Condition & Treatment – Cervix Cancer

Key Facts

  • Second most common cancer in India in women accounting for 22.86% of all cancer
  • Commonly presents in 3rd and 4th decade of life
  • Third largest cause of cancer mortality in India (10% of all cancer related deaths)
  • One woman dies of cervical cancer every 8 minutes in India
  • Women of all ages are at risk of cervical cancer

Risk Factors

  • Human Papilloma Virus (HPV) Infection (>90% cases) : contracted via sexual intercourse
  • Early age of first sexual activity
  • History of multiple sexual partners
  • More number of pregnancies
  • History of sexually transmitted diseases
  • Cigarette smoking


Clinical Signs And Symptoms

Common
  • Foul smelling sero-sanguinous or yellowish vaginal discharge
  • Metrorrhagia (intermenstrual bleeding), Menorrhagia (heavier menstrual flow) or postcoital bleeding.
  • Anemia (fatigue, generalised weakness etc)
Advanced Stages
  • Pelvic pain, flank and/ or leg pain
  • Painful micturition or blood in urine
  • Rectal bleeding
  • Persistent edema of lower extremities
  • Bowel obstruction (advanced disease)
  • Renal failure (advanced disease)

Investigations

  • Routine blood investigations including complete blood count, Kidney function test, Liver function test and urinalysis to see general well being of the patient
  • Punch biopsy to confirm histopathological diagnosis
  • Chest Xray to rule out lung metastasis
  • CECT/ MRI Contrast of Lower abdomen and pelvis to see tumor extension and lymph node involvement
  • Cystoscopy (to see urinary bladder invasion)
  • Recto sigmoidoscopy (to rule out rectum and bowel involvement)
  • PET CT Whole body scan (on clinician’s decision)

Treatment

Treatment options depend upon stage and prognostic factors. Common decisions are:

  • Surgery only
  • Surgery followed by post operative radiotherapy
  • Chemoradiotherapy
  • Only brachytherapy/ only External Beam Radiotherapy (EBRT)

Surgery

It is generally preferred in early stages.

  • Cryosurgery or cryotherapy
  • LEEP (Loop Electrosurgical Excision Procedure)
  • Conization
  • Hysterectomy with bilateral salpingo-oophorectomy.

Radiotherapy

  • Treatment by radiotherapy is commonly done by two techniques:
    • External beam radiotherapy by Cobalt-60/ Linear Accelerator (LINAC)
    • Brachytherapy by intra-cavitary applicators to give dose to the primary site
  • Common Radiotherapy protocol is a dose of 50 Gy in 25 fractions, 5 days a week for 5 weeks by EBRT followed by 3 cycles of brachytherapy 1 week apart. Total treatment duration is 8 weeks (should be strictly followed).
  • Advanced technologies like 3D- Conformal Radiotherapy (3D-CRT)/ Intensity Modulated Radiotherapy (IMRT) are helpful to decrease the dose to normal structures (Urinary bladder, Rectum, Small intestine, both Femur and Bone marrow).

Chemotherapy

  • Chemotherapy drug commonly used is Cisplatin as weekly schedule on OPD basis (commonest protocol).

Side Effects Of Radiotherapy

  • Burning sensation in urine
  • Increased frequency of urine
  • Burning sensation during defecation
  • Diarrhea
  • Skin changes
  • Vaginal stenosis
  • Painful sexual activity

Chemotherapy related

  • Nausea and vomiting
  • Loss of appetite
  • Possibility of derangement in kidney (more common) and liver function
  • Hair Loss (less likely with Cisplatin)

Prophylactic Human Papilloma Virus (HPV) Vaccination

  • Administered in females of 9-26 years
  • More effective when given before becoming sexually active
  • Dose schedules: 0,1,6 months and 0,2,6 months (as per Clinician’s decision)



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