In cancer care, a multidisciplinary approach is required where usually a team of doctors often work together to chart out a patient’s overall treatment plan which also includes different types of treatments. It is important to discuss all the treatment options with your doctors, including the possible side effects. It is also very important to ask questions if there is anything, you are not sure about. Cancer care teams involves other health care professionals, such as physician assistants, oncology nurses, social workers, pharmacists, counsellors, dietitians, and others.
Team of Doctors for the treatment of cervical cancer may include gynaecologic oncologist, A radiation oncologist and a medical oncologist who uses chemotherapy and other medicines to treat cancer. Several factors play a critical role in deciding the treatment plan for cervical cancer. These factors include the type and stage of cancer, possible side effects and the woman’s preferences. It is very important to learn about all your treatment options and be sure to ask questions about things that are unclear. Discuss out the goals of each treatment and what you can expect while receiving the treatment with your cancer care team. There are different types of treatment for patients with cervical cancer. Five types of standard treatments which are used are as follows:
Surgery Surgery is used as a prime treatment option for early-stage cervical cancer. Various factors like the size of your cancer, its stage and consideration for future pregnancy or family planning play a vital role in deciding the operation best suited for you. Surgery involves removal of the tumour and some surrounding healthy tissue during an operation. A gynaecologic oncologist is a doctor who specializes in treating gynaecologic cancer using surgery.
Various surgical options used are as follows:
Surgery for small tumour - For a very small lump, that can only be seen with a microscope, it might be possible to remove it entirely with a cone biopsy. This procedure involves cutting away a cone-shaped piece of cervical tissue, leaving the rest of the cervix intact. This process is called Conization. This option may make it possible for you to consider becoming pregnant in the future.
Surgery to remove the cervix (trachelectomy) - Radical trachelectomy procedure is usually used for early-stage cervical cancer, it involves removal of the cervix and some surrounding tissue. The uterus remains after this procedure, so it may be possible to become pregnant, if you choose. This surgery may be used for young patients who want to preserve their fertility. This procedure has become an acceptable alternative to a hysterectomy for some patients.
Surgery to remove the cervix and uterus (hysterectomy) - Radical hysterectomy operation, involves removing the cervix, uterus, part of the vagina and nearby lymph nodes. A hysterectomy can cure early-stage cervical cancer and is known to prevent its recurrence. But the downside of this procedure is the removal of the uterus that makes it impossible to become pregnant. This procedure can be done using a large cut in the abdomen, called laparotomy, or smaller cuts, called laparoscopy.
Minimally invasive hysterectomy- This is another option which involves making several small cuts in the abdomen rather than one large cut, this could also be explored as an option after discussing with your doctor for an early-stage cervical cancer. People who undergo minimally invasive surgery tend to recover more quickly and spend less time in the hospital. But some research has found minimally invasive hysterectomy may be less effective than traditional hysterectomy. If you are considering this surgery, discuss the benefits and risks of this approach with your surgeon.
Complications or side effects from surgery vary depending on the extent of the procedure. Occasionally, patients experience significant bleeding, infection, or damage to the urinary and intestinal systems. Before surgery, talk with your health care team about the possible side effects from the specific surgery you will have. Since these surgical procedures affect a woman's sexual health, women should discuss out with their doctor about their symptoms and concerns in depth before the surgery. The doctor may recommend ways to reduce the side effects of surgery and provide helpful resources on coping with any changes.
Radiation In radiation therapy high-powered energy beams, such as X-rays or protons, are used to kill cancer cells. For locally advanced cervical cancers radiation therapy is often combined with chemotherapy as the primary treatment. This therapy can also be used after surgery if there is an increased risk that the cancer will come back. Radiation therapy can be further classified as: -
External beam radiation therapy - The most common type of radiation treatment is called external-beam radiation therapy, which is radiation given from a machine outside the body or externally, by directing a radiation beam at the affected area of the body.
Internal radiation therapy (Brachytherapy) - When radiation treatment is given using implants, it is called internal radiation therapy or brachytherapy. It is done internally, by placing a device filled with radioactive material inside your vagina, usually for only a few minutes.
External and Internal radiation treatment - A radiation therapy regimen, or schedule, usually consists of a specific number of treatments given over a set period that combines external and internal radiation treatments. This combined approach is the most effective to reduce the chances the cancer will come back, called a recurrence. Side effects from radiation therapy may include: -
Side effects of internal radiation therapy may include abdominal pain and bowel obstruction, although it is uncommon. Most side effects usually go away soon after treatment is finished. 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.
Chemotherapy As the name suggests chemotherapy is a drug treatment that uses chemicals to kill cancer cells. This therapy may see drugs given through a vein or taken in pill form. Sometimes both methods are used. A chemotherapy schedule usually consists of a specific number of cycles given over a set period. A patient may receive single drug at a time or a combination of multiple drugs at the same time. For women with cervical cancer, chemotherapy is often given in combination with radiation therapy. The side effects of chemotherapy vary from person to person and the dose used, but they can include hair loss, fatigue, diarrhoea, risk of infection, nausea and vomiting and loss of appetite. These side effects usually go away after treatment is finished. Rarely, specific drugs may cause some kidney damage. Others may cause loss of hearing. Patients may be given extra fluid intravenously to protect their kidneys. Discuss with your doctor about the possible short-term and long-term side effects based on the drugs and dosages you will be receiving. Higher doses of chemotherapy might be recommended to help control symptoms of very advanced cancer.
Targeted therapy Targeted drug therapy focuses on specific weaknesses present within the cancer cells sparing the healthy cells. These weaknesses are blocked by stopping new blood vessels from forming which in turn slows down tumour development in advanced cervical cancer, because it has been found that tumours need new blood vessels for nourishment. This Targeted therapy drug approach can cause cancer cells to die. Targeted drug therapy is usually combined with chemotherapy. It might be considered as an option for advanced cervical cancer. Targeted therapy focuses on the entire tissue environment along with some specific cancer genes and proteins that contributes to cancer growth and survival. This therapy hinders the growth and spread of cancer cells while limiting damage to healthy cells.
It is important to note here that not all the cancer cells or lumps would have the same targets. Your physician might ask for some tests to identify the genes, proteins, and other factors in your tumour and then accordingly map out the most effective treatment plan for you. This helps doctors to grab a better understanding of your condition and accordingly advice for the most effective treatment plan. In addition, research studies continue to find out more about specific molecular targets and new treatments directed at them.
Immunotherapy Immunotherapy is a drug treatment that helps your immune system to fight cancer. Your body's disease-fighting immune system might not attack cancer because the cancer cells produce proteins that make them undetectable by the immune system cells. Immunotherapy works by interfering with that process. For cervical cancer, immunotherapy might be considered when the cancer is advanced and other treatments are not working. Immunotherapy, also called biologic therapy, is designed to boost the body's natural defences to fight the cancer. It uses materials made either by the body or in a laboratory to improve, target, or restore immune system function.
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