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treatment options for cervical cancer treatment options for cervical cancer

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Unread 01-26-2003, 12:41 PM
treatment options for cervical cancer

Here's a summary of the article by Montz, del Carmne, and Bristow (all MDs) in the January/February 2003 issue of Coping ( Karenann) It just seemed to be too valuable a resource to not put on the forum somehow and it's not the kind of thing we can go out and get very readily. So, I hope the following information helps.

For all Cervical Cancers, there are three parts of the treatment decision: stage of the disease, the desire to keep fertility, and general medical condition. With almost all cervical cancers, the ovaries do not have to be removed.

Stage I Cervical Cancer

Stage IA
Can be treated as well with a cone biopsy as with a simple hysterectomy. The cone biopsy may lower the ability to get pregnant but at least keeps that as an option.

Stage IA2
Preferred treatment is a modified radical hysterectomy (some of the ligaments that support the uterus as well as some vaginal tissue is taken out as well as the cervix and uterus) and a bilateral pelvic lymph node resection (basically testing to see if it's spread).

Stage 1B1
Two approaches are considered standard: radical hysterectomy (1) with pelvic lymphadenectomy (cut out) or (2) with primary pelvic radiation. If the woman is younger, they prefer number 1 because the radiation will likely kill off the ovaries too. These authors think that option 1 is better for older women too. It's safer with fewer long-term problems. If women feel they must maintain the ability to have children, radical trachelectomy is still an option at this stage (the cervix is cut out but the main part of the uterus is reattached to the vagina with a suture acting like the cervix to hold the baby in if pregnant). However, tracelectomy will mean it's very hard to get pregnant and not lose the baby and it hasn't been compared to a radical hysterectomy for long-term survivability.

Stage 1B2
Whether or not radiation is needed for this stage is controversial. Some think it has to be proven that the cancer has spread away from the cervix. Radical pelvic surgery and a therapeutic radation carries a risk of having long-term even life-threatening problems, so that's why some doctors prefer to avoid the radiation if possible.

Stage II Cancer

Stage IIA
The cancer has spread to the upper vagina. The usual plan is the same as for stage IB.

Larger stage IIA and stages IIB through IVA
since the 1960s the standard treatment for cancer that's moved away from the cervix is external (teletherapy) radiation and local (brachytherapy) radation. In the 1990s, they've now added chemosensitization--adding chemicals to help the radiation get the right cells. The most studied one is cisplatin.

Distally Metastatic Disease
Stage IVB--therapy is usually external radiation with chemosensitization.

Persistent or Recurrent Cervical Cancer
Basically, whatever wasn't done the first time is tried the second time. So if radiation was done without surgery, now it's surgery too. If it was trachelectomy now it's hysterectomy.

These guys seem to be saying that a radical hysterectomy can have as high as a 50% chance of a fistula occurring (urinary leak from the ureter/bladder to the vagina). I hadn't read that before.

They conclude with the call for more research and a comment about the great success of early testing--and I just want to add my personal thanks to the memory of Dr. George Nicolas Papanicolaou, who invented the Pap test and has saved so very many lives.

There's also a really good though somewhat technical webpage about cervical cancer that I thought I'd stick in here because it expands on this article so well:
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Unread 01-26-2003, 03:25 PM
treatment options for cervical cancer

This is great.........thank you, Trish!
Unread 01-27-2003, 03:19 PM
treatment options for cervical cancer

I would like to add that with adenocarcinoma, although it can be treated with a cone in stage 1A--there are more risks. Because it is higher up in the cervix there is a higher perecentage of a false positive with clear margins.

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