This week I went in for my 2nd opinion regarding post surgical treatment. My oncologist wanted me to consult with a doctor who specializes in radiation oncology about whether or not to go forward with radiation treatment. My type of cancer normally dictates that no further treatment is necessary after surgery. Normally…
Typically, recurrence with my type of cancer is small, less than 3%. But what happens when the tumor is filling the uterine cavity and is much larger than anyone expected? Does the risk of the cancer coming back go up?
So my husband and I went for my second opinion. Again, I was told that my tumor met the criteria for just an aggressive follow up and no further treatment. However, like my oncologist, the size of the tumor gave the doctor “pause” about the standard recommendation.
While there are lots of studies on Stage 1, Grade 1 uterine cancer treatment options, up until a few months ago none of those studies considered the size of the tumor.
Recently, French doctors noticed this gap in cancer research. So they pulled medical data on 600 French women, looking at tumor size under and over 3.5 mm (my tumor was 5 mm). While it isn’t a clinical trial, it was at least some data I could use to make my decision.
Turns out, the larger your tumor the higher your risk of the cancer coming back without additional treatment. So instead of a 3% chance, I have over a 15% risk of the cancer coming back within 2 years. If you go by the French study.
During the consult, it was clear I had 2 options.
Option 1: Roll the Dice! If I decide to forgo radiation and the cancer comes back, I’m looking at more surgery, radiation and chemotherapy. Even though my cancer is considered very survivable, that changes with a recurrence. That puts my odds of survival at 50/50.
Option 2: Radiation Treatment.
At this point I was leaning heavily towards radiation. But I also know there are risks involved with radiation and the chance that the treatment itself could cause cancer.
I learned there are two types of radiation treatments, and each come with some baggage. One with a whole lot more than the other.
Treatment 1: External Radiation.
This type of treatment delivers high doses of radiation outside my body. This technique reaches the lymph nodes and not just the vaginal cuff (location where the cancer most likely would pop up). However it also hits my bladder and rectum, causing incontinence and painful diarrhea. Those symptoms can range from a few weeks to permanent. Part of my pelvic bones also get exposed and increases my risk of easy hip breaks. Finally, the likelihood of this type of treatment causing cancer is greater because I’m under 50.
Treatment 2: Vaginal Brachytherapy (Internal Radiation)
With this treatment, the dosage of radiation is controlled at levels high enough to kill any remaining cancer cells, but minimizes exposure to normal tissue. An applicator is inserted in me. The radioactive material travels along a wire connected to the applicator. The material stops at specific spots in the applicator for a certain period of time (total time is 10 minutes). In some instances, you would stay in the hospital as the applicator stays inside of you for days. In my situation, it is removed after treatment.
The brachytherapy does have 2 side effects – a narrowing of the vagina and the vaginal walls becoming stuck together. However, there are two “exercises” I’d need to do 3 times a week for 2 years to prevent this from happening. I won’t go into the details, but lets just say my husband really likes the exercises!
It didn’t take me much time to make up my mind. I opted for the Vaginal Brachytherapy. The treatment takes my chances of the cancer coming back down to under 3%.
Once I officially hit the 6-week post surgery mark (around mid August), I can get fitted for my applicator. The treatment happens 2 times a week over a 3-week period. The “exercises” to prevent the side effects start about 2-3 weeks after treatment ends.
After treatment, I go in for pelvic and vaginal cuff exams every 3 months.
I found a video explaining the treatment. I’m always amazed at how medical videos try to be calm and soothing but end up being a tad creepy.
Finally Some Peace of Mind
Resting for weeks on end after major surgery just isn’t my thing. It is too easy to worry and The Google is so tempting while waiting for the next doctor’s appointment. But now I finally have some relief.
While I know I still have a long road ahead, at least I have a plan of attack. I feel like I can relax a little. I’m aware that even after this treatment the cancer could come back. But I can’t fret about a “maybe.” I have to focus on what I can control and take those steps to live my life.
Radiation treatment is of those steps.
Now I can turn my attention to tweaking my diet in the hopes of gaining an edge.