A hysterectomy involves the surgical removal of the uterus. Most are performed through a horizontal incision through the lower abdomen although newer techniques do allow for removal through an instrument called a laparoscope. This latter procedure allows for more rapid recovery. Either way, the emotional trauma from a hysterectomy may exceed the physical pain from the operation. Radiation may be used if the cancer is either not completely resectable or is at high risk of recurring or coming back in the pelvis. Radiation is a daily beam of energy that kills not only remaining cancer cells but also normal tissue as well. It is given daily through a high energy machine called a linear accelerator and may be given daily for several weeks.
Alternatively, depending on the center, radiation may be placed in the pelvis internally but this is an invasive procedure. All radiation can cause side effects to local organs which can cause significant discomfort or loss of function. Chemotherapy is only used in the most advanced cases or for those unfortunate women who suffer a recurrence of the cancer. Chemotherapy medicines are administered by vein and may cause significant nausea, vomiting, diarrhea, fatigue and low blood counts.
To diagnose cervical or vaginal adenocarcinoma in a DES daughter requires an invasive procedure called a biopsy. Next, depending on the stage or extent of the disease, a cancer operation is warranted to remove portions of the vagina, cervix, uterus, surrounding lymph nodes and often the ovaries to try and obtain a cure. Radiation, either external beam from a large machine called a linear accelerator or in the form of brachytherapy from an internally placed radiation implant, is needed to try and obtain a cancer free zone to prevent recurrence. Months of arduous chemotherapy may also be needed in the event that the cancer spreads outside the pelvis. Waggoner in 1994 performed a large case control study of 255 DES-associated clear cell adenocarcinoma patients, many of whom were diagnosed in their teens and early twenties (20). All required either surgery or radiation therapy and 21% of these DES exposed women died. A cancer diagnosis is never an easy one to accept, but for a young woman in particular, can be excruciating.
20. Waggoner S.E. et al. Influence of in Utero Diethylstilbestrol Exposure on the Prognosis and Biologic Behavior of Vaginal Clear-cell Adenocarcinoma. Gynecologic Oncology. 55: 238-244, 1994.