Cervical Cancer

Understanding Cervical Cancers Patient Information

Cervical Cancer: An Overview

Cervical cancer is a cancer that begins in the cervix, the part of the uterus or womb that opens into the vagina.

• It is the part of the uterus that dilates and opens fully to allow a baby to pass into the birth canal.

• The normal cervix has two main types of cells: squamous or flat cells, that protect the outside of the cervix and glandular cells, that are mostly inside the cervix, that make the fluid and mucus commonly seen during ovulation.

Cervical cancer is caused by abnormal changes in either of these cell types in the cervix, and is the only gynecologic cancer that can be prevented by regular screening and preventive vaccination. Cervical cancer usually affects women between the ages of 30 and 55.

Cervical cancer and cervical pre-cancers usually have no symptoms. That is why it is important to have a Pap test. A woman usually does not have any symptoms until the cells turn into cancer and invade the deepest parts of the cervix or other pelvic organs.

These are common symptoms in women who have developed cervical cancer.

  • Vaginal discharge
  • Abnormal vaginal bleeding
  • Vaginal odor
  • Pain

These symptoms may be caused by cancer or by other health problems. It is important for a woman to see her doctor if she is having any of these symptoms.

When a woman experiences concerning symptoms, a pelvic exam, including a rectovaginal exam, and a general physical should be performed. If the exam is abnormal, the woman might be recommended to undergo an HPV test or a colposcopy (observing the cervix through a magnifying scope) and a biopsy, depending upon the results of the colposcopy. If there is a frank growth/lesion, a biopsy maybe performed directly. Additional Investigations like CTscan/ MRI of the abdomen or pelvis may be performed if indicated. If cervical cancer is suspected or diagnosed, it is important to seek care first from a surgical oncologist.

Treatment usually depends on the clinical/radiological stage of the tumor.Surgery is the most common treatment for early cervical cancer, although radiation can also be used. The final choice for you will depend on several factors ,especially the stage and size of your cancer as well as your general health.

Women’s Cancer Treatment in Pune

Staging helps to determine what treatment plan is best for you and to give you an idea of how extensive your cancer is and your chances of a cure and it determined prior to  surgery.

Cervical cancer is grouped into four stages.

Stage I: The cancer is found only in the cervix.

Stage II: The cancer has spread from the cervix to the upper part of the vagina or the tissue around the uterus. It has not spread to the pelvic wall. (The pelvic wall is the muscle and connective tissues that line the insides of the pelvic bones.) Cancer cells may also be found in the lymph nodes in the pelvis.

Stage III: The cancer has spread to the lower part of the vagina or to the pelvic

wall. It may block the flow of urine to the bladder. Cancer cells may also be found in the lymph nodes in the pelvis.

Stage IV: The cancer has spread to other body parts within or outside of the pelvis. Cancer cells may be found in the bladder, rectum, abdomen, liver, intestines or lungs.

For Most Stage I, Surgery is the recommended treatment. For Stages II-IV various combination of chemotherapy and radiation is used for treatment.

Radical abdominal hysterectomy: This procedure may be performed through an abdominal incision or Laparoscopically.The word radical means that the uterus and the tissue between the uterus and pelvic wall, as well as part of the upper vagina, are removed. Lymph nodes in the pelvis are also removed and examined to determine if the cancer has spread (radical pelvic lymphadenectomy). In some cases, both ovaries and both fallopian tubes must be removed. This procedure is called a bilateral salpingo-oophorectomy.

Side effects of surgery

Some pain and discomfort are common after surgery. Pain can be controlled with medicine. Tell your treatment team if you are experiencing more than mild pain.

Other early side effects (days to weeks after surgery):

  • Nausea
  • Discomfort related to tubes, catheters and medical devices
  • Difficulty urinating so that that a catheter that may stay in your bladder for a few days to weeks is often necessary
  • Soreness of the abdomen around the incision
  • Cramps and gas pains
  • Watery vaginal discharge or bleeding

Later side effects (weeks to months):

  • Fatigue
  • Difficulty urinating
  • Constipation
  • Shortening of the vagina

Some things may be done at the time of your surgery to minimize these side effects (such as placement of a temporary drainage catheter in your bladder). Women who have a hysterectomy will stop having periods and will no longer be able to have children. Hormone levels will be the same if the ovaries are left in, or may fall to menopausal levels if the ovaries are removed.

Radiation therapy (also called radiotherapy) uses high-energy radiation to kill cancer cells or stop them from growing. Radiation therapy can be an effective treatment for early stage cervical cancers. However, in early cervical cancer, it is more commonly used as extra treatment after surgery for patients at highest risk for recurrence of their cancer (such as when the tumor might have spread beyond the cervix). Radiation is also used to treat larger or higher stage cancers where it is actually works better than surgery. Your individual need for radiation therapy will be determined using information from your staging tests, examinations, and surgery, if an operation was performed from findings at the time of your evaluation.

Two types of radiation therapy are used to treat cervical cancer. Radiation therapy for cervix cancer is most often given in combination with chemotherapy.

External radiation therapy uses a machine that directs the radiation toward a precise region of the body. The therapy is usually given daily, Monday through Friday, for about six weeks. Radiation does not hurt during the treatment and only takes a few minutes each day. You can be treated at a clinic, hospital, or radiation oncology office, and typically you return home each day after treatment.

Internal radiation therapy (also called brachytherapy) involves placing a small capsule of radioactive material inside the vagina or near the cervix. This procedure can sometimes be performed on an outpatient basis, and other times it requires hospitalization for a night or two.

Side effects of radiation

The side effects of radiation therapy depend on the dose used and the part of the body that is being treated. Common side effects for cervix cancer patients are listed below.

Early side effects (occur during treatment):

  • Dry, reddened skin in the treated area
  • Fatigue
  • Anemia
  • Diarrhea and nausea
  • Discomfort when urinating

Most of these side effects are temporary. Not everybody experiences all of these side effects. Be sure to talk with your treatment team members about any side effects you experience. They can help you find ways to manage them.

Later side effects from radiation therapy include:

  • Narrowing of the vagina and loss of lubrication
  • Urinary frequency (radiation cystitis)
  • Diarrhea (radiation colitis)
  • Early or sudden menopause (if the ovaries stop working)
  • Skin thickening and irritation

Chemotherapy is the use of drugs to kill cancer cells. Chemotherapy for cervical cancer is usually given intravenously (injected into a vein). You may be treated in the doctor’s office or the outpatient part of a hospital. Periods of chemotherapy treatment are alternated with

rest periods when no chemotherapy is given. Chemotherapy maybe given in combination with radiation therapy.

Side effects of chemotherapy:

Each person responds to chemotherapy differently. Some people may have very few side effects while others experience several. Most side effects are temporary. They include:

  • Nausea
  • Loss of appetite
  • Mouth sores
  • Increased chance of infection
  • Bleeding or bruising easily
  • Vomiting
  • Mild hair loss
  • Fatigue
  • Constipation
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