
- According to the American Cancer Society, nearly 83,000 women
per year are diagnosed with some form of gynecologic or GYN cancer.
- The most common gynecologic cancer is uterine cancer with more
than 40,000 cases diagnosed each year.
- Every year, more than 28,000 women die from a type of gynecologic
cancer.
- Widespread screening with the Pap test has allowed doctors to
find pre-cancerous changes in the cervix and vagina. This has
helped prevent the development of some invasive cancers.
Risk
Factors for Gynecologic Cancers
While all women are at risk
for gynecologic cancer, some factors can increase a woman's chances
of developing the disease.
- Uterine cancer: Never pregnant, beginning menstruation early,
late menopause, diabetes, use of estrogen alone (called unopposed
estrogen) for hormone replacement therapy, family history of uterine
cancer, high blood pressure and complex atypical hyperplasia.
Tamoxifen, a drug frequently used to treat breast cancer, increases
the risk of uterine cancer slightly. A genetic syndrome called
hereditary nonpolyposis colon cancer (HNPCC) may also increase
a woman's risk.
- Cervical cancer: Strongly associated with sexually transmitted
diseases, especially several strains of human papilloma virus
(HPV), sexual activity at an early age, multiple sexual partners,
smoking and obesity.
- Ovarian cancer: Obesity, never pregnant, unopposed estrogen,
personal or family history of breast or ovarian cancer, genetic
mutations in the BRCA1 or BRCA2 gene, HNPCC.
- Vaginal cancer: History of genital warts or an abnormal Pap
test. There is an increased risk of clear cell carcinoma in women
whose mothers took the drug diethylstilbestrol (DES) while pregnant.
Women previously treated for carcinoma in-situ or invasive cervical
cancer also have a higher risk of developing vaginal cancer.
Signs
and Symptoms of Gynecologic Cancers
There are often no outward
signs of gynecologic cancers. However, some common symptoms include:
- Unusual bleeding, such as postmenopausal bleeding, bleeding
after intercourse or bleeding between periods.
- A sore in the genital area that doesn't heal or chronic itching
of the vulva.
- Pain or pressure in the pelvis.
- Persistent vaginal discharge.
Screening
for Gynecologic Cancers
Gynecologic cancers are often
detected through a series of screening exams.
- Your doctor will first perform a pelvic exam to evaluate your
vulva, vagina, cervix, uterus, Fallopian tubes, ovaries and rectum.
- During the pelvic exam, your doctor will gently scrape some
cells from the cervix and vagina to examine under a microscope.
This is called a Pap test.
- If the Pap test is abnormal, your doctor may perform a test
called a colposcopy to closely examine the cervix. Scraping cells
from the cervical canal (endocervical curettage) may also be necessary.
- A small sample of tissue may be taken from any suspicious area.
This test is called a biopsy.
- Occasionally, doctors need to examine a larger sample of cervical
tissue. It is obtained during a procedure called conization or
cone biopsy.
- In some situations, your doctor may recommend an exam under
anesthesia to better evaluate the extent of a cancer. Tests requiring
anesthesia include examination of the bladder (cystoscopy) and
rectum (sigmoidoscopy).
- Abnormal uterine bleeding, a common symptom of uterine cancer,
is usually evaluated by performing a dilatation and curettage,
also called a D and C.
- Your doctor may also ask for MRI, CT, PET or ultrasound scans
of the abdomen and pelvis to better evaluate areas that cannot
be directly viewed, such as the ovaries.
Treatment
Options for Gynecologic Cancers
Treatment for gynecologic
cancer depends on several factors, including the type of cancer,
its extent (stage), its location and your overall health. It is
important to talk with several cancer specialists before deciding
on the best treatment for you, your cancer and your lifestyle.
- A gynecologic oncologist is a doctor who specializes in surgically
removing gynecologic cancers.
- A radiation oncologist is a doctor specially trained to treat
cancer with radiation therapy.
- A medical oncologist is a doctor who specializes in treating
cancer with drugs (chemotherapy).
Sometimes, your cancer may
be cured by using only one type of treatment. In other cases, your
cancer may be best cured using a combination of surgery, radiation
therapy and chemotherapy. Understanding
Radiation Therapy
Radiation therapy, sometimes
called radiotherapy, is the careful use of radiation to safely and
effectively treat cancer.
- Radiation oncologists use radiation therapy to try to cure cancer,
to control cancer growth or to relieve symptoms, such as pain.
- Radiation therapy works within cancer cells by damaging their
ability to multiply. When these cells die, the body naturally
eliminates them.
- Healthy tissues are also affected by radiation, but they are
able to repair themselves in a way cancer cells cannot.
External
Beam Radiation Therapy
External beam radiation therapy
involves a series of daily outpatient treatments to accurately deliver
radiation to the cancer. Each treatment is painless and is similar
to getting an X-ray. They are often given in a series of daily sessions,
each taking less than half an hour, Monday through Friday, for five
to six weeks. In some cases, you may receive more than one treatment
in a day, often several hours apart.
- 3-dimensional conformal radiotherapy (3D-CRT) combines multiple
radiation treatment fields to deliver precise doses of radiation
to the affected area. Tailoring each of the radiation beams to
focus on the tumor delivers a high dose of radiation to the tumor
and avoids nearby healthy tissue.
- Intensity modulated radiation therapy (IMRT) is the most recent
advance in the delivery of radiation. IMRT improves on 3D-CRT
by modifying the intensity of the radiation within each of the
radiation beams. This allows more precise adjustment of radiation
doses to the tissues within the target area.
Brachytherapy
Brachytherapy (also called
internal or intracavitary radiotherapy) involves placing radioactive
sources in or next to the cancer. This is usually done at the same
time or after external beam radiation therapy. Brachytherapy is
very important in the treatment of vaginal, cervical and uterine
cancers.
There are two main types
of brachytherapy:
- Low-dose rate brachytherapy is delivered over the course of
48 to 72 hours. You will be admitted into the hospital to receive
this treatment.
- High-dose rate brachytherapy is given over the course of several
minutes, but the entire procedure typically takes a few hours.
You may be able to go home immediately after this treatment.
Depending of the type of
cancer you have, you may need to have several sessions of brachytherapy
to cure your cancer. Potential
Side Effects
The side effects you may
experience will depend on the area being treated, the type of radiation
used and whether or not you also received chemotherapy. Before treatment,
your doctor will describe what you can expect.
- Some patients experience minor or no side effects and can continue
their normal routines.
- Some patients may notice fatigue, skin irritation, vaginal irritation,
frequent urination, burning with urination and/or diarrhea. These
will all resolve after treatment ends.
- Some patients will have sexual changes, such as changes in the
vagina.
- If at any time you develop side effects, tell your doctor or
nurse. He or she can give you medicine to help.
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