Bone Metastatic Cancer Radiation Therapy Treatment Plan: Fill & Download for Free

I was diagnosed with stage IV bladder cancer in May of 2015. I went into surgery believing (based on recent biopsies, CT scans and other tests) that I had a very early, minimally invasive bladder cancer which would be cured by surgically removing the bladder. I had already undergone two courses of “BCG therapy” (each consisting of six - weekly administrations of a substance into the bladder given for the purpose of stimulating the immune system to kill the cancer cells in the bladder lining) - which had not worked. When I woke up from the surgery, I was told that there was a 3 cm lymph node involved by metastatic cancer. After recovering from the surgery, I had various staging studies performed which also showed that it had spread to a pelvic bone.I went through the various stages leading to “acceptance” of my situation over the next several months - just like everybody else can (if they will allow themselves to endure the uncomfortable emotions involved in that journey). See -Gary Larson's answer to Daily Life: What is the most valuable skill a person can have for their entire life?There were several things that made my experience as a cancer patient different from someone who is not an oncologist.I knew the natural history, treatment options and survival statistics for my diseaseI knew what can (and occasionally does) go wrong in the process of carrying out the treatment.In thirty five years of treating bladder cancer patients, I had never known anyone who was cured once they developed distant metastatic disease (in my case - a bone metastasis)I generally did what my consultants recommended, although I was very much my own advocate during my treatment. I picked my doctors because I already knew how they treated patients and our philosophies were similar. I provided my input to the treatment plan, especially in regard to the radiation therapy.After six weeks of recovery from my bladder removal, six months of chemotherapy and six weeks of radiation therapy, I am blessed to be in complete remission. Like many other events in my life, a number of occurrences one would not predict played a vital role in shaping the outcome. (When I say “outcome” I must place it in the context of relatively short term survival - cancer treatment outcomes are generally measured five years after diagnosis.) For more on that, see -Gary Larson's answer to Have you ever almost died and had something inexplicable, miraculously save you?This experience, along with many others, have shown me that there are two ways I can live my life with respect to tragedies that might befall me or my loved ones.I can continually worry that any number of them are just around the corner - just waiting to ruin my life - or -I can assume that everything will be fine and my life will continue to go as I’ve planned.The first of these behaviors would be considered “neurotic” by most and would rob me of any joy I might otherwise find in the present.The second could be considered “denial” - I think that is true, but denial is a healthy response to the uncertainty of life. It is only a problem if we try to stay in it for too long when confronted by some aspect of life that we don’t want to acknowledge.Just an update - I remain in remission almost 5 years after completing treatment.

I'm not a medical professional. I'm a "professional" cancer patient; therefore I will answer this from my patient perspective.Standard of care usually dictates that in some early stage cancers, such as breast cancer, patients undergo chemotherapy first in order to shrink the tumor. Following the course of treatment recommend by ones medical team, surgery is next to resect the remaining tumor and any lymph nodes that may be impacted. Radiation is last but not least. Radiation treatment eliminates any micro cells that may be lurking.In my case, that's not what happened (is happening).I was diagnosed Stage 4 metastatic breast cancer de Novo (from day one). The cancer had already spread to my bones by the time it was found. Breast Cancer has roughly 18 different subtypes so at my stage of disease treatment plans are determined by pathology for as long as possible and palliative radiation when necessary. Lumpectomy's and mastectomies are usually not options or recommend (which personally I disagree with) because as they say: "the horse has already left the barn".My first line of treatment was an Aromatase Inhibitor (estrogen suppressors), injections that help suppress skeletal events (fractures) and palliative radiation for the metastatsis in my spine and ribs.Early stage patients count down their treatments - they start with 10 and go down from there. Metastatic patients like me, we count up. I will be on some kind of treatment for how ever long I live, until the cancer overtakes one or more of my vital organs. I am on my 4th line of treatment. I have not yet had traditional "chemotherapy"When a treatment fails, I go on to the next one that is best according to my tumor type, it's genomic make up amd/or possibly a clinical trial. Hopefully, each treatment gets me back to "stable" or NED (no evidence of disease) and I will stay on that particular treatment until that one fails.So, the role chemotherapy and radiation plays in my cancer treatment is that it's keeping me alive. August will be 6 yrs living with metastatic disease, which there is no cure for and is quite terminal.Hope that helps.

This will be a long one but i hope you get help :Uterine fibroids are benign tumors that originate in the uterus (womb). Although they are composed of the same smooth muscle fibers as the uterine wall (myometrium), they are much denser than normal myometrium. Uterine fibroids are usually round.Uterine fibroids are often described based upon their location within the uterus. Subserosal fibroids are located beneath the serosa (the lining membrane on the outside of the uterus). These often appear localized on the outside surface of the uterus or may be attached to the outside surface by a pedicle. Submucosal (submucous) fibroids are located inside the uterine cavity beneath the inner lining of the uterusUterine fibroids factsUterine fibroids are benign tumors that originate in the uterus (womb).It is not known exactly why women develop uterine fibroids.Most women with uterine fibroids have no symptoms. However, fibroids can cause a number of symptoms depending on their size, location within the uterus, and how close they are to adjacent pelvic organs. These are most commonly abnormal bleeding, pain and pressure.Uterine fibroids are diagnosed by pelvic exam and by ultrasound.If treatment for uterine fibroids is required, both surgical and medical treatment options are available.Women with uterine cancer may experience the following symptoms or signs. Sometimes, women with uterine cancer do not have any of these changes. Or, the cause of a symptom may be another medical condition that is not cancer.The most common symptom of endometrial cancer is abnormal vaginal bleeding, ranging from a watery and blood-streaked flow to a flow that contains more blood. Vaginal bleeding, during or after menopause, is often a sign of a problem.Unusual vaginal bleeding, spotting, or discharge. For premenopausal women, menorrhagia, or abnormal uterine bleeding (AUB).Difficulty or pain when urinatingPain during sexual intercoursePain in the pelvic areaWomen with uterine cancer may experience the following symptoms or signs. Sometimes, women with uterine cancer do not have any of these changes. Or, the cause of a symptom may be another medical condition that is not cancer.The most common symptom of endometrial cancer is abnormal vaginal bleeding, ranging from a watery and blood-streaked flow to a flow that contains more blood. Vaginal bleeding, during or after menopause, is often a sign of a problem.Unusual vaginal bleeding, spotting, or discharge. For premenopausal women, menorrhagia, or abnormal uterine bleeding (AUB).Difficulty or pain when urinatingPain during sexual intercoursePain in the pelvic areaFor most types of cancer, a biopsy is the only sure way for the doctor to know whether an area of the body has cancer. In a biopsy, the doctor takes a small sample of tissue for testing in a laboratory. If a biopsy is not possible, the doctor may suggest other tests that will help make a diagnosis.This list describes options for diagnosing this type of cancer, and not all tests listed will be used for every woman. Your doctor may consider these factors when choosing a diagnostic test:The type of cancer suspectedYour signs and symptomsYour age and medical conditionThe results of earlier medical testsIn addition to a physical examination, the following imaging tests may be used to diagnose uterine cancer:Pelvic examination. The doctor feels the uterus, vagina, ovaries, and rectum to check for any unusual findings. A Pap test, often done with a pelvic examination, is primarily done to evaluate for cervical cancer. However, sometimes a Pap test may occasionally find abnormal glandular cells, which are caused by uterine cancer.Transvaginal ultrasound. An ultrasound uses sound waves to create a picture of internal organs. In a transvaginal ultrasound, an ultrasound wand is inserted into the vagina and aimed at the uterus to obtain the pictures. If the endometrium looks too thick, the doctor may decide to perform a biopsy (see below).Computed tomography (CT or CAT) scan. A CT scan creates a 3-dimensional picture of the inside of the body using x-rays taken from different angles. A computer then combines these images into a detailed, cross-sectional view that shows any abnormalities or tumors. A CT scan can also be used to measure the tumor’s size. Sometimes, a special dye called a contrast medium is given before the scan to provide better detail on the image. This dye can be injected into a patient’s vein or given as a liquid to drink.Magnetic resonance imaging (MRI). An MRI uses magnetic fields, not x-rays, to produce detailed images of the body. MRI can also be used to measure the tumor’s size. A special dye called a contrast medium is given before the scan to create a clearer picture. This dye can be injected into a patient’s vein. This is particularly useful to get detailed images if the treatment option is primarily hormone management (see Treatment Options). MRI is often used when fertility conservation is considered.Doctors also use the following surgical tests to establish a diagnosis:Endometrial biopsy. A biopsy is the removal of a small amount of tissue for examination under a microscope. Other tests can suggest that cancer is present, but only a biopsy can make a definite diagnosis. A pathologist then analyzes the sample(s). A pathologist is a doctor who specializes in interpreting laboratory tests and evaluating cells, tissues, and organs to diagnose disease.For an endometrial biopsy, the doctor removes a small sample of tissue with a very thin tube. The tube is inserted into the uterus through the cervix, and the tissue is removed with suction. This process takes about 1 minute. Afterward, the woman may have cramps and vaginal bleeding. These symptoms should go away soon after and can be reduced by taking a nonsteroidal anti-inflammatory drug (NSAID) as directed by the doctor. Endometrial biopsy is often a very accurate way to diagnose uterine cancer. However, patients who have abnormal vaginal bleeding before the test may still need a dilation & curettage (D&C; see below) even if no abnormal cells are found during the biopsy.Dilatation and Curetage (D&C). A D&C is a procedure to remove tissue samples from the uterus. A woman is given anesthesia during the procedure to block the awareness of pain. A D&C is often done in combination with a hysteroscopy so the doctor can view the lining of the uterus during the procedure. During a hysteroscopy, the doctor inserts a thin, lighted flexible tube in the vagina, through the cervix, and into the uterus.Once endometrial tissue has been removed either during a biopsy or D&C, the sample is checked for cancer cells, endometrial hyperplasia, and other conditions. In the past, there was concern that a D&C would push cancer cells out of the uterus into other reproductive organs. However, research studies have shown that this has no effect on patients who received a D&C combined with a hysteroscopy.The stage provides a common way of describing the cancer, so doctors can work together to plan the best treatments.TNM staging systemOne tool that doctors use to describe the stage is the TNM system. Doctors use the results from diagnostic tests and scans to answer these questions:Tumor (T): How large is the primary tumor? Where is it located?Node (N): Has the tumor spread to the lymph nodes? If so, where and how many?Metastasis (M): Has the cancer spread (metastasized) to other parts of the body? If so, where and how much?The results are combined to determine the stage of cancer for each person. There are five stages: stage 0 (zero) and stages I through IV (one through four). The stage provides a common way of describing the cancer, so doctors can work together to plan the best treatments.The Roman numerals are stages used in another widely used staging system from the Federation Internationale de Gynecologie et d'Obstetrique, or FIGO. The FIGO system is the standard system used by most doctors to stage uterine cancer.Here are more details on each part of the TNM and FIGO system for uterine cancer:Tumor (T)Using the TNM system, "T" plus a letter or number (0 to 4) is used to describe the size and location of the tumor. Some stages are also divided into smaller groups that help describe the tumor in even more detail.TX: The primary tumor cannot be evaluated due to a lack of information. More tests may be needed.T0 (T plus zero): There does not seem to be a primary tumor in the uterus.Tis: This condition is called carcinoma (cancer) in situ, which means that the cancer is found only in the layer of cells lining the uterus and has not spread to deeper tissues of the uterus.T1/FIGO I: The tumor is found only in the corpus uteri (the body of the uterus).T1a/FIGO IA: The tumor is found only in the endometrium has spread to less than one-half of the myometrium.T1b/FIGO IB: The tumor has spread to one-half or more of the myometrium.T2/FIGO II: The tumor has spread to the cervical stroma (the connective tissue of the cervix) but has not spread beyond the uterus.T3a/FIGO IIIA: The tumor involves the serosa (the layer of tissue that covers the outer surface of the uterus) and/or the tissue of the fallopian tubes and ovaries.T3b/FIGO IIIB: The tumor has spread to the vagina or next to the uterus.T4/FIGO IVA: The tumor has spread to the lining of the bladder mucosa (lining of the bladder) and/or the bowel mucosa (lining of the bowel).Node (N)The "N" in the TNM staging system stands for lymph nodes, the tiny, bean-shaped organs that help fight infection. Lymph nodes near the uterus are called regional lymph nodes. Lymph nodes in other parts of the body are called distant lymph nodes.NX: The regional lymph nodes cannot be evaluated.N0 (N plus zero): There is no spread to regional lymph nodes.N1/FIGO IIIC1: The cancer has spread to the regional pelvic lymph node(s).N2/FIGO IIIC2: The cancer has spread to the para-aortic lymph nodes, which are located in the mid and upper abdomen, with or without spread to the regional pelvic lymph nodes.Metastasis (M)The "M" in the TNM system describes whether the cancer has spread to other parts of the body, called distant metastasis.M0 (M plus zero): The cancer has not metastasized.M1/FIGO IVB: There is distant spread, including to the abdomen and/or inguinal lymph nodes, which are in the groin or lower abdomenCancer stage groupingDoctors assign the stage of endometrial cancer by combining the T, N, and M classifications.Stage 0: The tumor is called carcinoma in situ, which means it is very early stage cancer. It is found only in 1 layer of cells and has not spread (Tis, N0, M0).Stage I: The cancer is found only in the uterus or womb, and it has not spread to other parts of the body (T1, N0, M0).Stage IA: The cancer is found only in the endometrium or less than one-half of the myometrium (T1a, N0, M0).Stage IB: The tumor has spread to one-half or more of the myometrium (T1b, N0, M0).Stage II: The tumor has spread from the uterus to the cervical stroma but not to other parts of the body (T2, N0, M0).Stage III: The cancer has spread beyond the uterus, but it is still only in the pelvic area (T3, N0, M0).Stage IIIA: The cancer has spread to the serosa of the uterus and/or the tissue of the fallopian tubes and ovaries but not to other parts of the body (T3a, N0, M0).Stage IIIB: The tumor has spread to the vagina or next to the uterus (T3b, N0, M0).Stage IIIC1: The cancer has spread to the regional pelvic lymph nodes (T1 to T3, N1, M0).Stage IIIC2: The cancer has spread to the para-aortic lymph nodes with or without spread to the regional pelvic lymph nodes (T1 to T3, N2, M0).Stage IVA: The cancer has spread to the mucosa of the rectum or bladder (T4, any N, M0).Stage IVB: The cancer has spread to lymph nodes in the groin area, and/or it has spread to distant organs, such as the bones or lungs (any T, any N, M1).Grade (G)Doctors also describe this type of cancer by its grade (G), which describes how much cancer cells look like healthy cells when viewed under a microscope. The doctor compares the cancerous tissue with healthy tissue. Healthy tissue usually contains many different types of cells grouped together. If the cancer looks similar to healthy tissue and contains different cell groupings, it is called differentiated or a low-grade tumor. If the cancerous tissue looks very different from healthy tissue, it is called poorly differentiated or a high-grade tumor. The cancer’s grade may help the doctor predict how quickly the cancer will spread. In general, the lower the tumor’s grade, the better the prognosis.The letter "G" is used to define a grade for uterine cancer.GX: The grade cannot be evaluatedG1: The cells are well differentiatedG2: The cells are moderately differentiatedG3: The cells are poorly differentiatedRecurrent uterine cancerRecurrent cancer is cancer that has come back after treatment. Uterine cancer may come back in the uterus, pelvis, lymph nodes of the abdomen, or another part of the body. Approximately 70% of recurrent uterine cancer happens within 3 years of initial treatment. Some symptoms of recurrent cancer are similar to those experienced when the disease was first diagnosed.Vaginal bleeding or dischargePain in the pelvic area, abdomen, or back of the legsDifficulty or pain when urinatingWeight lossChronic coughTreatment overviewIn cancer care, different types of doctors often work together to create a patient’s overall treatment plan that combines different types of treatments. This is called a multidisciplinary team. Your health care team should include a gynecologic oncologist, which is a doctor who specializes in the cancers of the female reproductive system.Cancer care teams also include a variety of other health care professionals, including physician assistants, oncology nurses, social workers, pharmacists, counselors, dietitians, and others.Uterine cancer is treated by one or a combination of treatments, including surgery, radiation therapy, chemotherapy, and hormone therapy. Combinations of treatments are often recommended. Each treatment option is described below, followed by an outline of treatments based on the stage of the disease. Treatment options and recommendations depend on several factors, including the type and stage of cancer, possible side effects, and the woman’s overall health, and her age and her personal preferences, including whether or how treatment will affect the ability to have children. Women with uterine cancer may have concerns about if or how their treatment may affect their sexual function and fertility, and these topics should be discussed with the health care team before treatment begins.Your care plan may also include treatment for symptoms and side effects, an important part of cancer care. Take time to learn about all of your treatment options and be sure to ask questions about things that are unclear. Also, talk about the goals of each treatment with your doctor and what you can expect while receiving the treatment. Learn more about making treatment decisions.SurgerySurgery is the removal of the tumor and some surrounding healthy tissue during an operation. It is typically the first treatment used for uterine cancer. A surgical oncologist is a doctor who specializes in treating cancer using surgery. Learn more about the basics of cancer surgery.Common surgical procedures for uterine cancer include:Hysterectomy. Depending on the extent of the cancer, the surgeon will perform either a simple hysterectomy (removal of the uterus and cervix) or a radical hysterectomy (removal of the uterus, cervix, the upper part of the vagina, and nearby tissues). For patients who have been through menopause, the surgeon will also perform a bilateral salpingo-oophorectomy, which is the removal of both fallopian tubes and ovaries. A hysterectomy may be performed as a traditional surgery with 1 large incision or by laparoscopy, which uses several smaller incisions. A hysterectomy when there is the possibility of cancer is usually performed by a gynecologic surgeon, which is a surgeon that specializes in surgery of the woman’s reproductive system. Robotically assisted hysterectomy may also be available. In this type of surgery, a camera and instruments are inserted through small, keyhole incisions. The surgeon then directs the robotic instruments to remove the uterus, cervix, and surrounding tissue. Talk with your doctor about whether your treatment center offers this procedure and how the side effects and results compare to traditional surgery or laparoscopy.Lymph node dissection. At the same time as a hysterectomy, the surgeon may remove lymph nodes near the tumor to determine if the cancer has spread beyond the uterus.Sentinel lymph node biopsy. Sometimes a sentinel lymph node biopsy is performed. A sentinel lymph node biopsy is a procedure that helps the doctor find out whether cancer has spread to the lymph nodes. This procedure is proven to be useful for breast and other cancers, and doctors are researching its usefulness in uterine cancer.Side effects of surgeryAfter surgery, the woman may remain in the hospital for several days. Woman who received laparoscopic or robotically assisted surgery often have a shorter hospital stay than women who received traditional surgery. The most common short-term side effects include pain and tiredness. If a woman is experiencing pain, her doctor will prescribe appropriate medicine. Other immediate side effects may include nausea and vomiting, as well as difficulty emptying the bladder and having bowel movements. The woman's diet may be restricted to liquids, followed by a gradual return to solid foods.If the ovaries are removed, this ends the body's production of sex hormones, resulting in premature menopause (if the woman has not already gone through menopause). While a hysterectomy substantially reduces the sex steroids that are produced by the body, the adrenal glands and fat tissues will provide some steroids as well. Soon after surgery, the woman is likely to experience menopausal symptoms, including hot flashes and vaginal dryness.After a hysterectomy, a woman can no longer become pregnant. For this reason, it is particularly important for patients who wish to become pregnant in the future to talk with their doctor about all of their treatment options, before any treatment begins. Sometimes, options to preserve your ability to have children might include less extensive surgery followed by hormone therapy (see below). Your doctor can talk with you about both the potential risks and benefits of this approach and provide information to help you make an informed decision.Before any operation for uterine cancer, women are encouraged to talk with their doctors about sexual and emotional side effects, reproductive health concerns, and ways to address these issues before and after cancer treatment.Radiation therapyRadiation therapy is the use of high-energy x-rays or other particles to destroy cancer cells. A doctor who specializes in giving radiation therapy to treat cancer is called a radiation oncologist. A radiation therapy regimen (schedule) usually consists of a specific number of treatments given over a set period of time. The most common type of radiation treatment is called external-beam radiation therapy, which is radiation given from a machine outside the body.Some women with uterine cancer need both radiation therapy and surgery (see above). The radiation therapy is most often given after surgery to destroy any cancer cells remaining in the area. Radiation therapy is rarely given before surgery to shrink the tumor. If a woman cannot have surgery, the doctor may recommend radiation therapy as another option.Radiation therapy options for endometrial cancer may include radiation therapy directed towards the whole pelvis, or applied only to the vaginal cavity often called intravaginal radiotherapy (IVRT) or vaginal brachytherapy.Side effects from radiation therapy may include fatigue, mild skin reactions, upset stomach, and loose bowel movements and will depend on the extent of radiation therapy given. Most side effects usually go away soon after treatment is finished, but long-term side effects causing bowel or vaginal symptoms are possible.Sometimes, doctors advise their patients not to have sexual intercourse during radiation therapy. Women may resume normal sexual activity within a few weeks after treatment if they feel ready.Learn more about the basics of radiation therapy. For more information about radiation therapy for gynecologic cancers, see the American Society for Therapeutic Radiology and Oncology's pamphlet, Radiation Therapy for Gynecologic Cancers.ChemotherapyChemotherapy is the use of drugs to destroy cancer cells, usually by stopping the cancer cells’ ability to grow and divide. Chemotherapy is given by a medical oncologist or gynecologic oncologist, a doctor who specializes in treating women’s reproductive cancer with medication. When recommended for endometrial cancer, chemotherapy is given usually after surgery, either with or instead of radiation therapy. Chemotherapy is also considered if the endometrial cancer returns after initial treatment.Systemic chemotherapy gets into the bloodstream to reach cancer cells throughout the body. Common ways to give chemotherapy include an intravenous (IV) tube placed into a vein using a needle or in a pill or capsule that is swallowed (orally). A chemotherapy regimen (schedule) usually consists of a specific number of cycles given over a set period of time. A patient may receive 1 drug at a time or combinations of different drugs at the same time.The goal of chemotherapy is to destroy cancer remaining after surgery or shrink the cancer and slow the tumor's growth if it comes back or has spread to other parts of the body. Although chemotherapy can be given orally, most drugs used to treat uterine cancer are given by IV. IV chemotherapy is either injected directly into a vein or through a catheter, which is a thin tube inserted into a vein.The side effects of chemotherapy depend on the individual, the type of chemotherapy, and the dose used, but they can include fatigue, risk of infection, nausea and vomiting, hair loss, loss of appetite, and diarrhea. These side effects usually go away once treatment is finished. Advances in chemotherapy during the last 10 years include the development of new drugs for the prevention and treatment of side effects, such as antiemetics for nausea and vomiting and hormones to prevent low white blood cell counts, if needed.Other potential side effects of chemotherapy for uterine cancer include the inability to become pregnant and early menopause, if the patient has not already had a hysterectomy (see Surgery above). Rarely, some drugs cause some hearing loss. Others may cause kidney damage. Patients may be given extra fluid intravenously for kidney protection.Learn more about the basics of chemotherapy and preparing for treatment. The medications used to treat cancer are continually being evaluated. Talking with your doctor is often the best way to learn about the medications prescribed for you, their purpose, and their potential side effects or interactions with other medications. Learn more about your prescriptions by using searchable drug databases.Hormone therapyHormone therapy is used to slow the growth of certain types of uterine cancer cells that have receptors to the hormones on them. These tumors are generally adenocarcinomas and are grade 1 or 2 tumors. Hormone therapy for uterine cancer often involves a high dose of the sex hormone progesterone, given in a pill form. Other hormone therapies include the aromatase inhibitors (AIs) often used for the treatment of women with breast cancer, such as anastrozole (Arimidex), letrozole (Femara), and exemestane (Aromasin). An AI is a drug that reduces the amount of the hormone estrogen in a woman's body by stopping tissues and organs other than the ovaries from producing it. Hormone therapy may also be used for women who cannot have surgery or radiation therapy or in combination with other types of treatment.Side effects of hormone therapy in some patients include fluid retention, increase in appetite, insomnia, muscle aches and weight gain. Most side effects are manageable with the help of your health care team. Talk with your doctor about what you can expect.Treatment options by stageYou may be recommended one or a combination of these treatment types depending a variety of factors, such as the tumor type, the tumor’s stage and grade, and other medical problems you may have.Stage ISurgery aloneSurgery with radiation therapy or chemotherapyHormone therapy with a progesterone-type drug. This is given orally or through an intra-uterine device that is used in special circumstances.Surgery, radiation therapy, and chemotherapyStage IISurgery with radiation therapy or chemotherapySurgery, radiation therapy, and chemotherapyStage IIISurgery with radiation therapy or chemotherapySurgery, radiation therapy, and chemotherapyStage IV (see below, Metastatic uterine cancer)SurgeryRadiation therapyHormone therapyChemotherapyIt is important to ask your doctor about the various treatment options, including clinical trials that are available to you.Getting care for symptoms and side effectsCancer and its treatment often cause side effects. In addition to treatment to slow, stop, or eliminate the cancer, an important part of cancer care is relieving a person’s symptoms and side effects. This approach is called palliative or supportive care, and it includes supporting the patient with his or her physical, emotional, and social needs.Palliative care is any treatment that focuses on reducing symptoms, improving quality of life, and supporting patients and their families. Any person, regardless of age or type and stage of cancer, may receive palliative care. It works best when palliative care is started as early as needed in the cancer treatment process. People often receive treatment for the cancer and treatment to ease side effects at the same time. In fact, patients who receive both often have less severe symptoms, better quality of life, and report they are more satisfied with treatment.Palliative treatments vary widely and often include medications, nutritional changes, relaxation techniques, emotional support, and other therapies. You may also receive palliative treatments similar to those meant to eliminate the cancer, such as chemotherapy, surgery, or radiation therapy. Talk with your doctor about the goals of each treatment in the treatment plan.Before treatment begins, talk with your health care team about the possible side effects of your specific treatment plan and palliative care options. And during and after treatment, be sure to tell your doctor or another health care team member if you are experiencing a problem so it can be addressed as quickly as possible. Learn more about palliative care.Metastatic uterine cancerIf cancer spreads to another part in the body from where it started, doctors call it metastatic cancer. If this happens, it is a good idea to talk with doctors who have experience in treating it. Doctors can have different opinions about the best standard treatment plan. Also, clinical trials might be an option. Learn more about getting a second opinion before starting treatment, so you are comfortable with your treatment plan chosen.Your treatment plan may include radiation therapy, especially for recurrent cancer in the pelvis, or surgery. Hormone therapy may be used for cancer that has spread to distant parts of the body. A cancer that is high grade or that does not respond to hormone therapy is treated with chemotherapy. Women with stage IV uterine cancer are encouraged to consider participating in clinical trials. Palliative care will also be important to help relieve symptoms and side effects.For most patients, a diagnosis of metastatic cancer is very stressful and, at times, difficult to bear. Patients and their families are encouraged to talk about the way they are feeling with doctors, nurses, social workers, or other members of the health care team. It may also be helpful to talk with other patients, including through a support group.Remission and the chance of recurrenceA remission is when cancer cannot be detected in the body and there are no symptoms. This may also be called having “no evidence of disease” or NED.A remission may be temporary or permanent. This uncertainty causes many people to worry that the cancer will come back. While many remissions are permanent, it’s important to talk with your doctor about the possibility of the cancer returning. Understanding your risk of recurrence and the treatment options may help you feel more prepared if the cancer does return. Learn more about coping with the fear of recurrence.If the cancer does return after the original treatment, it is called recurrent cancer. It may come back in the same place (called a local recurrence), nearby (regional recurrence), or in another place (distant recurrence). Find out more about recurrent uterine cancer in Stages.When this occurs, a cycle of testing will begin again to learn as much as possible about the recurrence. After testing is done, you and your doctor will talk about your treatment options. Often the treatment plan will include the treatments described above such as hormone therapy, radiation, and chemotherapy but they may be used in a different combination or given at a different pace. Sometimes, surgery is suggested for a return of cancer that is small or confined, called a localized recurrence. Your doctor may also suggest clinical trials that are studying new ways to treat this type of recurrent cancer. Whichever treatment plan you choose, palliative care will be important for relieving symptoms and side effects.People with recurrent cancer often experience emotions such as disbelief or fear. Patients are encouraged to talk with their health care team about these feelings and ask about support services to help them cope. Learn more about dealing with cancer recurrence.Here is a link for further reference with a fact sheet:Fibroid Tumors: What Every Woman Must Know