Living Through Cure Flashcards
What is the management of cervical cancer?
• Depending on stage, primary treatment of cervical cancer consists of surgery, radiotherapy or a combination of radiotherapy and chemotherapy.
What are the different surgical options offered to women with cervical cancer?
Radical trachelectomy
Laparoscopic hysterectomy and lymphadenectomy.
Pelvic exenteration
What is radical trachelectomy?
o Radical trachelectomy (cervicectomy) is the treatment of choice in women with early-stage cervical cancer wishing to preserve fertility.
Radical trachelectomy can be performed with a vaginal, abdominal or laparoscopic/robotic approach.
What is laparoscopic hysterectomy?
o Laparoscopic hysterectomy and lymphadenectomy are offered to women not wishing to retain their fertility. The presence of positive lymph nodes indicates the need for adjuvant chemoradiotherapy.
o Stages IB and IIA cervical cancer can be cured by radical surgery including pelvic lymphadenectomy or radiotherapy. The two procedures are equally effective but differ in terms of morbidity and type of complications.
o Radical surgery is associated with significant morbidity and complications. Morbidity may be minimised by using minimally invasive (laparoscopic or robotic) routes.
What is radical hysterectomy?
o Radical (Wertheim’s) hysterectomy:
This aims to provide definitive treatment for invasive, infiltrating and early metastatic cancer.
It involves excision of the primary tumour with a 1 cm margin of healthy tissue and en bloc resection of the main pelvic lymph node areas.
It may involve removal of the upper third of the vagina and uterovesical and uterosacral ligaments.
Bladder function returns only slowly and may cause chronic retention.
Occasionally, painful lymphocysts develop requiring drainage.
What is pelvic exenteration?
o Anterior, posterior or total pelvic exenteration:
All involve removal of pelvic adnexae plus removal of the bladder and/or rectosigmoid, with possible creation of one or two stoma.
The patient needs to be relatively fit and able to withstand very destructive surgery.
Which types of radiotherapy are used in the treatment of cervical cancer?
o Generally, a combination of external beam therapy and intracavity brachytherapy is used.
What is brachytherapy?
o A Cochrane review has recommended the use of high-dose-rate intracavity brachytherapy for all clinical stages of cervical cancer.
o Brachytherapy uses a radioactive source inserted via an applicator into the vagina/cervix. Because the radiation has a short range, a higher dose can be delivered to the tumour with less toxicity to surrounding organs.
o Currently women with stage IB2 to III are given non-surgical treatment (chemoradiation).
What are the complications of radiotherapy in cervical cancer treatment?
The most common acute reaction to radiotherapy is a change in bowel frequency, including diarrhoea starting 10-14 days after treatment begins and lasting for 3-4 weeks after it stops.
More acute bowel reaction may require treatment for subacute obstruction.
Most commonly, patients experience dysuria and frequency, which often settle quickly.
Lymphoedema - patients with symptoms suggestive of lymphoedema should be referred to a lymphoedema practitioner and be offered decongestive lymphatic therapy if symptoms are severe or poorly controlled.
Due to area irradiated to high dose, pelvic irradiation is likely to result in infertility due to loss of ovarian function.
It can also cause stenosis and dryness of vagina resulting in problems with sexual function. Patients are advised to use dilators to prevent stenosis and lubricants to deal with dryness.
Which cytotoxic drug is used as chemotherapy for cervical cancer patients?
o Many women with cervical cancer receive chemotherapy, either adjuvant, concurrent with radiation or palliative.
o Cisplatin-based chemotherapy is most commonly given.
What is cisplastin?
o Cisplatin is a platinum agent which acts by causing crosslinking of DNA thereby preventing DNA repair/synthesis.
Side effects of cisplastin?
o Side effects include bone marrow suppression, nephrotoxicity, ototoxicity, neurotoxicity, nausea and vomiting. It does not typically result in hair loss.
o Lithium reduces GFR therefore there is a dose reduction of cisplastin if a patient is taking lithium to reduce the risk of nephrotoxicity.
How is chemotherapy usually dosed?
o Chemotherapy is typically dosed on body surface area.
o Some chemo drugs are excreted entirely via kidneys use AUC dosing which is dependent on GFR.
What are the support available for cancer patients?
- Cancer information centre
- Employment support service
- Health and Wellbeing events- after-effects of cancer care.
- Look good, feel better- advice on skincare, makeup and free beauty products to women undergoing treatment for cancer.
- Maggie’s centre- provides support for people with cancer and their families and friends.
- Spiritual care
- Wig fitting service.
