Description detailed report on the causes, diagnosis, treatment and prevention of cervical cancer. Alternative NamesDysplasia; Human papilloma virus; Cytology of treatment for invasive cervical cancer therapy radiation and surgery are equally effective as one option for the treatment of cervical cancers too small in its early stages, with survival rates of up 85% to 90% for patients. Factors influencing the choice between radiotherapy and surgery in women with invasive cancer are patient's age and health and the spread of the disease. Both surgery and radiotherapy to eliminate the possibility of having children in premenopausal women. Although treatments for cervical cancer have several potentially serious side effects, are usually well tolerated. Women undergoing any of these treatments should feel free to seek support groups and counseling, which may be as important for medical standpoint as therapies.Surgery In the early stages of cervical cancer, surgery is usually the preferred method of treatment primary, since it preserves normal sexual function. Surgery for invasive cancer is almost always a hysterectomy. Some patients desiring fertility who have early stages of cancer may be candidates for the cone biopsy of the cervix. Hysterectomy. A hysterectomy attempts to remove cancerous tissue from the removal of the uterus. There are several variations of this operation, depending on the location of the tumor. In women of reproductive age, the ovaries usually can be left intact. Although a woman having a hysterectomy but retains the ovaries can not have children, do not go into premature menopause. (Studies indicate that leaving the ovaries intact is safe for most women and does not represent an increased risk of recurrence of cervical cancer.) Simple hysterectomy involves removing the uterus and cervix, but leaves the parametrium (tissue surrounding the uterus) and vagina intact. The pelvic lymph nodes are usually not removed. Click the icon to see an illustrated series detailing a hysterectomy. A radical hysterectomy removes not only the uterus and cervix, but also the parametrium, ligaments supporting the upper vagina, and some or all of the local lymph nodes (a procedure called lymphadenectomy). If the cancerous tumor recurs in the pelvis after primary treatment, a more extreme procedure can be performed called a pelvic exenteration, which combines radical hysterectomy with removal of the bladder and rectum. (In such cases, plastic surgery may be needed later to create an artificial vagina.) Patients undergoing this procedure is examined physically and psychologically in advance to determine if this is an appropriate choice. The success rate for pelvic exenteration to stop the progression of the disease is approximately 25% to 45%. Any form of hysterectomy is major surgery and requires at least one stay in the hospital three to five days. Although hysterectomy typically uses a wide abdominal incision, less invasive techniques which allow shorter recovery time may be possible for some women with early stage cancer when performed by experienced surgeons. Side effects include difficulty emptying the bladder or intestines and lower abdomen pain. Urinary tract infections are very common. Complications include fistulas (abnormal channels within the pelvis, which in this case are the result of surgery), bladder dysfunction, and cysts. Normal activity, including intercourse may be resumed in four to eight weeks. After removing the uterus, menstruation ceases. If the ovaries are removed, the symptoms of menopause will begin. These symptoms tend to be more severe in surgical menopause during the course of a natural passage to menopause. Hormone replacement therapy should be considered. [For more information on hysterectomy see WellConnected Report # 73, Fibroids: Uterineor Report # 74, Endometriosis.] Trachelectomy.An experimental procedure called trachelectomy is being investigated for preserving fertility in some women in the early stage, but it is very controversial and appropriate in only 5% of patients with cervical cancer. In the procedure, only the cancerous cervix is removed, while the rest of the uterus and cervix are left intact. The cervix is closed with a suture. Small, early studies suggest it may be effective for patients in stage 1 with no risk factors of aggressive cancer. 1999 in two small studies and 2000, conception rates were between 27% and 37%, and survival rates after two years were more than 95%. The procedure is done mainly outside the U.S., and few American surgeons are experts in this type of surgery at this time. Throughout the world, in fact, only a few hundred of these procedures have been performed to date. Women should also realize that conception rates are even lower than normal. And you can get pregnant even if there is a very high risk of miscarriage because the cervix is weakened. Larger and longerterm studies are needed to confirm its longterm security. Radiation therapy is an alternative approach for early stage cervical cancer. Radiation with concurrent cisplatinbased chemotherapy is currently the standard treatment for locally advanced cancer of the cervix. Radiation therapy uses high energy rays aimed at the body of an outside machine (external radiation) and radioactive materials placed inside the body against the cervix (intracavitary radiation). External radiation is given first and led to the lymph nodes along the pelvic wall. Usually involves a short period of direct radiation five days a week for six weeks in an outpatient setting. Intracavitary radiation (also called brachytherapy) follows and is designed to deliver high doses of radiation to the local tumor area. The radioactive material, usually cesium137, is encased in gold and platinum. These capsules are inserted in a long stainless steel tube called a tandem that is inserted into the uterus and in small stainless steel cylinders, called colpostats, which is placed against the cervix as close to cancer cells as possible . Usually, two or more radiation treatments are administered for about 35 hours each time. Radiation implants may also be inserted directly into the tumor using a needle. To be effective, radiation therapy should be powerful enough to destroy the ability of cancer cells grow and divide. This means that normal cells are also affected, which can cause significant side effects. Fortunately, healthy cells usually recover quickly from damage, while no abnormal cells. Advanced methods to direct the radiation more precisely are now available that limit damage to healthy tissue. Includes 3D conformal radiation and intensity modulated radiotherapy (IMRT): 3D conformal techniques use computers and a threedimensional image of the cervix to provide precise alignment of multiple tumor by high doses of radiation also beams.IMRT uses 3D techniques and employs very thin and precise beam of various intensities. Side effects. Side effects of radiation include fatigue, redness or dryness in the treated area, diarrhea, frequent or uncomfortable urination, and vaginal dryness, itching or burning. After treatment, side effects usually go away. Longterm complications. Complications include proctitis (inflammation of the rectum) and cystitis (bladder inflammation). Intestinal obstruction is a rare complication. Radiation therapy can also cause vaginal scarring, sexual difficulties, and premature menopause in younger women. Occasionally an abnormal tunnel between the bladder and vagina known as the vesicovaginal fistula, develop and may require surgery. Click the icon to view an image of the female anatomy. Research temporary silicone implants or a noninvasive device called the belly board can protect the small intestine during radiation therapy and help reduce complications. Radiation can increase the risk for subsequent development of cancer in the area surrounding the treated tissue. Despite the new more precise radiotherapy approaches should reduce this risk, there is some concern that IMRT may double the incidence of secondary cancers over time compared to the techniques of 3D line. This is of particular concern in younger patients. Radiation and hyperthermia. Researchers are studying hyperthermia (use of high temperatures often by ultrasound) in combinations with radiation therapy. This approach has shown some promise in achieving significant response rates in small studies. Comparison studies are important in determining whether this approach would be as beneficial with radiation and concurrent chemotherapy. Chemotherapy Chemotherapy uses drugs that kill cells known as cytotoxic agents to destroy cancer cells that have spread widely from their point of origin (primary tumor) and therefore can no longer be treated with surgery or radiation . For many years, chemotherapy is used only with very advanced disease to reduce symptoms. Platinumbased chemotherapy agents (cisplatin, usually) are used in many cervical cancer cases including the following: In combination with radiotherapy to improve survival rates in certain women, including some with locally cancer.In advanced some women with locally advanced cancer to reduce tumors to the point that cancer can be operable.When cancer has spread (metastasized), mostly to reduce symptoms such as pain. Chemotherapy agents used. Platinumbased agents. One of the most active chemotherapeutic agents for cervical cancer is cisplatin, which improves the effectiveness of radiotherapy in the treatment of patients with more advanced disease stages. Cisplatin and carboplatin are known as platinumbased drugs. In general, platinumbased agents are the standard drugs used for this disease. Concurrent platinumbased agents and radiotherapy are important treatment for many stages of cancer later. Even in the treatment of metastatic disease, cisplatin used alone has been more useful than even combinations of agents. There is some evidence that a combination of platinum plus paclitaxel with individual agents, possibly, others may be more effective than platinum alone in the treatment of metastatic disease. Other platinum agents such as nedaplatin, are under investigation. The radiationenhancing drugs. Some drugs are investigating appears to increase tumor response to radiation therapy, for what is known as radiation sensitizers or enhancers. Topotecan, a radioenhancer, for example, is showing some promise in early studies, although toxicity is high. Other agents. Other drugs, especially in combination, have also been investigated with some promise. Included with epirubicin, irinotecan, paclitaxel, bleomycin, mitomycin, vinorelbine, gemcitabine, and doxifluridine. For cancer that has spread to other areas of their original source (metastatic disease), chemotherapy regimens can use one or more agents, cytotoxic agents in combination. Administration. Cytotoxic agents can be administered orally or by injection. The treatment can be administered in a medical center, medical office, or even a patient's home. Some patients receiving chemotherapy may need to stay in hospital for several days so the effects of drugs can be controlled. The drugs are often given in cycles with a period of rest after a treatment period to allow recovery of side effects. Side effects. Chemotherapy affects all fast growing cells, including healthy ones, so side effects are inevitable. Side effects occur with all chemotherapeutic drugs. Are more severe with higher doses and increase over the course of treatment. Common side effects include: Nausea and Vomiting. Drugs known as serotonin antagonists, especially ondansetron (Zofran), can relieve these side effects in nearly all patients given moderate drugs and most patients who take more powerful drugs. In one study, a combination of dexamethasone (a corticosteroid) with ondansetron taken within 24 hours of chemotherapy achieved a reduction either up or complete nausea and hair vomiting.Diarrhea.Temporary loss.Fatigue.Anemia.Depression loss.Weight . Complications. Serious shortand longterm complications can also occur and may vary depending on the specific agents used. This includes the following: Increased chance of infection on the suppression of immune system.Severe drops in white blood cells (neutropenia). Certain agents such as taxanes, pose the greatest risk for this than other chemotherapeutic drugs. White blood cell count can be improved with the addition of a drug called granulocyte colony stimulating factor (either filgrastim and lenograstim). Liver and kidney damage.Abnormal blood clotting (thrombocytopenia). Allergic reaction, particularly platinumbased agents. Menopause (A simple skin test under investigation that may identify people with potential allergic response.). Menstrual abnormalities are common and occurs early in about 30% of women, especially those over 40.Rarely, secondary cancers, such as leukemia.Between quarter and one third of women report problems in concentration, motor function and memory, which can be long term. This effect may be due to reductions in estrogen levels after treatments. br br
