What is Cervix?
The uterine cervix is the last constricted part of the uterus (the hollow, pear-shaped organ that accommodates the growing fetus) that opens in the vagina. It is about 3 to 4 cm long cylinder-shape organ. It’s main function is secretion of cervical mucosa that makes the uterine environment favorable for sperms to fertilize an ovum.
It is lined with 2 types of epithelial cells: squamous epithelial cells (that cover the surface the interior part of the cervix near to uterus) and glandular epithelial cells (that cover the exterior part of the cervix, near the vagina). The junction of 2 types of cells is known as transformation zone, which is the most common site of cervical cancer.
What are the types of Cervical Cancer?
Squamous cell carcinomas are the most commonly encountered (about 90% of all cases) cervical cancers. Adenocarcinoma is the less common type of cervical cancer. Most cervical cancers develop from precancerous lesions, for example, cervical intraepithelial neoplasia (CIN) or adenocarcinoma in situ. These pre-cancerous changes can develop into invasive cervical cancer by a slow process. However, in some cases, the process can be faster.
What is the Staging of Cervical Cancer?
The staging system for cervical cancer is called as FIGO staging system. It helps in disease prognostication and choosing an appropriate treatment regimen.
FIGO Stage I
Stage Ia1 – Tumor invasion </=3.0 mm in depth and </=7.0 mm in horizontal dimention.
Stage Ia2 – Tumor invasion >3.0 mm but </=5.0 mm in depth and </=7.0 mm horizontally.
Stage Ib1 – Tumor is limited to the cervix and size </=4.0 cm
Stage Ib2 – Tumor is limited to the cervix and size >4.0 cm
FIGO Stage II
Stage IIa1 – Tumor extends beyond the cervix and the uterus but not to the parametria and size is </=4.0 cm.
Stage IIa2 – Tumor extends beyond the cervix and the uterus but not to the parametria and tumor size is >4.0 cm.
Stage IIb – Tumor has spread to the parametria.
FIGO Stage III
Stage IIIa – Tumor has spread to the lower third of vagina.
Stage IIIb – Tumor has spread to the pelvic wall and may block the ureter causing hydronephrosis.
FIGO Stage IV
STAGE IVA – Tumor has invaded beyond the pelvis into the bladder or the rectum.
The figure below shows tumor infiltration posteriorly into rectum.
And here the tumor infiltrates anteriorly into bladder.
STAGE IVB – Tumor has spread to distant body parts such as non-regional nodes, lungs, bones, or liver.
What is the Stagewise Treatment of Cervical Cancer?
Treatment of cervical cancer depends on stage of disease (as discussed above), patient preference (e.g. desire to retain fertility), comorbidities, performance status, along with other factors. But the final treatment decision is taken by the oncologist after clinical evaluation of the patient.
Stage 0 is precancerous lesion that is treated by LEEP, cold knife technique or total hysterectomy (removal of uterus by surgery).
Hysterectomy is the preferred treatment for stage I disease. Although, in some cases of early stage disease and in patients desiring to retain fertility, radical trachelectomy is also an option. In selected patients unfit for surgery, radiation therapy with/without chemotherapy may be given.
Stage II disease is preferably treated with concurrent chemoradiotherapy. Hysterectomy with/without chemoradiotherapy is an option for early stage disease.
Concurrent chemo radiotherapy is considered in most of the cases of stage III disease.
Chemotherapy with/without radiotherapy may be considered depending upon the extent of disease and other factors. Targeted drugs are also available for treatment of stage IV disease.
What are the surgical options available for Cervical Cancer Treatment?
What is Cryosurgery/Laser surgery/Conization
This technique is used for the treatment of certain very early-stage cervical cancers that are limited to superficial cervical layer. Cells in the affected are killed with the help of supercooled metal probe (cryosurgery), focused laser beam (laser surgery), or a cone-shaped tissue is removed with the help of a biopsy device (conization).
In a total hysterectomy procedure, the entire uterus containing the cervix is removed. In a radical hysterectomy, the uterus along with associated tissues like parametria, uterus ligaments, part of the vagina, pelvic lymph nodes, and fallopian tubes and ovaries are removed.
For women who wish to retain fertility, a trachelectomy procedure can be performed, where only the cervix along with the upper part of the vagina is removed keeping the uterus in place. This surgery allows a woman to have a child in future.
Do I need Radiation Therapy for treatment?
Radiation therapy (or radiotherapy) uses high-energy radiation directed to the affected area to kill cancerous cells. It can be employed either by using an external radiation source (external beam radiation therapy) or by directly placing the source of radiation near the cancer tissue (brachytherapy).
It is commonly used as first-line treatment of certain early stage cervical cancers or in conjunction with surgery/chemotherapy for the treatment of locoregionally advanced] cervical cancer. It may sometimes be used for palliation of symptoms such as pain, bleeding, etc.
Is chemotherapy also a part of Cervical Cancer treatment?
Chemotherapy means treatment with anti-cancer drugs that kill or decrease the growth of rapidly growing cancer cells. It is considered to be the mainstay of treatment for advanced stage disease that has spread to distant body parts. In earlier stage disease also, it may also be combined with other treatment options to accelerate the benefit achievement.
What is the role of Targeted therapy?
Targeted drugs work differently than chemotherapy drugs that they target a specific gene or protein characteristic of the cancer cells, for example, bevacizumab targets vascular endothelial growth factor (VEGF) that stimulates the formation of blood vessels in the cancerous tissue.
They are generally used alone or in combination with chemotherapy for the treatment of advanced-stage disease. The side effects associated with targeted therapy vary according to the drug used.
Best Cervical Cancer Specialist in Delhi
Dr Sunny Garg is a renowned Medical Oncologist in New Delhi with an experience of more than 6 years of treating cervical cancer patients. He has practiced in leading cancer hospitals in Delhi, and currently practicing at Manipal Hospital, Dwarka.
He has a vest experience of treating cervical cancer patients in all stages of disease. He is well versed with Targted Therapy and Chemotherapy for Cervical Cancer treatment and also general supportive care for patients. He works in close collaboration with surgical and radiation oncologists, oncopathologists, nuclear medicine, and genetic counselors for comprehensive cancer care for the patients.
Call +91 9686813020 for appointment.