- How is endometrial cancer treated?
- Surgery for endometrial cancer
- Radiation therapy for endometrial cancer
- Chemotherapy for endometrial cancer
- Hormone therapy for endometrial cancer
- Clinical trials for endometrial cancer
- Complementary and alternative therapies for endometrial cancer
- Treatment options for endometrial cancer by stage
- More treatment information about endometrial cancer
Radiation therapy for endometrial cancer
Radiation therapy is the use of high-energy radiation (such as x-rays) to kill cancer cells. Radiation therapy may be given by placing radioactive materials inside the body near the tumor. This is called internal radiation therapy or brachytherapy. Another option is to give radiation from a machine outside the body in a procedure that is much like having an x-ray. This is called external beam radiation therapy. In some cases, both brachytherapy and external beam radiation therapy are given. The stage and grade of the cancer help determine what areas need to be exposed to radiation therapy and which methods are used.
For vaginal brachytherapy, a cylinder containing a source of radiation is inserted into the vagina. The length of the cylinder (and the amount of the vagina treated) can vary, but the upper part of the vagina is always treated. With this method, the radiation mainly affects the area of the vagina in contact with the cylinder. Nearby structures such as the bladder and rectum get less radiation exposure. The most common side effect is changes to the lining of the vagina (discussed in more detail below).
This procedure is done in the radiation suite of the hospital or care center. About 4 to 6 weeks after the hysterectomy, the radiation oncologist inserts a special applicator into the woman's vagina, and pellets of radioactive material are inserted into the applicator. There are 2 types of brachytherapy used for endometrial cancer, low-dose rate (LDR) and high-dose rate (HDR).
In LDR brachytherapy, the radiation devices are usually left in place for about 1 to 4 days. The patient needs to stay immobile to keep the radiation sources from moving during treatment, and so she is usually kept in the hospital overnight. Several treatments may be necessary. Because the patient has to stay immobile, this form of brachytherapy carries a risk of serious blood clots in the legs (called deep venous thrombosis or DVT). LDR is less commonly used now in this country.
In HDR brachytherapy, the radiation is more intense. Each dose takes a very short period of time (usually less than an hour), and the patient can return home the same day. For endometrial cancer, HDR brachytherapy is often given weekly or even daily for at least 3 doses.
External beam radiation therapy
In this type of treatment the radiation is delivered from a source outside of the body.
External beam radiation therapy is often given 5-days-a-week for 4 to 6 weeks. The skin covering the treatment area is carefully marked with permanent ink or injected dye similar to a tattoo. A special mold of the pelvis and lower back is custom made to ensure that the woman is placed in the exact same position for each treatment. Each treatment takes less than a half-hour, but the daily visits to the radiation center may be tiring and inconvenient.
Side effects of radiation therapy
Short-term side effects: Common side effects of radiation therapy include tiredness, upset stomach, or loose bowels. Serious fatigue, which may not occur until about 2 weeks after treatment begins, is a common side effect. Diarrhea is common, but can usually be controlled with over-the-counter medicines. Nausea and vomiting may also occur, but can be treated with medication. These side effects are more common with pelvic radiation than with vaginal brachytherapy. Side effects tend to be worse when chemotherapy is given with radiation.
Skin changes are also common, with the skin in the treated area looking and feeling sunburned. As the radiation passes through the skin to the cancer, it may damage the skin cells. This can cause irritation ranging from mild temporary redness to permanent discoloration. The skin may release fluid, which can lead to infection, so care must be taken to clean and protect the area exposed to radiation.
Radiation can irritate the bladder, and problems with urination may occur. Irritation to the bladder, called radiation cystitis, can result in discomfort, blood in the urine, and an urge to urinate often.
Radiation can also cause similar changes in the intestine. When there is rectal irritation or bleeding, it is called radiation proctitis. This is sometimes treated with enemas that contain a steroid (like hydrocortisone) or suppositories that contain an anti-inflammatory.
Radiation can irritate the vagina, leading to discomfort and drainage (a discharge). If this, called radiation vaginitis, occurs, your radiation doctor may recommend douching with a dilute solution of hydrogen peroxide. When the irritation is severe, open sores can develop in the vagina, which may need to be treated with an estrogen cream.
Radiation can also lead to low blood counts, causing anemia (low red blood cells) and leukopenia (low white blood cells). The blood counts usually return to normal within a few weeks after radiation is stopped.
Long-term side effects: Radiation therapy may cause changes to the lining of the vagina leading to vaginal dryness. This is more common after vaginal brachytherapy than after pelvic radiation therapy. In some cases scar tissue can form in the vagina. The scar tissue can make the vagina shorter or more narrow (called vaginal stenosis), which can make sex (vaginal intercourse) painful. A woman can help prevent this problem by stretching the walls of her vagina several times a week. This can be done by having sexual intercourse 3 to 4 times per week or by using a vaginal dilator (a plastic or rubber tube used to stretch out the vagina). Still, vaginal dryness and pain with intercourse can be long-term side effects from radiation. Some centers have physical therapists who specialize in pelvic floor therapy which can help to treat these vaginal symptoms and sometimes improve sexual function. You should ask your physician about this if you are bothered by these problems.
Pelvic radiation can damage the ovaries, resulting in premature menopause. However, this is not an issue for most women who are being treated for endometrial cancer because they have already gone through menopause, either naturally or as a result of surgery to treat the cancer (hysterectomy and removal of the ovaries).
Pelvic radiation therapy can also lead to a blockage of the fluid draining from the leg. This can lead to severe swelling, known as lymphedema. Lymphedema is a long-term side effect; it doesn't go away after radiation is stopped. In fact it may not appear for several months after treatment ends. This side effect is more common if pelvic lymph nodes were removed during surgery to remove the cancer. There are specialized physical therapists who can help treat this. It is important to begin treatment early if you develop it.
Radiation to the pelvis can also weaken the bones, leading to fractures of the hips or pelvic bones. It is important that women who have had endometrial cancer contact their doctor right away if they have pelvic pain. Such pain might be caused by a fracture, recurrent cancer, or other serious conditions.
Pelvic radiation can also lead to long-term problems with the bladder (radiation cystitis) or bowel (radiation proctitis). Rarely, radiation damage to the bowel can cause a blockage (called obstruction) or for an abnormal connection to form between the bowel and the vagina or outside skin (called a fistula). These conditions may need to be treated with surgery.
If you are having side effects from radiation, discuss them with your doctor. There are things you can do to get relief from these symptoms or to prevent them from happening.
Last Medical Review: 07/25/2012
Last Revised: 01/17/2013