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radiation vs. radical hysterectomy radiation vs. radical hysterectomy

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Unread 03-31-2011, 09:42 AM
radiation vs. radical hysterectomy

Hi. I am a 43 year old who has stage 1 cervical cancer. I am done having children. I was told I could choose between radiation and hysterectomy. The problem with radiation is that once you receive radiation, if cancer re-occurs- you cannot receive additional radiation. I have HPV and that was probably the cause of the 3mm tumor on my cervix.

I am nervous about the side effects of both procedures- and concerned about the sexual side effects and any effects on bowel and bladder from the hysterectomy. I know that diarrhea, hair loss in the pelvis and shrinking vagina are potential side effects from the radiation.

How do you pick the less of two evils while trying to keep yourself safe? Can you still enjoy sex after a hysterectomy? Any input would be appreciated. THANKS!
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Unread 03-31-2011, 11:43 AM
Re: radiation vs. radical hysterectomy

Out of curiosity....did the doctor say why s/he is giving you an option between the 2 treatments? Typically with stage 1b1 and lower they opt for a radical hyster as a cure. For stage 1b2 and higher they go straight to radiation with a chemo booster. The radiation can treat a wider area in case the cells are "on the move".

Some women have gone through surgery, only to have radiation and chemo afterwards. (I'm one of them)

There are pros and cons to both. You can keep your ovaries and thus extend the natural progression to menopause if you opt for surgery. With radiation there is a risk of them being effected and shutting down.

Both carry risk of bowel and bladder side-effects.

With surgery you feel crappy for the first couple weeks, then begin to see improvement as you heal. Internal healing can take much longer than the initial 6 weeks, but not to the point that it has a large impact. There are only a few trips for follow-ups. There is the risk of infection with the incision though.

With radiation you feel good in the beginning and things start to decline as the treatments build up in your system. But then you'll begin to see improvement within a couple weeks of treatments ending. You will have to make daily trips to the treatment center for the 5-6 weeks of radiation.

Its really a personal decision. These are just a few of the things to consider.
Unread 03-31-2011, 12:25 PM
Re: radiation vs. radical hysterectomy

If I was given a choice, personally, I would have opted for the hysterectomy. I would have healed from the surgery and had a few scars for my troubles and gone on with things.

I'm curious as well why you are given a choice. Are you seeing a gynocology oncologist?
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Unread 03-31-2011, 02:44 PM
Re: radiation vs. radical hysterectomy

I had a different diagnosis (endo ca) but I had both a hysterectomy and radiation. I have no regrets about it.

I had my uterus, tubes and ovaries removed in one procedure, then had to go back to have my cervix and lymph nodes removed a couple months later. My recovery from both surgeries was relatively easy - just had to rest and avoid heavy lifting for a few weeks. I was perimenopausal so I had some problems with hot flashes, mood swings and dryness but those all leveled off after a couple of months.

Did your doctor mention whether or not you could keep your ovaries? That would make a difference. Also, with cerv ca, you might have the option of HRT.

As for radiation, side effects vary from one person to the next, and you may need internal radiation which can be more intense. I had 28 external treatments. I had mild diarrhea (easily controlled by dietary adjustments and occasional immodium). My vagina got drier and tighter and irritated, but I used dilators after treatment to stretch it back out. My worst symptom was very painful burning with urination, so bad I cried when I went. That cleared up completely within 2 weeks after treatment. My rad oncologist thought the 6 cycles chemo I had prior to rad was a factor in the pain. I had lost my pubes from chemo. After rad, they grew back sparser than before but I wouldn't mind if they hadn't come back at all.

Possible TMI follows, but I think this is a place where we can be frank.

After hyster, sex will be different. Your vagina will be slightly shorter. You'll lose the sensations from the cervix and the feelings of fullness and contractions in the uterus. (If you ever had those - some women don't.) Orgasms will be different but you can still have them. Unless you have unexpected complications, you can still have a good sex life. It takes patience and some adjustments. You'll probably have dryness so Astroglide or another lube will become part of foreplay.

Having been through both, if given the option between hyster and rad, I would have chosen hyster. I had less pain from that and I wanted teh cancer taken out of my body. I was 50 and already perimenopausal, so that was a factor.

Is your doctor a gyn oncologist? They are the experts in this field and that makes a big difference in outcomes. If you're not comfortable with what your doctor is telling you, get a second opinion.

Good luck with whatever you decide. It's a hard choice to make.
Unread 04-01-2011, 04:50 AM
Re: radiation vs. radical hysterectomy

Yes, you can enjoy sex again after a rad hysterectomy. It just takes several months.
Unread 04-01-2011, 09:17 AM
Re: radiation vs. radical hysterectomy


I'm so sorry you're facing this decision at all, sweetie.

My cervical cancer was IAI, so my "only" treatment was surgery. And, as the others stated, things go on afterwards with some manageable changes. I didn't experience any bladder issues, but my bm's have changed from being like clockwork to having to actively keep them regular by drinking PlumSmart juice (this is what works for me) which isn't really a big deal, all things considered. Some ladies have no issues whatsoever, and some have issues that resolve on their own. Then, some of us have our "new normal." But, the important thing is we're still here!

Do your research, get as many opinions as needed, then go with what you think is best for yourself long term. Oh, and definitely see a gyn/onc!

Unread 04-01-2011, 12:11 PM
Re: radiation vs. radical hysterectomy

Treatment Options are hell. All I can say is you need to listen to your instincts. I too am faced with options. I had an ovarian cyst removed on 2/14 along with a D&C. Post op pathology revealed stage 3 grade 1 endo cancer. I had a full hysterectomy on March 7th. All my post op pathology came back negative. My GYN/Onc recommends 5 weeks of radiation both vaginal and external. He says I will make a full recovery. However yesterday I went for a 2nd opinion on treatment and that doctor recommended both Radiation & Chemotherapy. I am 38 years old with 2 kids and I was so unsure on what the right treatment plan was. If I have no cancer left inside of me why do I need Chemo? Ultimately I went with my original treatment plan given to me by my oncologist who did my surgery. Again, go with your instincts and if necessary go for a 2nd opinion. I did and it only made me see how much I trusted my original doctor. Good Luck to You!!!!!!!!!!!!
Unread 04-02-2011, 07:26 AM
Re: radiation vs. radical hysterectomy

Susabella.... I see you are scheduled for the 15th... I am scheduled for the 18th for a TAH.
My cancer is stage 1B1 and my gyn/onc recommended full radical hysterectomy. We discussed radiation treatment but quite frankly I want "it" out of my body so I won't be thinking about what ifs.

I am 49.... and have already been experiencing hot flashes, night sweats etc....
I am concerned with instant menopause - but I think I will be okay. Looking into alternative methods since HRT is not an option for me due to family history of breast cancer.

I am actually in pre-surgery shape up mode ... going to the gym 3 days a week so that I am strong going into surgery and it helps with the pre-surgery stress as well.

I wish you the best with your decision and will be thinking of you on the 15th.
Unread 04-04-2011, 08:33 AM
Re: radiation vs. radical hysterectomy

Thanks so much for the replies. I did see a gyn onc. at Cooper in SOuth Jersey, but, I am going to get a second opinion at a Fox Chase in Phila. Not sure why he gave me the option- but he did. I am leaning toward the radical hyst. and changing care teams. I really appreciate all the responses- they have been very helpful and given me more confidence in my choice.

Thanks Iowacatlover for your frank and honest info. I will miss my orgasm...but I guess life and living is a reasonable tradeoff (still a little bummed though- took me awhile to get there and now it's going away)

Trying to look at the bright side!I have a feeling I will be leaning on this site of amazing women for support! SO glad it is here!
Unread 04-04-2011, 07:56 PM
Re: radiation vs. radical hysterectomy

I would defn. get the 2nd opinion. What is the actual stage (1a1/1b2???) I am fairly certain that the protocol for cervical cancer 1a is hysterectomy unless you are not a surgical candidate.

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