Cervical Cancer
Uterine cervix is the part of uterus that protrudes into the back of the vagina. Cervical cancer is the third most common gynecological cancer, ranking behind endometrial and ovarian cancers. Approximately 14,500 new cases are diagnosed each year. Average age at the time of diagnosis is 47 years. This cancer affects women of a lower socio-economic class and those with inadequate access to preventive medicine.
Causes
Following is list of factors that increase the risk of these cancers:
- HPV (human papiloma virus) infection, which is sexually transmitted
- HIV infection
- Cigarette smoking
Signs and Symptoms
With the assistance of routine pap smears, most cases are diagnosed in early stages. Patients who present with later stages of this cancer may complain of :
- Vaginal bleeding
- Bowel obstruction, which may cause abdominal pain and distention
Diagnosis
When there is a suspicion of this condition, patients should be seen by a specialist. who will perform a physical examination, including a pelvic examination and a PAP smear or a biopsy. The tissue sample is sent to a pathologist.
Staging
- Stage 0, In situ cancer
- Stage 1, Disease that is limited to the cervix
- Stage 2, Disease that extends to the pelvic tissue
- Stage 3, Disease that extends to the pelvic wall
- Stage 4, Disease spread to other organs, i.e., bladder, rectum, lungs, liver, etc.
Information obtained from pelvic examination, along with X rays, CT Scan, Sigmoidoscopy, etc. will determine the best treatment option.
Treatment
Most patients are treated with a combination of Surgery, Chemotherapy and Radiation therapy. Surgery is most appropriate for patients with very early stages of a disease, especially when the location and stage of cancer makes it easy to operate.
For patients with more advanced disease, a combination of chemotherapy and radiation therapy may still control a good percentage of patients. Most patients are treated with a combination of Cisplatinum and Adriamycin administered intravenously. This regimen is repeated every four weeks. Other active drugs are Bleomycin, Ifosfamide, Cytoxan, Carboplatin, Methotrexate.
Patients benefit from having a Port-A-Cath for administration of chemotherapy. Most important Side effects of this regimen are:
- Hair loss
- Nausea, Vomiting
- Low white blood counts
- Anemia
- Soreness of the mouth
- Heart Problems
Radiation therapy
Radiation for cancer of cervix is a treatment that is offered over six to eight weeks five days a week. Brachy Therapy is another form of radiating the cancer and refers utilizing radioactive needles inside the cervix . Following is a list of potential acute and immediate radiation complications:
- Burning while urinating
- Tiredness
- Diarrhea
- Pelvic skin irritation
- Urinary problems
Most of these side effects will subside after completion of Radiation; however, some may persist for a long period of time.
Prognosis
Prognosis depends on the extent of the disease at the time of diagnosis, as well as response to treatment, Most patients with early stage cancers can be cured. In others, the disease can be controlled with treatment for a period of time which may vary from months to years. If the disease reoccurs, the treatment will probably be chemotherapy or possibly surgery.
Special Situations
Patients with advanced cervical cancer may develop any of the following complications:
- Bone metastasis
- High Calcium level
- Pain
- Vaginal Bleeding may be profuse and is best treated with radiation therapy. Local measures to control bleeding may prove difficult.
Follow up
After completion of treatment, in any combination that might have taken place, patients need to remain under surveillance for possibility of recurrence of cancer. Follow-up should be scheduled on a regular basis, initially every one to three months for one to two years. The frequency of follow-up will depend on the condition of the patient and her disease. In each follow-up visits, patients undergo examination and, normally, a chest x-ray is obtained every few months and CT scan of pelvis once a year.
Treatment of recurrent disease will depend on the stage and extent of the reoccurred disease. Most patients are treated with chemotherapy using the same agents mentioned above. Radiation therapy may be helpful in managing painful or symptomatic areas, where the cancer has spread. If patients experience pain, various pain medications may be used to alleviate the pain. For patients with advanced disease, where most treatments have failed, one could consider assistance from Hospice.
