My Story – Uterine (Endometrial) Cancer: My First Encounter with a Radioactive “Pig”

  And So Irradiation Begins . . .

Note: The blue-green highlighted terms in the text contain links to previous posts.

Radiation Treatment #1–Check √

As discussed in the January 10, 2014 post about radiation therapy, my post-hysterectomy treatment plan includes three “fractions” of high-dose rate (HDR) vaginal radiation, or brachytherapy. The first treatment was yesterday, January 23. The other two treatments are scheduled for February 4 and February 13. I had been fairly apprehensive about this form of therapy since I’d first heard about it—just the thought of a radioactive “tampon” gave me psychological shivers. But by the end of the big day yesterday, I was breathing easier—I’d gotten through it pretty much unscathed.

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The experience was what I’ll call inconvenient and uncomfortable, but not painful and not really frightening after all—despite the fact that a radioactive “pig” injected nuclear material into my “treasure vault.” Actually, the radioactive material—Iridium-192—is encased in a lead-lined digital treatment-delivery instrument called the “microSelectron” (although I can imagine the protruding part looking like a snout, I doubt this is the origin of the porcine nickname; I need to investigate more about this odd term).

  A catheter is fed from the radioactive canister through the snout and then attached to the applicator, which is sort of a super-sized plastic “tampon” that is inserted into the vagina—after it’s covered with a condom. Mine measures 2.5 x 5.5 cm (.98 x 2.17 inches). (I hope you’re taking note of the remarkable restraint I’m showing in not making gratuitous jokes right about now . . . so much good material. . . .)

Once you’re positioned on the treatment table with your knees bent, the radiation oncologist inserts the condom-covered cylinder, encouraging you to report “get it out now!” pain, if any. I did have some discomfort as the applicator was gently pushed against the vaginal cuff incision, which is still healing, and she adjusted it so that the position was quite tolerable. Then the medical people leave the room, as the very thick door slowly closes on its own behind them, leaving you alone with the pig.

The room is equipped with a camera so they can watch you to be sure you’re not in any sort of distress. It also has a two-way microphone for communicating information (them) and requests for help (you). They never did explain what might lead to this distress or a cry for help, and I didn’t ask. Luckily, I never found out. The other notable machine in the room is the radiometer (I guess that’s what it might be called), a red box with a needle showing that radioactivity is happening. Once I saw that needle move, I heard quiet clicks and felt subtle pulses as the radiation was injected into the condomed cylinder nestled inside of me. The Iridium-192 never touches your tissues directly, so no glowing in the dark afterward.

I have to say that the pelvic ultrasound I had before the surgery, and even a routine pelvic exam with a speculum, are more painful than this procedure was. The discomfort I felt when the applicator was inserted felt similar to these other procedures (maybe there’s such a thing as “phantom cervix syndrome”?), but was much less uncomfortable–once the applicator is inserted, it stays put with no rummaging around.

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But we need to backtrack a bit to the phase that occurred just before the irradiation, which consisted of a CT scan to check placement of the applicator in the vagina and establish the treatment parameters. The radiation physicist maps out the treatment plan based on this scan, and at the time of the treatment the applicator is placed in exactly the same position to spare as much healthy tissue as possible, primarily the bladder and rectum, from being subjected to radiation, which does have toxic effects (more about this later).

Both the CT scan portion of the treatment and the radiation injection itself require a full bladder, which is terribly inconvenient when you need to drive an hour-and-a-half and arrive at the appointment ready to hop on the table. I don’t possess the ability to focus on traffic patterns and urine retention at the same time, so I am dependent on transportation help. The drive to St. Barnabas is only an hour in the middle of the day, but it took an additional 30 minutes at rush hour for my stepson to get me there for my 8:45 AM appointment yesterday.

Without getting too graphic, I do need to pause here to mention the other type of biological waste, which in my case became medically relevant. We left the house at 7:15 AM, expecting to arrive early (we didn’t). I just had time to drink a cup of tea before leaving, but not to benefit from is effects. In other words, I hadn’t had a bowel movement. En route, I drank half a bottle of water. So by the time I arrived at the hospital, I was full of “materials” that wanted to come out–badly. I asked the radiation oncologist whether it mattered that I hadn’t had a BM, and she said no, and I also said I didn’t have the self-control to take care of that before the CT scan and not urinate. So I held my own until after the study was done, which fortunately took only about 10 minutes. Then they let me loose, and I took full advantage of the restroom.

I had an hour-and-a-half wait while the physicist worked on the treatment plan, which gave me time to refill my bladder before the radiation injection. A distended bladder is necessary to keep the bowel, which is sensitive to radiation, out of the way. When it was time for me to meet the pig, the doctor happened to ask whether I’d had a BM. I had. Oh. Was that a problem? Maybe. She checked the CT scan and said it was OK, but ideally conditions should be exactly the same during the treatment. How in the world they would have expected me to have the same contents in my lower bowel for each visit I’ll never know. Anyway, although they proceeded with the treatment yesterday, afterward they said they wanted to redo the CT scan next time before they do the second treatment to be sure the applicator positioning is optimal. Because the appointment is at 8:00 AM, I’m going to have to figure out some way to alter my biological routine so I can comply with the medically necessary evacuation.

OK, enough of that. But take note in case you face a similar situation: start a high-fiber diet well in advance of your treatment.

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In the next post, I’ll discuss a bit more about why vaginal brachytherapy is the best post-operative treatment option for me, which requires a quick review of the final diagnosis and a brief discussion of pelvic radiation.

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With my husband in India on professional and personal business, I am dependent on friends–and my stepson–to help me with transportation, and they are very kindly stepping forward to do so. I can’t end this post without expressing my sincere gratitude for their help. Thank you!