There are several different types of cancers which affect the uterus, and these all fall under the category of Uterine Cancer. The uterus is an organ in the female anatomy composed of two basic components, the myometrium and endometrium. Cells from either of these two areas can become malignant, and the kind of cancer which may develop is based on the originating location and type of originating cell. Uterine Sarcomas are cancers originating from the myometrium or muscular layer of the uterus, with the most common uterine sarcoma being a leiomyosarcomas. Cancers originating from the endometrium, or glandular cell of uterine lining include adenocarcinomas, papillary serous carcinoma and uterine clear-cell carcinoma. Mixed Müllerian tumors are rare endometrial tumors, which show both glandular and sarcomatous features.

Early signs of uterine and gynecologic cancers can include abnormal vaginal bleeding or discharge, particularly in postmenopausal women, and pelvic pain or cramping. These symptoms warrant immediate evaluation to ensure early detection and treatment.

Endometrial adenocarcinoma, is typically referred to as endometrial cancer and is the most common form of uterine cancer the most common gynecologic cancer with an estimated 66,200 women diagnosed in the US in 2023, according to American Cancer Society statistics. It is the fourth most common cancer in women. One in 37 women will be diagnosed with endometrial cancer in their lifetime. The majority of cases occur in women aged 50 to 70 years, with most diagnoses happening after menopause. While endometrial cancer is more prevalent among Caucasian women, African American women face a higher risk of mortality from this condition.

Cervical cancers arise from the cervix, an organ or area that is the connection between the lower portion of the uterus and the upper portion of the vagina. Cervical cancers are known to have a primary cause from the persistent infection with high-risk types of human papillomavirus (HPV). Regular screening through Pap tests and HPV testing can often detect precancerous changes in the cervix, allowing for intervention before cancer develops. Newer HPV vaccines are given to young adults before they are sexually active and can drastically reduce the development of these cancers.

The main types of cervical cancer are squamous cell carcinoma, originating in the thin, flat cells lining the outer part of the cervix, and adenocarcinoma, arising from the glandular cells. Early stages of cervical cancer typically present with minimal or no symptoms, but advanced disease can lead to abnormal vaginal bleeding, pelvic pain, or pain during intercourse.

Cervical cancer was once one of the most common causes of cancer death for American women, but the death rate has significantly decreased due to the effectiveness of the Pap test. The American Cancer Society estimates that about 13,960 new cases of invasive cervical cancer will be diagnosed in the US in 2023, and about 4,310 women will die from the disease. Vaccination against HPV, regular screenings, and follow-up on abnormal test results are key strategies in preventing cervical cancer.

Ovarian cancer starts in the ovaries, the female reproductive glands where eggs are produced. It is often difficult to diagnose in the earlier stages as it usually doesn’t cause any specific symptoms until more significant growth may have occurred, and where it may be more difficult to treat.

Types of ovarian cancer include epithelial tumors, germ cell tumors, and stromal tumors, with epithelial tumors being the most common. Risk factors include age, inherited gene mutations (such as BRCA1 and BRCA2), family history of ovarian cancer, and previous breast cancer diagnosis.

Due to its vague symptoms and lack of early detection tests, only about 20% of ovarian cancers are found at an early stage. It’s estimated that about 19,710 women were diagnosed with ovarian cancer diagnosis in 2023 in the United States.

Vulvar and vaginal cancers are relatively rare gynecologic cancers that start in the vulva or vagina, respectively. Vulvar cancer most often occurs on the inner edges of the labia majora or labia minora. Vaginal cancer typically forms in the lining of the vagina. Risk factors for both include HPV infection, age, smoking, and a history of cervical precancerous conditions.

Symptoms may include itching, pain, or tenderness in the vulva area, changes in vulva color or skin, such as a rash or warts, and abnormal vaginal bleeding or discharge. Early detection improves the treatment outcome, but these cancers are often diagnosed at later stages due to the subtlety of symptoms.

While specific statistics for vulvar and vaginal cancers are less commonly reported due to their rarity, raising awareness about HPV vaccination and regular gynecologic examinations can help in early detection and prevention.

The journey to diagnosing uterine or gynecologic cancers often begins with a pelvic exam and may include a pap smear test or imaging studies like a transvaginal ultrasound. For a definitive diagnosis, a biopsy may be necessary, a procedure that is generally well-tolerated and may be performed without anesthesia, typically by a gynecologist or gynecologic oncologist.

Following a diagnosis, further tests such as chest X-rays, CT, or MRI scans, and possibly more specialized procedures, help assess the cancer’s spread, guiding the treatment plan.

The primary approach to treating uterine and gynecologic cancers may involve surgery, such as a hysterectomy, often combined with the removal of the ovaries. Some forms of gynecologic cancers such as cervical or vulvar cancers may not be easily amenable to surgery, and definitive radiation (with or without varying forms of systemic chemotherapy) may be used. In either case, the extent of additional treatments, including radiation therapy or chemotherapy, will be dependent on the cancer’s stage, it’s risk of recurrence, and whether the disease has spread beyond the local tissues or remains contained.

Radiation therapy plays a crucial role in treating gynecologic cancers, with options tailored to each patient’s specific condition:

External Beam Radiotherapy (EBRT), delivery technologies such as Volumetric Modulated Arc Radiation Therapy (VMAT) Intensity-Modulated Radiation Therapy (IMRT), and Image Guided Radiation Therapy (IGRT) focus radiation accurately on the tumor from outside the body, with precision that minimizes exposure to surrounding healthy tissue.

High-Dose Rate (HDR) Brachytherapy delivers radiation internally directly to the cancerous area or areas at risk using specialized technologies that can temporarily expose internal parts of the body to a small high-dose radiation source, which is guided in a robotic-like fashion, based on a plan created by the radiation oncologist and physics treatment team. This ensures optimal doses to the tumor or tissues at risk while simultaneously protecting nearby organs from unnecessary exposure.

Radiation therapy to the pelvic region may have side effects which could include fatigue, gastrointestinal discomfort, and changes in urinary or sexual function. These are generally temporary, and strategies exist to manage and mitigate these effects.

At Advanced Radiation Centers, our priority is not only to treat cancer effectively but also to care for our patients’ overall well-being, ensuring they receive the most compassionate and comprehensive care possible.

Radiation treatment demands meticulous preparation by a dedicated team, ensuring precision and patient safety throughout the process.   Each step of the radiation treatment process is designed with precision, safety, and your well-being in mind, ensuring that you receive the most effective and personalized care possible.

Consultation

The initial step involves you and your family meeting with an ARC radiation oncologist to discuss your diagnosis, review your medical history, and consider the most effective radiation treatment options tailored to your specific case.  Expectations of therapy, side effects and treatment alternatives will be discussed.

Simulation

Once a course of radiation is agreed upon a simulation, or treatment planning session is performed over a 45-60 minute period.  During the simulation, the positioning of the body is set, often used a thermoplastic “mask” which is customized to the head/face area, and ensures daily reproducibility in positioning on a day-to-day basis, aiding in pre-treatment alignment.  An imaging scan is performed to pinpoint the exact location of the cancer or areas at risk relative to the geometric position of the body and treatment room. This step is crucial for designing a treatment plan that maximizes the radiation dose to the cancer while sparing surrounding healthy tissue.

The Planning Process (Behind the Scenes)

For a week or two following the simulation, a multi-disciplinary team composed of the radiation oncologist, medical physicists and dosimetrists, collaborate behind the scenes using advanced software to 3-dimenionally reconstruct the anatomic areas of consideration and map out the precise treatment plan, calculating the optimal radiation dose distribution.  This dosimetry plan is a “blueprint” that will be used to ensure accuracy in the treatment delivery.

Daily Radiation Treatments

Radiation therapy typically involves daily treatments over several weeks using a machine that generates high energy photons called a linear accelerator. The treatment room is large and is not claustrophobic. Each session typically takes place in a 10-15 minute appointment slot, with most of this time used in positioning and alignment, while the actual beams of radiation are on for only a few minutes. The radiation is invisible and not felt.  Patients can drive themselves to and from the appointments, continue to work or exercise and maintain their normal daily activities.  Specific restrictions, if any, can be discussed with your radiation oncologist at consultation and during the weekly on-treatment visits.

Weekly On-Treatment Physician Review

Regular meetings with patients undergoing radiation are conducted with the radiation oncologist throughout your treatment course. These check-ins allow the doctor to monitor your progress, briefly exam the area under treatment for any possible side effects, provide any medications or treatment adjustments, and discuss any questions or concerns that may arise during therapy.

Completion of Therapy and Follow-Ups

Upon finishing the radiation treatment course, a final conversation with your radiation oncologist will discuss the next steps, expectations for resolution of side effects, and any further treatment or monitoring needed.  Regular follow-up appointments are crucial after completing radiation therapy, and allow the radiation team to monitor your recovery, manage any late side effects, and check for signs of cancer recurrence.