Treatment of cervical cancer is complex, using multiple therapeutic methods, which should succeed and combine – radiation, surgery, chemotherapy, adjuvant treatment.
Each therapeutic sequence is applied after the detailed analysis of each case, the stage of disease, local and general condition of the patient, so that aspect takes the form of a true therapeutic strategies. Decision must be made jointly by a team composed of a gynecologist, pathologist, radiotherapists, and oncologist.
Before establishing a therapeutic strategy there is needed a general balance sheet that includes complete genital examination (with clinical staging), general exam, chest x-ray, ECG, blood count with platelets, liver analysis, the sphere of urination, pregnancy test and for advanced stages: urography, cystoscopy, and limfography, rectoscopy.
SURGICAL TREATMENT of cervical cancer
Watches first the vital prognosis, sacrificing functionality for cancer radicalism – surgical excision extending beyond the apparent tumor lesion, with removal in block of the pathways and lymphatic satellite stations.
In Europe the first techniques developed in last century as two concepts:
• enlarged organ surgery;
• lymphatic territory surgery, both promoting cervical cancer surgery by abdominal approach. Excessive mortality led to techniques with vaginal approach.
Later in the twentieth century techniques were improved, with special contributions JLFaurre, J.V. Meigs (USA) and Okabaiashi (Japan).
Currently, most are followers of radical hysterectomy which seeks removal of the uterus, 1/3 of vagina, and ligaments uterosacrates, parameters, nodal stations of the ureters, hypogastric and external iliac.
Ovarian metastases are rare and therefore the ovaries are preserved in young women in the early stages.
Immediate postoperative complications include bleeding through the iliac vessel injury, ureteral injury, bladder and intestinal loops.
Postoperative complications are infection, hematoma, thrombophlebitis, thromboembolic disease or appearance of limfochysts.
Late complications are dominated by bladder dysfunction, urinary tract fistula, secondary lymphedema of suprapubic region and / or legs.
I. Brachytherapy: the radiation source is in contact with the tumor. In many cases is the first therapeutic act. The most frequent radionuclides used today are cesium (137Cs) and Iridium (192lr). The sources are introduced intrauterine and intravaginal simultaneously or separately. Based on clinical experience, today are used different irradiation systems, but all derive from three classic systems.
1. PARIS system uses a probe placed intrauterine and three sources intravaginal. Total activity is the lowest of all systems and the irradiation time is 6-8 days. Classical system does not involve any fixed distance between vaginal sources and no connection between them and intrauterine source.
2. Stockholm system uses a intrauterine radiation source and one intravaginal source placed in front of cervix, connected or not with the intrauterine source. The activity is high and the exposure time shortened from 27 to 30 hours, repeated every three weeks. Radiation is more intense and homogeneous.
3. Manchester system is essentially a variant of the PARIS system. The duration of irradiation is about 70 hours, repeated 5 days.
II. Teletherapy. The source of radiation is away from the tumor, using beams of gamma radiation, X photons, electrons. Is the essential treatment of cervical cancer because it has the ability to cover, at least with the reference dose, the treatment volume, which includes the target volume.
Teletherapy can be done throughout the pelvis, including the upper half of the vagina, parameters, pelvic lymphatics, pelvic lymph node chains.
Brachytherapy usually is associated teleterapia.
It’s an auxiliary treatment and has the following indications:
1. The presence of lymph node metastases, ovarian metastases, diagnosed histologically after radio-surgery. May be associated with a short course of radiation.
2. In advanced forms of disease associated with radiotherapy.
3. Recurrence or distance metastasis, in combination with radiation therapy.
Chemotherapy uses at least 3 drugs per course. Chemotherapy drugs: Cyclofosfamide, Cysplatin (alkylating agents), methotrexate (antimetabolite group), bleomycin, Adriamycin, Adriablastine, vincristine, vinblastine (plant alkaloids).
The indication of chemotherapy needs a complete investigation of the case: age, general condition, associated diseases, hematological indices, renal function, cardiovascular condition.
In conclusion: the treatment is different for each patient. The conduit for each treatment depends of age, stage of disease, local and general condition, other associated diseases, laboratory tests and investigations.
How to prepare for the cervical cancer treatment? Watch the video: