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Radiation after radical hysterectomy for cervical cancer

Radiation after radical hysterectomy for cervical cancer

Question

Dear OncoLink "Ask The Experts,"
After undergoing a radical hysterectomy with the removal of lymph nodes and ligaments for cervical cancer with no evidence of spread, I am now faced with the possibility of 6 weeks of radiation therapy. This therapy has been recommended because of the position of the tumor (3 mm from the cervical wall). I am hesitant to put my body through this treatment. Can you suggest other methods/tests to closely monitor the pelvic area for recurrence of disease?  

Answer

Christina S. Chu, MD, Assistant Professor of the Division of Gynecologic Oncology at the University of Pennsylvania Health System, responds:

After radical hysterectomy for cervical cancer, some patients are at higher risk for recurrence of cancer. For example, patients with large tumors (more than 4 cm in size), positive lymph nodes, deep invasion into the tissue of the cervix, or invasion into the small blood or lymphatic vessels, may put patients at higher risk for recurrence even though there is no gross evidence of tumor present after the surgery. I do not know all of the details of your case, but I assume that your physicians are recommending additional radiation because of the closeness of the tumor to the margin of tumor removal. They are recommending radiation to try to decrease your risk of having tumor recurrence. You should be aware that patients who do not have clear evidence of tumor in their body after surgery may still develop recurrence. The only methods in routine use for detecting disease recurrence include physical examination, Pap testing of the upper vagina, CT scan, and MRI. PET scan is another promising option, but the test has not yet been fully validated to detect recurrence of cervical cancer. You must understand that it is much easier to prevent a recurrence of cancer with radiation therapy then to treat a recurrence once it occurs. Overall, radiation therapy is tolerated well, and you should have additional discussions with your gynecologic oncologist and radiation oncologist regarding your concerns.