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Cervical Cancer: Bane to the Womanhood

Cervical Cancer Treatment

What Is Cervical Cancer Treatment And Surgery?: 

Cervix is the lower portion of uterus, which connects it with vagina. An abnormal growth of cells in the cervix leading to mass of cells is called as cervical cancer/tumor. The specialty of gynecology which deals with the curing of cervical cancer is known as cervical cancer treatment. The growth may progress slowly and remain confined to the cervical walls making it a benign cancer. If it invades the adjacent tissues such as liver, lungs, anal cavities, it is termed as a metastatic cancer.

Causes of Cervical Cancer:

A host of factors can be attributed to cause cancer of the cervix. These are as follows:

  • A virus known as Human Papilloma Virus HPV is known to induce abnormalities in cervical cells and promote growth in the number of cells. It is also responsible for formation of cervical warts.
  • Unattended bacterial/viral/fungal infections may also lead to cancerous conditions.
  • Oral contraceptive pills (birth control pills) are also known to be a major factor causing cancer of the cervix. This may be attributed to the fluctuations they cause in the hormonal levels in the blood stream.
  • Engaging into sexual intercourse at an early age, multiple sexual partners, unhygienic sexual intercourses can also lead to cervical cancer.

Signs and Symptoms of Cervical Cancer:

  • Pain in the pelvic and lower abdominal region
  • Vaginal bleeding after menopause
  • Heavy vaginal discharge at regular intervals
  • Foul odour from the vaginal areas
  • Itchiness, dryness, redness in the vaginal region
  • Bleeding from the vagina repeatedly after sexual intercourse
  • General discomfort in the lower pelvic region
  • Smoking is also considered as one of the etiologic factors since nicotine is known to cause tissue irritation and result in the abnormal growth of cells

Diagnosis Of Cervical Cancer:

A number of tests can be run in order to detect cancer of the cervix and once detected, plan the treatment accordingly. The diagnostic tests are as follows:

  • Biopsy: A small portion from the abnormal growth of cells in the cervix are extracted via the vaginal path and studied in the labs for the detection of type of cervical cancer. It is one of the most common methods used whenever cancer of any type is suspected.
  • PAP test: If a cancer of the cervix is suspected, a scraping from the vaginal walls can be obtained with the help of cotton swabs and sent to labs to study it under the papinicolou stain. This helps to identify the type of abnormal cells and also the nature of the tumor. It is the most confirmatory type of diagnostic test for cervical cancer.
  • Ultrasound USG: This is a non ionizing type of radiation which is used to locate the cancer in the cervix. It helps to identify which part of the cervix has abnormal growth of cells, in what number and size.
  • Colposcopy: It is used when the patient has an abnormal pap smear test but the physical examination is normal. A microscope called as a colposcope is used for the examination of the cervix. The cervix is stained with a dye which helps the instrument to locate the cancer cells easily. With the help of the colposcope, the cells are removed for biopsy. The cervix is enlarged by 15 times to its original size by the colposcope and helps in the easy identification of the abnormal cells that need a biopsy.
  • Loop electrosurgical excision procedure (LEEP): This method makes use of an electrified loop of wire to extract a sample of tissue from the cervical walls which is then studied for the biopsy procedure. 
  • Conization: This is a minor surgical procedure performed under general anesthesia where a small portion of the cervix is removed for the purpose of lab tests. A cold knife or a cold scalpel is generally used for this procedure.
  • In addition to the above mentioned tools for the diagnosis, in cases where it has already been established that cancer of the cervix present, further tests need to be run in order to check for the invasive and metastatic nature of the cancer. These include:
  1. Chest xray to see the involvement of lungs
  2. MRI to check for the involvement of the lymph nodes
  3. SGOT and SGPT levels in blood to check for the liver function
  4. CT and MRI of the urinary tract in order to check for their involvement

Types of Cervical Cancer:

The most commonly encountered cervical cancer is the squamous intraepithelial lesion which involves the layers of cervical lining in succession. There are two major types of intraepithelial lesions as follows:

  • Low grade intraepithelial lesion LGSIL: It is also known by the name of cervical intraepithelial neoplasia. It occurs between the ages of 25 to 35 years in women, however can be seen in much older women too. This is the milder form in which a change in the size and shape of the cells is seen on the surface of the cervical lining. They may either wither away with time or may progress to a high grade lesion.
  • High-grade intraepithelial lesion HGSIL: These are characterized by a large of abnormal cells in the cervical lining which are distinctly abnormal in size. These lesions are also known as moderate or severe dysplasia or carcinoma in situ. These are mostly seen in women in the age group of 40 to 60 years. 

How does your body tell you, that you might be suffering from cervical cancer?

The most common way of presentation in people who participate in cervical screening programmes is by an abnormal cytology report of the PAP (Papanicolau) smear. If a suspicion of invasive disease is present, then a colposcopy assisted biopsy is performed in order to identify any lesion on tissue histopathology.

 

The other common ways in which the patient may present are:

  1. Incidental detection during treatment of cervical intraepithelial neoplasia (pre-invasive form)
  2. Post coital bleeding: It refers to bleeding from the front passage of the woman after coitus or sex.
  3. Post menopausal bleeding: This is a relatively rarer way of presentation, because cervical cancer will not be the first diagnosis in any case of post menopausal bleed.
  4. Other rarer presentations suggestive of advanced disease are:
  • Weight loss and loss of appetite as seen in any malignancy
  • Heavy menstrual bleeding and anaemia due to chronic blood loss
  • Ureteric obstruction: due to the tumour mass pressing onto the ureters
  • Bowel disturbance and constipation: due to mass effects, pushing onto the rectum
  • Vesicovaginal fistula formation: Fistulae are abnormal connections and here it exists between the bladder and the vagina. This is the most common type associated with cervical cancers, though other fistulae like rectovaginal fistulae can also be seen.

How to treat a case of cervical cancer?

Any cancer is treated based on the stage of the disease, for which examinations and investigations are mandatory. In cervical cancer, we do a FIGO (International federation of gynaecology and Obstetrics) staging, based on which treatment is decided at the end of the multidisciplinary team discussion.

 

Stage

Substage

Extent of disease

5 year survival

Stage I: Limited to cervix

Ia

 

Microscopic disease

>95%

 

Ia1

Microscopic disease with stromal invasion <=3mm

 

 

Ia2

Microscopic disease with stromal invasion >=3mm and <5mm in depth

 

Ib

 

Macroscopic disease or microscopic disease with invasion >=5mm

 

 

Ib1

Invasive carcinoma >=5mm depth of stromal invasion and <2 cm in greatest dimension

~90%

 

Ib2

Invasive carcinoma >=2cm and <4cm in greatest dimension

~80-85%

 

Ib3

Invasive carcinoma >=4cm in greatest dimension

 

Stage II: Extends beyond cervix, but not to pelvic side wall or lower 1/3rd of vagina

IIa

 

Involves upper 2/3rds of the vagina without involving the paraqmetrium

~75-78%

 

IIa1

Invasive carcinoma <4cm in greatest dimension

 

 

IIa2

Invasive carcinoma >4cm in greatest dimension

 

IIb

 

Obvious parametrial involvement

 

Stage III: Extends to pelvic side wall, and/or lower 1/3rd of vagina or causes hydro-nephrosis or non- functioning kidney and involves pelvic and/or para-aortic lymph nodes

IIIa

 

Lower 1/3rd of vagina involved

~47-50%

IIIb

 

Extension to pelvic side walls (includes all cases of hydronephrosis or non-functioning kidneys, unless known to be due to another cause)

 

IIIc

 

Involvement of pelvic and/or para-aortic nodes, irrespective of tumour size

 

 

IIIc1

Metastasis to pelvic nodes only

 

 

IIIc2

Metastasis to para-aortic nodes only

 

Stage IV: extension beyond true pelvis or involvement of bladder/bowel mucosa

IVa

Extension to adjacent organs

~20-30%

IVb

Distant metastases

 

Treatment Procedures for Cervical Cancer::

It becomes essential nowadays to screen women for cervical cancer. Once it is suspected that a cancer may develop, further planning can be done. A treatment for cervical cancer can be broadly classified as

  • Preventive Treatment
  • Curative Treatment

Preventive: A preventive treatment would involve a thorough screening of the vagina and the cervix with the help of a thorough physical examination aided by various diagnostic methods. Another method for the prevention of cervical cancer is the administration of HPV vaccinations to the female population in the age group of 18 to 50 years.

Curative: The curative treatment starts once the cancer is confirmed. It can again be divided into non surgical and surgical methods.

 

Non surgical methods:

  • Radiation therapy: It is a branch of imaging radiology which aims at killing the cancer cells in the early stages. In this method, beams of ionizing radiation are targeted towards the nucleus of the cancer cells. As a result of this, disintegration of the cells occur leading to death of the cancer cells. It may be the sole modality for the treatment of cancer or may also be used as an adjunct to chemotherapy and the surgical interventions. Radiation therapies also provide symptomatic relief from the cancer symptoms, if not being able to cure the cancer. The oncologist and the gynecologist decide the number of appointments and the dose of radiation to be administered depending upon the nature and degree of the cancer.
  • Chemotherapy: A chemotherapy session replaces the radiation session by the use of anti cancer drugs instead of the radiation beams. These drugs have the ability to interfere with the metabolism of the cancer cells such as causing a reduction in the oxidation of cells and blocking the pathways in which nutrients are supplied to the cells. An ultimate death of the cells results as result of improper metabolic activities. Also they prevent spreading or migration of the tumor mass into the adjacent spaces. Reduction or shrinkage of the cancer mass may also be achieved with chemo sessions. The frequency of chemo & type of drug to be used along with its dosage is a collective decision of the oncologist & chemotherapist
  • Implant radiation: This is a variant of radiation therapy in which capsules containing ionizing radiations are used. These capsules are placed in the vaginal and the cervical walls either for a few hours or for a few days and the patient may require hospitalization. These capsules emit the radiations to the cancer masses and are relatively neutral to the normal cells. The cancer cells on absorption of the radiation tend to disintegrate brining about a curbing of the cancer mass in the cervix.

 

Surgical methods:

  • Hysterectomy: The surgical procedure of removal of the uterus is known as hysterectomy. If the cervical cancer has progressed upwards and involved the endometrium, bladder and it is suspected to involve the lymph nodes, liver and lungs; then it is best to remove the entire uterus along with the cancer mass. The procedure is done under general anesthesia and may require a prolonged hospitalization. Radiation and chemotherapy may be advised in alternate cycles after the surgical procedure to completely eradicate the cancer and prevent even the slightest of its chance to recur.

This procedure can be carried out both in the conventional manner with incisions and sutures or also with the help of laser technology. However for a cervical cancer, a radical type of hysterectomy is advised. In a radical type of procedure, the infected lymph nodes are also removed along with the entire mass of uterus.

  • LEEP: The loop electrosurgical excision procedure can be used as both a diagnostic as well as a treatment procedure. The part of cancer that is excised to study in labs may be the only part of cancer in the entire cervix. Thus it can be removed with a small margin of the normal tissues and be considered as a surgical removal. Nevertheless medications, radio and chemo sessions are carried out to prevent the recurrence.
  • Conization: It is yet another diagnostic biopsy procedure which can also be used as curative method for cervical cancer. A cone shaped part of the cervix is removed with a cold knife or a scalpel leaving behind only a small portion of healthy cervix behind. The part of cervix removed can be studies in the pathology labs in order to determine the type and nature of the abnormal cells which gives an insight into the recurrence of the cancer mass. This will also help in planning the radio and chemo sessions accordingly, if at all needed after the surgical removal.

Complications And Risk Factors Associated With Cervical Cancer:

  • Radiation and chemotherapy are known to induce hair loss, skin irritations and soreness in throat region.
  • Smoking and alcohol are major contributing factors to the cervical cancer stages, may aggravate the chemo and the radio sessions.
  • Underlining diseases such as hypertension, asthama and diabetes tend to pose threats at the time of surgical planning.

Am I Good Candidate for Cervical Cancer Treatment:

You are an apt candidate for any of the cervical cancer treatments if any of below mentioned symptoms bother you at any stage in life:

  • Vaginal bleeding in between menses associated with tremendous pelvic pain
  • Foul vaginal discharges with lower abdominal discomfort
  • Excessive bleeding while sexual intercourse
  • Uncontrolled vaginal bleeding after sexual intercourse

Recovery Time:

  • A surgical procedure such as hysterectomy requires a 4 -6 weeks of recovery time
  • Procedures such as LEEP and conization require a minimum of one week to ten days of recovery time
  • Radiation and chemotherapy kill cancer cells over a period of time, may cause certain side effects which also tend to heal over days and years

Success Rate:

  • Hysterectomy is known to have cent percent success rate for women in all age groups.
  • Conization and LEEP are more of diagnostic than curative procedures and cancer is known to recur in almost 80 percent of the cases.
  • Medications prescribed however can only suppress the cancer symptoms and are known to cause more harm to the normal cells than the destruction they are expected to cause to the cancer cells.
  • Radiation and chemo therapy both have a 74.55 and 78.66 percent chance of being successful causing some amount of adverse effects including hair loss, soreness, dryness of skin.

Benefits of  Cervical cancer Treatment:

  • A surgical procedure will remove the entire cancer mass and cause immediate relief from the cancer symptoms
  • Medications help in the suppression of the symptoms
  • Radiation therapy and chemo therapy help in the killing of the cancer cells and over a period of time, the cancer can be curbed.

Cost comparisons:

  • A hysterectomy in India would cost about 1,50,000 INR, UK would cost 6500 pound sterling, in US would cost $8000.
  • Radiation and chemotherapy in India roughly would cost you about 100000 to 250000 INR per session, can range between $4000 to $6000 in the United States.
  • Screening and vaccinations for the Indian rural population are mostly done free of cost, 1000 to 2000 INR are the charges for the vaccinations in the urban cities.

Why Choose India?

MedcureIndia, an Indian platform for medical tourism has always based its foundation on the betterment of its clients. India is undoubtedly the best place to get the treatment done for cervical cancer in the lowest possible range of fees, assuring an utmost best treatment outcome.

 




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