Dr. Bhooshan Zade is a post graduate in Radiation Oncology from the prestigious Tata Memorial Hospital, Mumbai.
Gynecolgic (Gyn) Cancers include cancers of the uterus, ovaries, cervix, vagina, vulva, and fallopian tubes Facts:
The most common gynecologic cancer is uterine or endometrial cancer. More than 40,000 cases are diagnosed each year. Yearly more than 28,000 women die from gynecologic cancer. Screening with the Pap smear has allowed for the earlier detection of abnormalities of the cervix and vagina. This early detection has helped prevent the development of more advanced disease and has improved survival rates. Risk Factors : Uterine or Endometrial Cancer
• Never pregnant
• Young age at onset of menstruation
• Late menopause
• Unopposed estrogen use for hormone replacement therapy
• Family history of uterine cancers
• Tamoxifen—a drug used to treat breast cancer-can slightly increase the risk of endometrial cancer
• HNPCCa genetic syndrome called hereditary nonpolyposis colon cancer
• Associated with sexually transmitted diseases--especially human papilloma virus (HPV)
• Sexual activity at an early age
• Multiple sexual partners
• No pregnancies
• Unopposed estrogen
• Personal or family history of breast or ovarian cancer
• Genetic mutations in the BRCA1 or BRCA2 gene
• HNPCC-hereditary nonpolyposis colon cancer
• Genital warts
• Women born to mothers who took the drug diethylstilbestrol (DES) while pregnant
• History of cervical cancer
Signs and Symptoms
There are often no outward signs or symptoms of these cancers. However, some of the more common ones are listed below.
• Unusual vaginal bleeding
• A sore in the genital area that does not heal
• Pain of pressure in the pelvis
• Abdominal bloating
The treatment of gyn cancers is varied. It depends on the type of cancer, its extent or stage, its location, and your overall health. Prior to your physicians determining the best course of treatment, you will often need a thorough physical exam which may need to be done under anesthesia, biopsies of the tumor, and radiographic studies, such as MRI, CT, PET, or ultrasound to determine the extent of the cancer.
Your treatment team may be composed of multiple physicians:
• The gynecologic oncologist - a surgeon who specializes in -gyn cancers
• The radiation oncologist - a doctor trained to treat cancer with radiation
• The medical oncologist - a doctor trained to treat cancer with drugs or chemotherapy
Your cancer may be treated using only one modality of treatment or you may need some combination of surgery, chemotherapy, and radiation.
Radiation Therapy For Gyn Cancers
Radiation therapy or radiotherapy is the careful use of radiation to treat cancer. Radiation oncologists use radiation to try and cure cancer or to control cancer growth to relieve symptoms. Radiation works by interfering with the ability of cancer cells to multiply. It causes the cancer cells to die and then the body can naturally eliminate these cells. Healthy tissues can be affected by radiation but they are able to repair the radiation damage.
The radiation for gyn cancers often involves a combination of two types of radiation external beam radiation and brachytherapy.
External Beam Radiation
External beam radiation involves a series of outpatient treatments to accurately target the radiation dose to the tumor. Each treatment is painless and is like getting an x-ray. The treatment takes only a few minutes each day and is given Monday though Friday typically for five to six weeks.
3-Dimensional Conformal Radiation
A planning CT scan is used to design multiple radiation beams or fields to accurately target the cancer. This allows dose to be focused on the tumor while avoiding surrounding normal tissues.
Intensity Modulated Radiation Therapy (IMRT)
IMRT is a recent advance in the delivery of radiation. IMRT takes 3-dimension radiation one step further by modifying the intensity of each of the radiation beams. This allows more precise adjustments of radiation doses to the tumor and normal tissues.
Brachytherapy is also known as intracavitary or internal radiation. It involves the placement of radioactive sources within applicators which are then placed within the vagina or uterus. This allows a higher dose of radiation to be delivered to the tumor while minimizing dose to the surrounding structures. Brachytherapy is often done at the same time or after external beam radiation. Often several sessions are required. Occasionally it can be used as the sole modality of radiation.
Low dose rate brachytherapy
The radiation is delivered over 48-72 hours and requires admission to the hospital.
High dose rate brachytherapy
The radiation is delivered over the course of several minutes and usually does not require a hospital stay
Potential Side Effects
The side effects of radiation depend on the area being treated and the type of radiation used. They also depend on whether you are getting chemotherapy along with the radiation.
Many patients experience minor or no side effects and continue with their normal activities. The more common side effects are listed below. These will resolve after the treatment ends.
• Irritation of the skin within the treatment area
• Vaginal irritation
• Frequent urination
• Burning with urination
• Rectal soreness
Your physicians will help you manage these side effects during the treatment.