My Story – Uterine (Endometrial) Cancer: The “Demon Seed”

 In the 1977 movie Demon Seed based on the book by Dean Koontz, Julie Christie’s character is impregnated by a computer that wants to experience life.

This is what I thought of during my second vaginal brachytherapy treatment yesterday–although it’s too late for me to be impregnated by anything but radiation (so to speak). The only “demon seed” I am concerned with resides within this canister (called a “pig”), which contains the radioactive source (called a “seed”). Radiation is injected into the plastic applicator through a catheter–and into me.Anyway, no baby-bots for me. And I hope the final treatment next week puts an end to any baby cancer cells that might be lingering following my hysterectomy in December for endometrial adenocarcinoma.

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The snowstorms pummeling this part of the country gave us a respite on Sunday for the Super Bowl. This was followed by a storm that left us with 10 inches of snow the next day, Monday. Another storm hit us last night into today, Wednesday, dumping ice over the 10 inches of snow. But Mother Nature must have a soft spot for me as well as for the Seahawks–the frozen waters parted yesterday, Tuesday, to allow me to have my second radiation treatment. Had it been today, I wouldn’t have gotten there. And yet another storm is expected this weekend. With any luck, the frozen waters will part again next Thursday, February 13–the day of my third and final radiation treatment, two months to the day that I had a hysterectomy for uterine cancer.

Before I continue, just a reminder from yesterday’s post that February 4 is World Cancer Day. Here’s my sincere wish that everyone affected by the many forms of this disease, directly or indirectly, gets to see the tail end of it in their lifetime.

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As I said in the January 24, 2014 post, the day after my first radiation treatment, I thought it would be worthwhile to compare internal brachytherapy with external pelvic radiation. This naturally leads to a discussion of cancer staging and treatment side effects.

I have previously discussed cancer staging in some detail, most recently in the January 16 post. Briefly, because my tumor was contained within the uterus and the pathology report showed no metastasis into the cervix or in the 24 lymph nodes that were removed, it was classified as stage 1–but stage 1B. The tumor had penetrated 70% into the myometrium (muscle wall of the uterus), and the cells making up the tumor were abnormal enough for it to be classified as grade 3. So although it is a common uterine cancer, my adenocarcinoma was labeled “aggressive,” and the doctors tell me I am at high-intermediate risk of recurrence. This means there is a 15+% chance that the cancer could recur in the vaginal cuff incision area if microscopic (or submicroscopic) abnormal cells remain that can’t be detected with current technology. A very small chance exists that any such cells could break away and cause a recurrence elsewhere in my body, but none of my doctors placed a percentage of risk on this.

I was offered two treatment plans: (1) five weeks/five days a week of low-dose-rate (LDR) pelvic external-beam radiation therapy (EBRT) followed by three high-dose-rate (HDR) vaginal brachytherapy treatments spaced 10 days apart, or (2) three vaginal brachytherapy treatments alone. Pelvic radiation is most appropriate where the site of probable recurrence is the lymph nodes. Because my 24 nodes were all negative for cancer cells, and because the most likely site of recurrence in my case is in the upper vagina, I opted to have brachytherapy alone. This reduces my risk of recurrence to about half, or 7-8%. Having both kinds of treatment may have lowered the risk by a percentage point or two, but weighing the potential side effects against the possible benefits, I believe I chose the best course for me–targeted vaginal radiation.

Radiation destroys the DNA of cancer cells so that they can no longer divide. But it also affects normal cells the same way, resulting in short-term and long-term effects depending on when the cells of the irradiated tissues divide. Toxic effects vary somewhat from patient to patient in appearance and severity. Common side effects of pelvic radiation are bladder and bowel changes, skin burns and irritation, nausea (because the bowel drops down into the space vacated by the removed uterus), lymphedema (swelling caused by an accumulation of lymphatic fluid) in the legs, and tiredness. Because vaginal brachytherapy is much more localized, and care is taken to minimize normal tissue involvement when plotting out the treatment plan using a CT scan, it is typically only the vagina itself that sustains radiation effects. So far, I can’t say that I’ve noticed any problems, although I did have some bladder and bowel changes after the surgery that may be slightly exacerbated by the radiation treatments. Later, I am told I can expect vaginal dryness and shortening of the vaginal canal (on top of what I’ve already experienced as a menopausal woman). After my final treatment, I will get more information about this and will pass it along.

So, one final treatment on Thursday, February 13, two months to the day after my hysterectomy, and I should be in maintenance mode. But maintaining good health in body, mind, and soul isn’t something to be taken lightly and deserves a considerable amount of attention. Stay tuned.

For a comprehensive discussion of radiation treatment, please see the American Cancer Society site–the online information is also downloadable as a PDF.

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And if you’re in the path of these winter storms . . .

take special care so your world doesn’t turn upside down.