Advanced Cervical Cancer

What are the available treatment options of cervical cancer?

Depending on the stage of cancer, one may need to be given a combination of available treatment options.

Depending on the stage of cancer, one may need to be given a combination of available treatment options. Currently available treatment options for cervical cancer are:

I. Surgery

The various types of surgery options depending on stage of disease for cervical cancer patients include:

i. Cryosurgery

During cryosurgery, a cold metal probe is placed in the cervix to kill the abnormal cells by freezing. One can expect brown watery discharge for a few days after cryosurgery.

ii. Laser surgery

In laser surgery, a focused laser beam directed through cervix is used to burn off abnormal cells. Both cryosurgery and laser surgery can be done at the doctor’s clinic.

iii. Conization

This refers to removal of a cone-shaped piece of cervix using surgical or laser knife, which is then examined for positive cancerous margins.

iv. Simple hysterectomy

During simple hysterectomy, the uterus (but not the structures next to uterus) is removed. Other structures such as vagina, pelvic nodes, ovary and lymph nodes are not removed.

v. Radical hysterectomy

In radical hysterectomy, the surgeon removes the uterus as well as the tissues next to it such as parametria and uterosacral ligaments, as well as the upper part of vagina. Both these type of surgeries result in infertility, but do not affect the woman’s ability to feel sexual pleasure.

vi. Trachelectomy

A trachelectomy allows the woman to be treated without losing her ability to bear children. The surgeon here removes the cervix and upper part of vagina, but not the uterus, and places a ‘purse-string’ stitch that serves as an artificial opening to the uterus.

vii. Pelvic exenteration

In pelvic exenteration, organs such as bladder, vagina and rectum may in addition be removed along with uterus and adjacent organs. Recovery after pelvic exenteration may be slow and gradual.

II. Radiation therapy

Radiation therapy uses high energy radiations (X-rays or radioactive particles) to kill cancer cells. Radiation may be performed alone or may be followed by surgery, as a part of main treatment. It may also be given together with chemotherapy.

III. Chemotherapy

Chemotherapy (Chemo) drugs may be injected into the vein or given orally. Chemotherapy is given in cycles with intervals of recovery periods. It may be used as a part of main treatment or to treat cancers that might have recurred. Chemo is preferred along with radiation where the former helps the latter work better. Some commonly prescribed chemotherapeutic drugs for cervical cancer are Cisplatin (with or without 5-fluorouracil), carboplatin, paclitaxel, topotecan and gemcitabine, alone or in combination.

IV. Targeted therapy

Targeted therapeutics work differently from standard chemotherapy in that they act in a targeted manner, thus more or less, specifically targeting the cancerous cells, when compared to normal cells. Bevacizumab is a targeted therapeutic which has been proven to effectively treat advanced cervical cancer cells by targeting the molecule Vascular Endothelial Growth Factor (VEGF). Bevacizumab may be given along with chemotherapy for a while, which can then be switched to bevacizumab alone, depending on progress of cancer.

V. Immunotherapy

In immunotherapy, a person’s immune system is boosted to recognize and destroy cancer cells effectively. Pembrolizumab a monoclonal antibody is an approved immunotherapeutic drug, which, by blocking a protein PD-1 on T cells, boosts body’s immune response against cancer cells.

What measures can one take to cope with the disease?

Coping with the disease

It helps to know how to manage the disease and side-effects of treatment.

• Friends and family play a big role in helping a woman having cervical cancer and associated treatment, cope with the disease. Discomfort associated with cervical cancer, that affects the sex organ, can be difficult or uncomfortable for the patient to discuss. It is important to create a conducive environment for the patient to freely communicate these matters to caregivers or close ones.
• There is no reason to feel guilty, hopeless or embarrassed if diagnosed with cervical cancer. Most sexually active women are exposed to the virus that causes cervical cancer. Only that in some, the infection persists and results in cancer. Talk to your doctor or to a close one if you are experiencing any negative emotions.
• If you have had a hysterectomy, know that it results in infertility (inability to have children). Hysterectomy however does not affect the woman’s ability to feel sexual pleasure.
• Complications after hysterectomy are unusual. However, one must allow complete rest for faster recovery and to avoid complications such as excessive bleeding or wound infection. Do not take any discomfort lightly during recovery, but talk to your doctor immediately.
• Women who have undergone a trachelectomy are able to carry a pregnancy to full term and have the baby delivered through C-section. However, as these women are more prone to have miscarriage, special care and counsel of doctor must be taken during the term of pregnancy.
• Recovering from pelvic exenteration may be very slow and gradual. It is important to determine and practice positive thinking so as to regain normal life quickly.
• Radiation therapy may lead to vaginal stenosis (narrowing of vagina due to scar, with lesser ability to stretch), pain during sex or vaginal dryness. It may help to practice vaginal stretching exercises several times a week to regain earlier state. Talk to your doctor to know more on gels, creams or other medication that can be used to help with the dryness.