Complications From Extensive Radiation For Gynecologic & Urologic Cancers
Houston Methodist provides excellence in caring for you — before, during and after treatment. Cancer begins when cells from organs or tissues grow out of control and form a tumor. These cells eventually displace normal healthy cells in the body. When tumors spread to other areas of the body, rapid cell growth can occur.
Several types of cancer, including cancers of the bladder, cervix, vagina, prostate, colon and rectum, are treated with surgery. Pelvic surgery for gynecological and urological cancers may require removal of the bladder and rectum (lower portion of the large intestine). Our specialists at Houston Methodist combine the latest advances in vaginal reconstruction, urological reconstructive surgery and restoration of colon continuity for the most effective reconstruction of pelvic health. Treatment goals include restoration of function and preservation of body image.
Radiation therapy is a common technique for treating cancer. It is estimated that more than 60 percent of cancer patients will undergo some kind of radiation therapy, either externally or internally, to prevent cancerous cells from spreading throughout the body.
- Postradiation injury
- Coverage of complex wounds
- Urinary bladder reconstruction and diversion
The effects of radiation can be difficult to cope with, and patients require care beyond their therapy. One of the services at Houston Methodist is postradiation injury care.
When radiation passes through the body to kill damaged or cancerous cells, it can also damage healthy cells. Ionizing radiation can tear atoms and molecules apart, causing what we call radiation injury. Any person can be exposed to ionizing radiation just by stepping outside in the sunlight, by X-ray machines and, less commonly, by radioactive elements.
Radiation you need to be aware of include the following sources:
- Therapeutic — Radiation applied to the diagnosis and treatment of cancer
- Natural — Exposure to sunlight and cosmic radiation
- Intentional — Exposure is rare and related to use of nuclear weapons such as hydrogen and atomic bombs
- Accidental — Exposure within a controlled area, such as a laboratory, by mistake (when radioactive elements are accidentally spilled)
When physicians assess radiation damage, there are a number of factors to consider:
- Type of radiation exposure
- Proximity of source of the radiation exposure
- Extent of the exposure
Although radiation therapy is remarkable in reducing symptoms and effects of tumors, the radiation energy that impedes the growth of cancer cells can also affect normal tissue and hinder wound healing, resulting in a longer recovery time, and some incisions may not heal at all. Standard treatments of gynecological, urological and soft tissue tumors have included radiation therapy. As a result, irradiated, chronic open wounds of the pelvic, perineal or genital areas are not uncommon. Radiation also affects the blood vessels near the wounds and interferes with the delivery of antibiotics; making treating infections difficult.
At the Houston Methodist Cancer Center, we offer a variety of cutting-edge radiation oncology treatment options, including intensity-modulated radiation therapy (IMRT). Houston Methodist was the first in the nation to provide IMRT, which delivers a high dose of radiation while restricting exposure to surrounding healthy tissues. We continue to develop advanced treatments and technologies to better screen, diagnose and treat cancers in order to reduce complications and improve survival rates.
Treatment for Radiation
Serious conditions or injuries after pelvic and abdominal radiation for gynecological and urological cancer can become a problem any where from 6 to 24 months after completing therapy. Depending on the complexity of the injuries, more than one treatment may be available. The ultimate goal is restoration of form and function. Treatments may include the following procedures:
- Pelvic floor muscle electrical stimulation
- Coverage of complex wounds
- Penile reconstruction and scrotum reconstruction
- Vaginal reconstruction
- Bladder reconstruction and surgeries for incontinence
Coverage of Complex Wounds
Wounds that occur during trauma or after radical resection for cancer or severe infection can lead to complex wounds of the perineum, vulva, penis or scrotum. Often, reconstruction is required for full recovery. Coverage and reconstruction will depend on the actual size of the wound, as well as the availability of local tissue (or flap). A skin graft, which takes flaps from the thigh or pubis region, is one option for wound coverage. Skin grafts are used to cover large, shallow wounds and do not require radiation therapy.
A skin flap is used to treat irradiated wounds. The flap can be transferred to the wound and survive on its own blood vessels, which will bring additional nutrition and antibiotics to the damaged wound. The irradiated wound has a better chance of healing with this technique verses a skin graft for coverage because blood vessels cannot grow in the area. The muscle or skin flaps are generally harvested from the abdominal wall, the buttocks area and the thighs to cover wounds in the pelvic region.
For deeper wounds, a musculocutaneous flap may be required for coverage. Musculocutaneous flaps pull muscle, skin and blood vessels from the donor site to the wound. Muscle flaps are taken from the inner thighs (gracilis flap), the back of the thighs (posterior thigh flaps) or the abdominal area (rectus abdominis flaps).
The difference between skin grafts and free flaps is that free flaps are taken from distant parts of the body to cover large and complex wounds. These free flaps require microsurgery, reconnecting the arteries and veins under a microscope, to reestablish blood flow and nourishment to the area. Sensation can also be restored with the use of microsurgery.
Urinary Bladder Reconstruction and Diversion
When the urinary bladder is removed due to cancer, other medical condition, or because the organ no longer works, another method must be devised for urine to exit the body. Urinary reconstruction and diversion is a surgical method to create a new way for you to pass urine. For all of these types of procedures, a portion of the small and large bowel is disconnected from the fecal stream and used for reconstruction.
Three main types of urinary diversion surgeries may include the following:
Ileal conduit urinary diversion
With this procedure, the ureters drain freely into part of the ileum, the last segment of the small intestine. The end of the ileum into which the ureters drain is then brought out through an opening in the abdominal wall. This opening, called a stoma, is covered with a bag that gathers the urine as it drains from the ileal conduit.
Indiana pouch reservoir
With the Indiana pouch, a reservoir or pouch is made out of a portion of the large intestine (the ascending colon on the right side of the abdomen) and a portion of the ileum (the last segment of the small intestine). The ureters are repositioned to drain into this pouch. The urine flows freely in a downward direction from the kidneys into the pouch. This positioning prevents urine from backing up into the kidneys, which protects the kidneys from infection. A short piece of small intestine is then brought out through a small opening in the abdominal wall (a stoma).
Unlike the ileal conduit, no external bag is needed, and the stoma is very small and can be covered with an adhesive bandage. Instead, a one-way valve is surgically created to keep the urine inside the pouch. Several times a day, usually every four to six hours, a small, thin catheter must be passed through the stoma and into the pouch to empty the urine. An adhesive bandage is worn over the stoma at all other times (when not actively emptying the pouch), and a new catheter is used each time.
Neobladder to urethra diversion
This procedure most closely mimics the storage function of a urinary bladder. With this procedure, a small part of the small intestine is made into a reservoir or pouch, which is connected to the urethra. The ureters are repositioned to drain into this pouch. As with the Indiana pouch, this downward flow of urine from the kidneys into the pouch helps prevent urine back up, which helps protect the kidneys from infection. Urine is able to pass from the kidney to the ureters to the pouch and through the urethra in a manner similar to the normal passing of urine. To be a candidate for this surgical procedure, there must be a low risk of cancer recurrence in the urethra, and you must be able to pass a catheter into the urethra to empty the pouch, if necessary.
It takes one to two months on average to feel well again and to regain your strength. Also, it is not unusual to feel a little discouraged after surgery. As with any life change, an adjustment period is normal. Do not hesitate to call your doctor or your other Houston Methodist health care team members for assistance or if you have questions. Their goal for you is to get you back to your normal lifestyle as soon as possible.
The Center for Restorative Pelvic Medicine at Houston Methodist Hospital is the first of its kind in the Greater Houston area and is still one of the few centers in the country that offers a single-center location for the diagnosis and treatment of complex pelvic-floor disorders. Urogynecologists — specialty physicians trained in the areas of urology and gynecology — as well as traditional gynecologists and colorectal surgeons provide the most advanced care available for women and men with problems related to the lower urinary tract and the pelvic floor.
Our physicians at Houston Methodist specialize in managing complications from extensive radiation at the following convenient locations: