Uterine Cancer Treatment

Uterine cancer most often refers to endometrial cancer, which begins in the lining of the uterus. Many cases are diagnosed early because abnormal bleeding, especially after menopause, brings patients to medical attention. Surgery is usually the first treatment and often includes hysterectomy with removal of the fallopian tubes and ovaries. Lymph node evaluation may also be performed depending on the case.

After surgery, the pathology report helps determine whether additional treatment is needed. Important risk factors include tumor grade, depth of myometrial invasion, lymphovascular space invasion, cervical stromal involvement, lymph node involvement, tumor size, margin status, and histologic subtype such as serous carcinoma, clear cell carcinoma, carcinosarcoma, or high-grade endometrioid cancer.

Radiation therapy may be recommended when there is a higher risk of the cancer returning in the vaginal cuff, pelvis, or lymph node regions. The goal is to reduce the chance of local or regional recurrence while limiting side effects. Radiation may also be used to treat isolated vaginal or pelvic recurrence, sometimes with curative intent.

How Radiation Helps Treat Uterine Cancer

There are two main radiation approaches for uterine cancer: vaginal cuff brachytherapy and pelvic external beam radiation therapy.

Vaginal cuff brachytherapy treats the top of the vagina, which is one of the most common sites of recurrence after hysterectomy. A smooth cylinder-shaped applicator is placed in the vagina for a short treatment. A tiny radioactive source travels inside the applicator and delivers radiation from within. Because the source is very close to the target, the dose falls off quickly. This allows a strong dose to the vaginal cuff while limiting the dose to the bladder and rectum.

Brachytherapy is often used for early-stage patients with intermediate-risk features. It is outpatient, does not require an incision, and usually takes a short time once setup is complete.

Pelvic external beam radiation therapy is used when the risk extends beyond the vaginal cuff, such as risk in the pelvic lymph nodes or tissues around the uterus. A technique called IMRT, or intensity modulated radiation therapy, shapes radiation around the pelvis while reducing dose to the bowel, bladder, rectum, and bone marrow. Daily image guidance confirms patient positioning before each treatment.

For higher-risk disease, radiation may be combined with chemotherapy. Radiation helps reduce the chance of pelvic or vaginal recurrence, while chemotherapy addresses the risk of cancer cells elsewhere in the body. The exact sequence depends on stage, pathology, and medical or gynecology oncology recommendations.

Treatment for Recurrence

If uterine cancer returns in the vaginal cuff or pelvis and has not spread widely, radiation may still offer long-term control. Depending on the recurrence location, treatment may include brachytherapy, IMRT, SBRT (stereotactic body radiation therapy), or a combination. For a small vaginal recurrence, brachytherapy with or without pelvic radiation therapy can be utilized to treat the tumor. For a pelvic lymph node recurrence, IMRT or SBRT may be used depending on size, location, and nearby organs.

Side Effects and How We Manage Them

Side effects depend on whether the patient receives brachytherapy alone, pelvic radiation, chemotherapy, or combined treatment.

Possible side effects may include:

• Fatigue
• Vaginal dryness, irritation, discharge, or spotting
• Temporary urinary frequency or urgency
• Loose stools, diarrhea, or abdominal cramping
• Mild pelvic discomfort
• Skin irritation in pelvic skin folds, less common with modern techniques
• Vaginal narrowing or shortening over time
• Rare bladder, rectal, bowel, or pelvic bone complications

How we manage these effects:

• We use vaginal cuff brachytherapy when the risk is localized to the top of the vagina.
• We use IMRT and daily image guidance to reduce dose to the bowel, bladder, and rectum.
• We provide vaginal moisturizers and dilator guidance when appropriate.
• We manage urinary symptoms with hydration guidance and medication if needed.
• We treat diarrhea with diet changes, hydration, and anti-diarrheal medication when appropriate.
• We monitor fatigue and encourage light activity balanced with rest.
• We coordinate with gynecologic oncology and medical oncology when chemotherapy is part of care.
• We provide follow-up to monitor healing, vaginal health, and recurrence risk.

Call 847-698-0600 ext. 112 to schedule a consultation.