Squamous cell carcinoma is the most common cervical cancer histology. Cervical cancer is leading cause of cancer in females particularly in rural India.
Treatments of Cervical Cancer depend on several factors like the extend of disease spread as well as the performance status of the patient. Surgery, radiation, chemotherapy, targeted drug therapy; immunotherapy or a combination of the above therapies may be used either together or sequentially.
When deciding on treatment, cervical cancer is classified as -
- Early stage cancer
- Locally advanced cancer
- Advanced cancer
Early Cervical Cancer
Surgery
Cancers confined to the cervix are early stage. Most of them are are treated with surgery – TAH or TLH (hysterectomy) which involves removing the cervix and the womb (uterus). Part of the vagina, the ovaries and nearby lymph nodes in the pelvis may also be removed.
Radiation
In patients who are not fit for surgery,
radiation treatment is an alternative treatment option.
Locally Advanced Cervical Cancer:
Cancers that are bulky or have spread to the surrounding organs or to the lymph nodes in the pelvis are considered as locally advanced. Here we cant offer them surgery.
Radiation treatment is often combined with chemotherapy a/k/a (concurrent chemo-radiation). Chemotherapy enhances the effectiveness of the
radiation treatment. Cisplatin is the most commonly used drug.
Radiation:
High Energy X-rays are used to kill
cancer cells. Radiation therapy consists of external beam and internal radiation:
- External beam Radiation: Radiation beam is directed at the affected area from outside the body.
- Internal Radiation (Brachytherapy): Insertion of hollow tube (applicator) that contains radioactive material into the vagina. This allows high-dose radiation to be delivered to the cervix and the vagina. The radioactive material is inserted for a few minutes and then removed.
Chemotherapy:
The most commonly used chemotherapy is a Platinum drug called cisplatin. Carboplatin may be used in some patients
Treatment of Advanced or
Recurrent Cancer of the Cervix:
Chemotherapy is a systemic treatment.
There are several drugs that are effective in the treatment of cervical cancer. Commonly used drugs include cisplatin, carboplatin, paclitaxel,
gemcitabine. It can used on its own, but more commonly given as a two-drug combination. A typical course of chemotherapy treatment takes 4-6 months.
Bevacizumab a VEGF Blocker is a targeted treatment that disrupts the blood vessels which supply nutrients to the cancer cells, thereby causing cancer cell death through deprivation of nutrients. This is a short infusional treatment, given once every 3-weekly, usually given with chemotherapy and as maintenance treatment to control the cancer better.
These are drugs that boost the body’s immune system to recognize and fight cancer cells. Immune checkpoint inhibitors, such as Pembrolizumab, Nivolumab work by releasing the natural brake on the
immune system so that the immune system will kill the cancer cells. It is given as a short infusion every 3 weeks.
Thus understanding the disease biology and
planning treatment according to the stage increases survival outcomes.
Dr Ravi Jaiswal.
Medical Oncologist.
