Cancer is sometimes difficult to detect until it is relatively advanced, and already causing symptoms. Unfortunately in some cases, even when symptoms are present, they may not be reported by the patient or diagnosed as cancer by a health care professional for various reasons. Perhaps the symptoms are not considered to be caused by a serious disease such as cancer and therefore ignored by the patient, or not diagnosed as cancer by the health care professional.Another reason for not reporting symptoms could be an underlying fear on the patient’s side of discovering that the symptoms are indeed related to a serious illness.
Financial restrictions could also prevent or delay patients going to see an appropriate health care professional. In South Africa, thousands of people die each year from cancers that could have been effectively treated, had they been detected at an earlier stage. Among them are thousands of women suffering from the five main gynaecological cancers, ie cervical, uterine, ovarian, vaginal and vulval.
Second to breast cancer, cervical cancer is the second most common cancer among South African women, with around one in 42 women likely to develop it in their lifetimes. National Cancer Registry figures show that in 2009 alone, 5,270 women were diagnosed with cervical cancer: the vast majority of them being black women.
The same year, 1,073 women were diagnosed with cancer of the uterus, 425 with ovarian cancer, 153 with cancer of the vagina and 212 with cancer of the vulva.
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While it is impossible to prevent all forms of cancer, there are measures that can reduce a woman’s risk of developing these common gynaecological cancers. HIV and HPV infection are known to increase the risk of developing cervical cancer, for example, so reducing the risk of HIV and HPV infection can reduce the risk of developing cervical cancer.
The aim of HPV vaccination programs is to prevent young women becoming infected with HPV in the future. Earlier detection of cervical cancer is also important for effective treatment, so it is important that all women undergo regular PAP smears, as well as consulting a specialist about any unusual gynaecological symptoms.Knowledge and treatment of cancer is continually evolving and today’s surgical and radiotherapy techniques as well as medicines allow for a more targeted and personalised treatment approach.
Read: HPV test beats pap smear
Cancerous cells can be more effectively treated whilst the damage to surrounding healthy tissue is limited. One of these targeted treatment options is brachytherapy, a minimally invasive radiotherapy treatment. During brachytherapy radioactive sources are placed within or directly next to the tumour.
This means that a highly targeted and conformal dose of radiation can be delivered, allowing a high effective dose to be delivered to the cancerous cells, whilst the healthy tissue is spared. As a result the cancer is effectively treated and the side effects caused by irradiation of healthy tissue are reduced with brachytherapy.
Whilst brachytherapy dates back to the origins of radiation therapy, brachytherapy treatment has evolved tremendously in recent decades and has been accepted as an important treatment option with strong supporting data for many cancers.
In prostate cancer for example brachytherapy use is widespread and in locally advanced cervical cancer the survival benefit demonstrated by brachytherapy means that it is standard of care in these patients. Recent advances in brachytherapy have mainly been driven by advancements in imaging such as CT, MR and ultrasound allowing more accurate applicator and radioactive source placement and therefore optimal treatment of the cancer whilst sparing healthy tissue.
Read: New HPV vaccine stops vulvar cancer
Brachytherapy treatment for cervical cancer may involve a stay in hospital during which the applicator is inserted inside the body, and a small radioactive source is automatically and frequently sent to specific positions in the applicator to deliver the required radiation dose over a few days.
A more commonly used technique is an outpatient treatment where each treatment session lasts a few hours and consists of applicator insertion and delivery of a specified radiation dose. The applicator is then removed and the patient can go home. These outpatient sessions are repeated up to 5 times over 2 weeks until the required total radiation dose has been delivered.
In locally advanced cervical cancer brachytherapy treatment is standard of care and is given at the end of a course of external beam radiation treatment often in combination with chemotherapy. Guidelines recommend this chemoradiation treatment for locally advanced cervical cancer, because it is associated with better survival outcomes than surgery.
1-7Brachytherapy plays a key role in this treatment, because it allows a very effective high “boost” dose of radiation to be delivered to the cancer cells without causing excess radiation damage to surrounding healthy tissue such as bladder and bowel.
This very high boost dose and healthy tissue sparing cannot be achieved with external beam radiation. It has been shown in studies that patients survive longer when brachytherapy is used and bladder and bowel side effects are reduced, thus improving quality of life for the patient.8,9
Risk factors for cervical cancer
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SAMJ: Vol 103, No 5 (2013) >Richter Paradigm shift needed for cervical cancer: HPV infection is the real epidemic
CANSA: Researched and Authored by Prof Michael C Herbst [D Littet Phil (Health Studies); D N Ed; M Art et Scien; B A Cur; Dip Occupational Health] Approved for Distribution by Ms Elize Joubert, Acting CEO May 2015
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2. Viswanathan A et al. Brachytehrapy 2012;11:47-52.
3. Viswanathan A et al. Brachytherapy 2012;11:33-46.
4. NCCN guidelines http://www.trikobe.org/nccn/guideline/gynecological/english/cervical.pdf accessed August 2013.
5.http://screening.iarc.fr/doc/FIGO-Global-Guidance-for-Cervical-Cancer-Prevention-and-Control_1.pdf. Accessed August 2013.
6. ESMO guidelines Haie-Meder C et al. Annals of Oncol 2010;21:V37-40.
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