Treatment for cervical cancer can involve surgery, radiation therapy and chemotherapy. Patients are often treated by a team of specialists. The team may include gynaecological oncologists, radiotherapy oncologists and chemotherapists. The doctors may decide to use one treatment method or a combination of methods. Some patients take part in a clinical trial (research study) using new treatment methods. Such studies are designed to improve cancer treatment.
Surgery
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urgical removal of cervical cancer depends on the stage of the disease. If the cancer is still at a very early invasive stage and has not invaded deeper layers of the cervix, the doctor may perform an operation to remove the tumour by means of a large conisation but leave the uterus, tubes and ovaries.
In most other early stage cases, however, the patient may need to have a radical hysterectomy with removal of the tissue next to the cervix and uterus (parametrium) to offer the best therapeutic chance for long-term survival. In this procedure, the surgical team not only performs a total hysterectomy (uterus and cervix), but also removes the upper third of the vagina, the ovaries and fallopian tubes. In addition, the nearby lymph nodes are removed to learn whether the cancer has spread.
Radiation therapy and chemotherapy
The decision whether to perform surgery or radiation therapy with chemotherapy depends on the stage of the disease. Radiation therapy (also called radiotherapy) uses high-energy rays to destroy cancer cells and stop them from growing. The radiation may come from a large machine (external radiation) or from radioactive materials placed directly into the cervix (implant radiation). Some patients receive both types of radiation therapy in succession.
A woman receiving external radiation therapy is hospitalised or goes to the hospital each day for treatment. Usually, treatments are given five days a week for five to six weeks.
For internal or implant radiation, a capsule containing radioactive material is placed directly in the cervical canal. The implant radiates cancer-killing rays close to the tumour while sparing most of the healthy tissue around it. A special type of cannula with a long pipe is first placed into the cervical canal through which the radioactive material is moved from a safe container into the cervix and back by remote control. This is repeated several times while the patient stays in hospital.
The effect of radiotherapy is enhanced by simultaneous administration of chemotherapy (drugs to kill cancer cells). Radiotherapy and chemotherapy are used when cervical cancer is not localised to the cervix and has spread to other parts of the body or if the tumour is very large. The doctor may use just one drug or a combination of drugs. Chemotherapy for the treatment of cervical cancer is usually given by injection into a vein. This is also referred to as systemic treatment meaning that the drugs flow through the body via the bloodstream.
Side-effects of treatment
It is difficult to limit the effects of therapy so that only cancer cells are removed or destroyed. Because treatment also damages healthy cells and tissues, it often causes unpleasant side-effects.
The side-effects of cancer treatment depend mainly on the type and extent of the treatment. Also, each patient reacts differently. Doctors and nurses can explain the possible side-effects of treatment, and they can help relieve symptoms that may occur during and after treatment. It is important to let the doctor know if any side-effects occur.
Side-effects of surgery
Radical hysterectomy entails the removal of the womb and the cervix together with the additional removal of adjacent tissues, tubes, lymph nodes and sometimes also the ovaries. For a few days after the operation, the woman may have pain in her lower abdomen. Medicine to control the pain is very effective. A woman may have difficulty emptying her bladder and may need to have a catheter inserted into the bladder to drain the urine for a few days after surgery. Sometimes the bladder problems may even be permanent. She may also have trouble having normal bowel movements. For a period of time after the surgery, the woman's activities should be limited to allow healing to take place. Normal activities, including sexual intercourse, can usually be resumed in four to eight weeks.
Women who have had their uterus removed (total hysterectomy for precursors, radical hysterectomy for invasive cancer) no longer have menstrual periods. Sexual desire and the ability to have intercourse are usually not affected by total hysterectomy but may be affected by radical hysterectomy. After surgery, a woman's view of her own sexuality may change, and she may feel an emotional loss. An understanding partner is important at this time. Women may want to discuss these issues with their doctor, nurse, medical social worker, or member of the clergy.
Side-effects of radiotherapy and chemotherapy
Patients are likely to become very tired during radiation therapy, especially in the later weeks of treatment. Resting is important, but doctors usually advise patients to try to stay as active as they can.
With external radiation, it is common to lose hair in the treated area and for the skin to become red, dry, tender and itchy. There may be permanent darkening or "bronzing" of the skin in the treated area. This area should be exposed to the air when possible but protected from the sun, and patients should avoid wearing tight clothes to prevent friction at the treated area. Patients will be shown how to keep the area clean. They should not use any lotion or cream on their skin without the doctor's advice.
Usually, women are told not to have intercourse during radiation therapy. However, most women can have sexual relations within a few weeks after treatment ends. Sometimes, after radiation treatment, the vagina becomes narrower and less flexible, and intercourse may be painful. This may also occur after surgery if a portion of the upper vagina has been removed together with the cervix and uterus. Patients may be taught how to use a dilator as well as a water-based lubricant to help minimise these problems.
Patients who receive external or internal radiation therapy also may have diarrhoea and frequent, uncomfortable urination. The doctor can make suggestions to control these problems.
The side-effects of chemotherapy depend mainly on the drugs and the doses the patient receives. In addition, as with other types of treatment, side-effects vary from person to person. Generally, anticancer drugs affect cells that divide rapidly. These include blood cells that fight infection, help the blood to clot, or carry oxygen to all parts of the body. When blood cells are affected by anticancer drugs, patients are more likely to get infections, may bruise or bleed easily, and may have less energy.
Cells in hair roots and cells that line the digestive tract also divide rapidly. When chemotherapy affects these cells, patients may lose their hair and may have other side-effects, such as poor appetite, nausea, vomiting, or mouth sores. The doctor may be able to give medicine to help with side-effects. Side-effects gradually go away during the recovery periods between treatments or after treatment is over.
Follow-up care
Regular follow-up examinations - including a gynaecological examination, a Pap smear and other laboratory tests - are very important for any woman who has been treated for pre-cancerous lesions or for cancer of the cervix. The doctor will do these tests and examinations at regular intervals for several years to check for any signs that the condition has returned.
Cancer treatment may cause side-effects many years later. For this reason, patients should continue to have regular check-ups and should report any health problems that appear.
Support for cancer patients
Living with a serious disease is not easy. Cancer patients and those who care about them face many problems and challenges. Coping with these problems is often easier when people have helpful information and support services.
Patients with cancer may worry about holding their job, caring for their family, keeping up with daily activities, or starting a new relationship. Worries about tests, treatments, hospital stays, and medical bills are common. Doctors, nurses and other members of the health care team can answer questions about treatment, working or other activities. Also, meeting with a social worker, counsellor or member of the clergy can be helpful to patients who want to talk about their feelings or discuss their concerns. Friends and relatives can be very supportive.
It helps many patients to discuss their concerns with others who have cancer. Cancer patients often get together in support groups, where they can share what they have learnt about coping with cancer and the effects of treatment. It is important to keep in mind, however, that each patient is different. Treatments and ways of dealing with cancer that work for one person may not be right for another - even if they both have the same kind of cancer. It is always a good idea to discuss the advice of friends and family members with the doctor.
The Hospice Society of South Africa and CANSA (Cancer Association of SA) are two of the well-known organisations that work with cancer patients and their families. One of these organisations is usually represented in a town or district. The contact telephone numbers should be in the local telephone directory.
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