Treatment Of Cervical Cancer

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Treatment of cervical cancer includes surgery, chemotherapy, radiotherapy, or a combination of all three. The method chosen depends upon several factors, namely the stage of cancer, type of cancer, as well as the health condition of the patient. A number of treatments that can be performed on cervical cancer include:

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Surgery

Some surgical methods can handle cervical cancer, especially in the early stages. Among them are:

Surgery laser. Laser surgery aims to destroy cancer cells by firing a laser beam through the vagina.

Treatment of cervical cancer includes surgery, chemotherapy, radiotherapy, or a combination of all three. The method chosen depends upon several factors, namely the stage of cancer, type of cancer, as well as the health condition of the patient. A number of treatments that can be performed on cervical cancer include:

Surgery

Some surgical methods can handle cervical cancer, especially in the early stages. Among them are:

Surgery laser. Laser surgery aims to destroy cancer cells by firing a laser beam through the vagina.

Cryosurgery. Cryosurgery uses liquid nitrogen to freeze and destroy cancer cells.

Conization or cone biopsy. This procedure aims to remove cancerous cells using a scalpel, laser, or a thin wire which is electrified (LEEP). Methods of conization of which is selected depending on the location and type of cancer.

Hysterectomy. A hysterectomy is surgery to remove the uterus (uterus) and the neck of the womb (cervix). Removal of cancer cells can be done through an incision in the abdomen (abdominal hysterectomy), or with laparoscopy (laparoscopic hysterectomy). In addition to the two methods, the cancer can also be removed through the vagina (vaginal hysterectomy).

In cancer that has spread widely, the doctor will also remove the area of the vagina, as well as the ligaments and surrounding tissue. In addition, the ovaries (ovaries), fallopian tubes, and lymph nodes will also be removed. This procedure is called a radical hysterectomy.

Please be aware that the hysterectomy will make the patient is no longer able to have children, and resulting in menopause in women who should not experience it. In addition, a hysterectomy can also cause short-term complications such as infection, bleeding, formation of blood clots, and injury to bladder, ureter (the tube urine from the kidneys to the bladder), or the rectum.

While in rare cases, long-term complications that can occur is lymphedema (swelling in arms and legs due to blockage of the lymph channels) and urinary incontinence (urine out uncontrolled). The possibility of other complications can be either the onset of a blockage in the intestine due to scarring, and pain during sex due to vaginal too short and dry.

Trakelektomi radical. Surgical trakelektomi aimed at lifting the cervix, upper vagina, and lymph nodes in the pelvis area, through laparoscopy. On trakelektomi, the uterus does not come lifted, and connected to the lower part of the vagina. Therefore, the patient is still possible to have children.

Bilateral salpingo oophorectomy. Surgery is used to lift both ovaries and fallopian tubes.

The Pelvic exenteration. Pelvic exenterationadalah major surgery that is only recommended if the cervical cancer recurred after being cured. This operation is done if the cancer returns to the pelvis area, but has not spread to other regions.

There are two stages of a pelvic exenteration should be skipped. In the first stage, the cancer and the vagina will be removed. The bladder and rectum also may have raised. Then in the second stage, 1-2 hole (stoma) will be created in the stomach as a way to excrete urine and feces. Dirt be put in a bag storage called a colostomy bag.

After the surgical procedure is completed, the doctor will use skin and tissue from other parts of the body to make a new vagina.

Radiotherapy

Radiotherapy is a cancer treatment method that uses a beam of high radiation to kill cancer cells. For early cervical cancer, radiotherapy can be run as a single treatment or combined with surgery. While at cervical cancer advanced stage, radiotherapy can be combined with chemotherapy to control pain and bleeding.

Radiotherapy can be given in two ways, namely:

1. Radiotherapy external. External beam radiotherapy or also called external beam radiation therapy (EBRT), is performed using a radiotherapy machine. This machine will be firing waves of energy high into the pelvic area of the patient to destroy the cancer cells. In general, patients undergoing EBRT 5 days a week, for 6-7 weeks. EBRT will be combined with the provision of chemotherapy drugs in low doses, such as cisplatin. However, EBRT can also be given as a single treatment, especially in patients who cannot undergo chemotherapy.

2. Radiotherapy internal. Radiotherapy or internal brachytherapy is performed by inserting the radioactive implant through the vagina, and placed directly on the cancer cells or nearby. Brachytherapy is often combined with EBRT as primary therapy of cervical cancer. Brachytherapy can be given with a low dose for a few days. Can also be given in high doses during the week. In brachytherapy high dose, the radioactive implant will be inserted and allowed to stand for a few minutes, then issued.

In the short term, EBRT can cause side effects such as diarrhea, nausea, vomiting, abdominal cramps, body weakness, skin irritation, bleeding in the vagina or rectum, and urinary incontinence. Other side effects include pain in the vagina (especially during urination), changes in the menstrual cycle, early menopause, cystitis, as well as a lack of blood cells such as white blood cells (leukopenia). While in brachytherapy, short-term side effects that generally appear is irritation of the vagina.

In some cases, the above side effects can be permanent. But, most side effects will disappear within 2 months after completing treatment.

In the long term, EBRT and brachytherapy in cause side effects such as vaginal stenosis (vaginal narrowing or retracts). This condition will cause pain in the vagina during sex. In addition, radiation therapy to the pelvis can weaken the bones. In fact, fractures of the pelvis can occur 2-4 years after undergoing radiotherapy. Other side effects is lymphedema or swelling of the legs due to blockage of the lymph channels.

To prevent side effects such as infertility, the doctor will advise the patient undergoing egg retrieval, so that the patient can undergo ivf at a later date. Meanwhile, to prevent premature menopause, the ovaries can be moved into the pelvic area which is not exposed to radiation. This procedure known as ovarian transposition.

Chemotherapy

Chemotherapy is a method of treatment by giving patients anticancer drugs in the form of oral medication or injectable. This drug can enter the bloodstream and spread throughout the body. Therefore, chemotherapy is very useful in killing cancer cells of various areas of the body.

Generally, chemotherapy is combined with radiotherapy simultaneously to increase the effectiveness of radiotherapy. This method is also called with kemoradiasi. Examples of drugs used in the kemoradiasi is cisplatin (given 4 h before patients undergo radiotherapy) or cisplatin with 5-fluorouracil (administered every 4 weeks for patients undergoing radiotherapy).

Chemotherapy is also used to handle cancer that has spread to other organs and tissues. Some chemotherapy drugs used in these conditions, among others, are carboplatin, cisplatin, gemcitabine, or paclitaxel.

In addition to combined with radiotherapy, chemotherapy can also be given as a single treatment in advanced cervical cancer. The goal is to slow the spread of cancer cells and relieve the symptoms experienced. This method is also called chemotherapy palliative.

Although effective in killing cancer cells, chemotherapy can also damage cells of the body healthy. Therefore, a number of side effects arise due to the use of chemotherapy drugs. Side effects appear depends on the type and dose of drugs used, and duration of treatment undertaken. Side effects most often arise in patients undergoing chemotherapy is hair loss. Nevertheless, not all chemotherapy drugs cause hair loss, for example cisplatin.

Chemotherapy drugs can damage the cells producing blood in bone marrow. This condition will cause the body lacks blood cells, so the patient prone to infection, bruising and bleeding, and shortness of breath.

Some other side effects that can arise due to chemotherapy is:

Diarrhea
Loss of appetite
Nausea vomiting
Thrush
Limp
Please be aware that chemotherapy drugs can damage the kidneys. Therefore, it is important for patients undergoing chemotherapy to perform routine tests of blood, so kidney condition is always observed.

Targeted Therapy

Targeted therapy is the administration of drugs that inhibit the growth of tumors. Types of drugs used in targeted therapy has a different function with chemotherapy drugs. One of a class of drugs, targeted therapy is an inhibitor of angiogenesis (e.g., bevacizumab). These drugs work by inhibiting angiogenesis, i.e. the process in which tumors form new blood vessels, in order to support its development.

Side effects that may appear due to the therapeutic target can be either high blood pressure, weakness, and loss of appetite. In rare cases, more serious side effects include bleeding, formation of blood clots, and the formation of a fistula (an abnormal tract between the vagina and part of the large intestine).

After the cancer is successfully removed, it is very important for the patient to undergo further examination, especially in the vagina and the neck of the uterus (if uterus not removed). The inspection aims to look at the possibility of cancer growing back. If the examination shows suspicious results, your doctor can perform a biopsy.

Patients are advised to undergo a further examination every 3-6 months once, during the first 2 years after treatment is completed. Then followed every 6-12 months for the following 3 years.

For patients who are pregnant, the treatment of cervical cancer depends on stage and age of pregnancy. In patients with cervical cancer stage 1, the doctor could run conization or trakelektomi radical. Whereas in patients with cervical cancer stage 2 to stage 4, it is not permissible to undergo radiotherapy or surgery to the patient giving birth. Instead, your doctor may give you chemotherapy in the second or third trimester of pregnancy.