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Would you explain the process of how endometrial cancer is treated with internal radiation?

Endometrial cancer is primarily treated with surgery unless, for medical reasons, patient can not undergo surgery. If based on surgical specimen the pathologist determines that the disease was early stage, patient may not need any additional treatment. The least amount of treatment needed would be addition of so called “internal radiation” or brachytherapy aka “vaginal cuff boost”. During the surgery uterus and cervix is removed and the top of the vagina is sutured off. This area is called vaginal cuff and has the highest risk of recurrence for cancer. Therefore to reduce the risk of cancer recurring in this area, we would insert a cylinder like applicator into the vagina and through that applicator insert a radioactive radiation source and irradiate the tissue at the top of vagina a few minutes each time for 3-6 times one week apart.

If a radiation oncologist determines that the lymph nodes in the pelvis are also at risk of recurrence, then he/she would recommend addition of five weeks of daily external beam radiation therapy as well.

The exception to all of the the above is a patient who can not undergo surgery. In that scenario, radiation therapy would become the primary treatment. A combination of internal and external radiation would be indicated. For internal radiation, a double tandem intrauterine catheter and High Dose Rate (HDR) machine would be utilized. In the absence of HDR machine, one may use Hayman Capsule catheters and Low Dose Rate Brachytherapy technique.

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