How is cervical cancer treated abroad?

Before proceeding to the treatment of cancer, it is necessary to undergo diagnostics and to identify the stage of the disease. The choice of the method of therapy directly depends on the exact location of cancer in the cervix, its type, the patient's age, the general state of her health and the desire to have children after treatment. It is important to remember that carcinoma of the cervix is one of the most rapidly progressive tumors. Therefore it is vital to establish the diagnosis in time and seek treatment from an experienced doctor.

Stage

Methods of treatment of cervical cancer in stages

0

for patients who plan to have children

  • cryosurgery
  • laser surgery
  • Loop electrosurgical excision procedure (LEEP)
  • cryoconization

without preservation of reproductive function

  • hysterectomy

1

1А1

  • conization
  • total hysterectomy (if conization is ineffective)

1А2

  • total hysterectomy with lymph nodes removal
  • brachytherapy (internal radiation therapy, in which the radiation source is injected into the body) + radiotherapy
  • trachelectomy (if preservation of reproductive function is possible)

1B

1B1

  • total hysterectomy with removal of the lymph nodes of the pelvis and abdominal cavity. Sometimes it is combined with chemotherapy if cancer has spread to surrounding tissues and lymph nodes
  • high-dose irradiation
  • radical trachelectomy (an organ-preserving operation)

1B2

  • chemotherapy + brachytherapy + pelvic radiotherapy
  • total hysterectomy. Then radiotherapy is prescribed, less often - in combination with chemotherapy, if cancer cells were found in the tissues and lymph nodes

2

2А

  • external radiotherapy + brachytherapy (if a tumor is larger than 4 cm). The chemotherapeutic drug cisplatin is prescribed along with radiotherapy
  • radical hysterectomy + brachytherapy sessions

2В

  • sessions of external and internal radiotherapy
  • radiotherapy is prescribed along with chemotherapy (cisplatin or carboplatin plus fluorouracil)

3,4А

  • external + internal radiation therapy
  • it is mandatory to perform diagnostic procedures (CT, MRI or biopsy) for the evaluation of lymph nodes and possible metastasis

4В

  • radiation therapy: palliative effect - pain relief, metastases treatment
  • chemotherapy - drugs based on platinum in combination with another drug such as paclitaxel (Taxol), gemcitabine (Gemzar), or topotecan

What are the treatment methods for cervical cancer?

In stages 1, 2 of cervical cancer, surgical treatment is predominantly performed. The question of ovarian removal is decided individually and depends on whether the patient plans to give birth in the future.

Surgical methods of cervical cancer treatment:

Conization

Conization is both a diagnostic procedure and an independent type of cancer treatment at the early stages. A cone-shaped piece of tissue is removed from the cervix. It is done using a surgical or laser knife (cold knife cone biopsy) or using a thin wire heated by electricity (the loop electrosurgical procedure).

Trachelectomy

The main advantage of this procedure is the preservation of reproductive function.The surgeon removes the cervix and the upper part of the vagina, keeping the body of the uterus. The operation is done either through the vagina or the abdomen and is sometimes done using laparoscopy (keyhole surgery). The chance of relapse is small.

Pelvic exenteration

Extensive surgical intervention performed at advanced stages of cancer or in case of a relapse.

The doctor removes the uterus with the vagina, the bladder, the rectum, the nearest lymph nodes, and part of the colon depending on where cancer has spread. The vaginal plastic is made from patients own tissues.

Hysterectomy

The surgeon removes the uterus along with the tissues next to it, a part of the vagina next to the cervix, and some pelvic lymph nodes. The ovaries and fallopian tubes are not removed. This surgery is usually done through an abdominal incision.

A radical (total) hysterectomy can also be done using laparoscopy (keyhole surgery) or robot-assisted laparoscopic surgery.

Types of hysterectomy

Types of hysterectomy

Description

Radical

The uterus is completely removed with the surrounding tissues and the upper third of the vagina. Surgery is performed through the incision in the anterior abdominal wall. Often, the surgeon removes the lymph nodes of the pelvis.

Open

The uterus is removed through an open incision in the abdomen.

Laparoscopic

The doctor removes the uterus using laparoscopy equipment.

Vaginal

The removal of the uterus is performed through the vagina

Hysterectomy with Da Vinci robotic surgery

Minimally invasive surgery performed with the innovative robotic da Vinci system. It provides low risk of complications, low blood loss, a short period of hospitalization and rehabilitation.

Radiation therapy - the newest technologies in the fight against cancer

Radiation therapy for cervical cancer

Radiation therapy for cancer is high doses of X-rays aimed to kill cancer cells. Radiation therapy may be used for cervical cancer as a part of the main treatment or to treat cervical cancer that has spread to other organs.

There are 2 types of radiation therapy used to treat cervical cancer:

  • External beam radiation
  • Brachytherapy

Depending on the stage and indications for treatment, a doctor prescribes external or internal irradiation, sometimes the combination of two.

The duration of irradiation sessions lasts from 5 to 8 weeks.

External beam radiation therapy

Duration of 6 weeks, sessions for 10 minutes 5 days a week.

IMRT - external radiation therapy with modulated intensity. It is a more precise method that is used for more aggressive tumors. It helps to determine the localization of the irradiation zone with the help of a 3D model of the tumor and to select the desired intensity of irradiation.

3D-CRT (TomoTherapy) - a device that combines CT and IMRT. This type of radiotherapy is used for patients who were previously exposed to radiation and reached its maximum dose.

Brachytherapy (internal radiotherapy)

Depending on the situation, the radioactive material is placed inside the tumor, next to it or delivered to the site of exposure using special delivery devices (temporary implants, catheters, needles, applicators). As isotopes, iodine, palladium, cesium, etc.

If necessary, the physician combines brachytherapy with IMRT to maximize the dose of irradiation on the tumor. The duration of brachytherapy is significantly less than in other radiotherapy options.

Intraoperative radiotherapy

IORT delivers a concentrated dose of radiation to a tumor during surgery.

Is chemotherapy effective for the cancer of the cervix?

Chemotherapy is used for high differentiation of cancer, and in later stages for the control of metastases. Drugs are administered orally or intravenously. Substances enter the bloodstream and reach all organs, making chemotherapy an effective method of fighting metastatic cancer of the cervix.

Chemotherapy of the cervix is performed with cisplatin, ifosfamide, 5-fluorouracil (5-FU), paclitaxel and topotecan. They are administered separately; sometimes the doctor prescribes a combination of them. Drugs destroy malignant cells but at the same time negatively affect healthy ones, causing side effects:

  • lack of appetite;
  • loss of hair;
  • nausea, vomiting.

Targeted therapy for cervical cancer

Target therapy is aimed at blocking the growth and spread of cancer by destroying cells or preventing their division. It is prescribed mainly in addition to chemotherapy, radiotherapy. Example of targeted drug Avastin (bevacizumab). This drug can be used to treat advanced cervical cancer and is often prescribed with chemo.