CERVICAL CANCER

CERVICAL CANCER
The cervix is the muscular lower portion of the uterus that holds in pregnancies and dilates during labor. Cervical cancer occurs in several forms. The most common is squamous cell carcinoma, which accounts for 85 to 90 percent of cervical cancers. Other forms include adenocarcinomas and combination cancers such as adenosquamous carcinoma. Some strains of the human papillomavirus (HPV), a virus transmitted during sex, play a role in causing most cases of cervical cancer.

Dharamshila Hospital And Research Centre is one of the top cancer hospitals of India for advanced cancer treatment. Dharamshila Hospital offers comprehensive care for patients with Cervical Cancer, including advanced diagnosis and best treatment options. The Department has been regularly carrying out radical surgeries for all gynecological cancers and achieving good results. Such radical surgeries, require additional training and experience compared to general gynecology. In addition, management of cancer today follows a multimodal approach, and integration of surgery with non-surgical treatments such as, chemotherapy and radiation therapy is essential to improve outcome. Gynecological oncologists are best suited for this as they are focusing only on gynecological cancers.

DIAGNOSTIC AND STAGING WORK UP
The role of the Pap smear is to screen for cervical cancers and cervical pre-cancers. In its early stages, cervical cancer usually has no symptoms.

To diagnose cervical cancer, Gyneconcologist first performs the following procedures:

Pap smear. In this test, Gyneconcologist collects cells from the cervix during a vaginal exam to look for abnormal, or precancerous, changes in the lining of the cervix
Colposcopy. If the Pap smear results are abnormal, Gyneconcologist may check the cervix using a magnifying lens (colposcopy) and collects and examines cells (biopsy) to determine whether cancer is present.

If the exams reveal precancerous changes in cells, such as CIN (Cervical Intraepithelial Neoplasia) or carcinoma in situ, Gyneconcologist may remove tissue with LEEP / Laser Excision or destroy with electric / cryo cauterization or laser vaporization. If the exams show invasive cancer, Gyneconcologist will order more tests to determine the extent of the cancer. These tests might include:

Physical exam. This exam involves per vaginum bimanual and per rectal examination.
Cystoscopy. Gyneconcologist examines the bladder using a lighted scope.
Rectosigmoidoscopy. Gyneconcologist visually inspects the rectum to determine if cancer is present.
Positron emission tomography (PET) scan. This scan can detect the spread of cancer beyond the cervix or to nearby lymph nodes.
Computed tomography (CT) scan. A CT scan can show the extent of spread of cancer especially in lymph nodes.
Intravenous Pyelogram. Gyneconcologist injects a special dye into the vein and takes an X-ray of the urinary system.
A chest X-ray - As part of metastatic work up and several physical check up.
Blood tests. Based on the doctor's evaluation, the cancer will be classified into one of more than 10 substages. Staging helps Gyneconcologist determine what treatments may be more effective. In general, stages for cervical cancer include:
Stage 0 or carcinoma in situ. Stage 0 cancer is preinvasive cancer, and abnormal cells appear only in the first layer of cells that line the cervix.
Stage I. Stage I cancer is confined to the cervix. Gyneconcologist may further classify it as Stages IA1, IA2, IB1 or IB2 depending on the size of the tumor and how deeply the cancer has invaded.
Stage II. Stage II cancer has spread beyond the uterus, but not to the pelvic sidewall or the upper third of the vagina. Gyneconcologistmay classify it as Stage IIA or IIB.
Stage III. In Stage III, the cancer extends to the pelvic wall or the lower third of the vagina or causes expansion of the ureters, resulting in kidney problems. Gyneconcologistmay classify it as Stage IIIA or IIIB based on whether cancer cells have extended to the sidewall of the pelvis.
Stage IV. In Stage IV, the cancer has invaded the bladder or rectum and may extend beyond the pelvis. Gyneconcologistmay identify it as Stage IVA or IVB.

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TREATMENT OPTIONS
Tumour Board Evaluation
Each and every Cervical cancer patient is evaluated by a special team of Gyneconcologist, surgical oncologists, medical oncologists, Radiation Oncologists, Onco-pathologists and Imaging Specialists. Depending on the age, general condition, type of pathology and stage of the disease, a custom made treatment plan is charted out for each and every patient as per International Treatment Guidelines.

gynecologic oncologists, medical oncologists and radiation oncologists work together at DHRC to tailor treatment to the needs. For most Stage I and II cancers of the cervix, you'll have a choice of surgery or combined chemotherapy and radiation therapy. If the cancer is more advanced, Gyneconcologist may recommend a combination of treatments that could include surgery, chemotherapy and radiation therapy.
Types of surgery
Gyneconcologists at DHRC perform many procedures based on the stage of disease and the needs of the patient. Gyneconcologist may recommend:

Cervical cone biopsy (conization). Using a scalpel, Gyneconcologist removes a cone-shaped piece of cervical tissue where the abnormality is found.
Laser surgery. A narrow beam of intense light is used to kill abnormal cells. Surgeons usually perform this surgery to remove precancerous cells.
Loop electrosurgical excision procedure (LEEP). In this procedure, Gyneconcologist uses a wire loop to pass electrical current, which cuts diseased tissue from the cervix.
Cryosurgery. Gyneconcologist kills cancerous and precancerous cells by freezing them.
Simple hysterectomy. In this procedure, Gyneconcologist removes the cervix and uterus.
Radical hysterectomy. In this procedure, the surgeon removes the cervix, uterus and surrounding tissue.
Lymphadenectomy. In a lymphadenectomy, Gyneconcologist removes the lymph nodes that drain the cervix.
Exenteration. Gyneconcologist may recommend exenteration if you have an advanced cancer that has spread to organs next to the cervix but not to distant parts of the body, or when following previous treatment. This surgery involves removal of the uterus, cervix, lymph nodes and possibly the bladder, vagina, rectum and part of the colon.
Reconstructive surgery. Often used to treat advanced cases of cervical cancer, reconstruction may be necessary for the vagina, bladder, pelvic floor and parts of the pelvis.

Radiation therapy
Radiation therapy is often the most effective treatment for cervical cancer at any stage of development. At DHRC, state-of-the-art radiation therapy includes:

Intensity-modulated radiation therapy (IMRT). This form of external radiation minimizes the high-dose radiation applied to healthy tissue around the tumor. Doctors also aim external beam radiation at lymph node tissue in the pelvis that the cancer has invaded.
Brachytherapy. Brachytherapy is internal radiation directed into the vagina and uterus. You can receive brachytherapy in the outpatient setting.

Chemotherapy
Chemotherapy uses anti-cancer drugs given intravenously or by mouth to destroy cancerous cells. Doctors prescribe higher doses of chemotherapy when the cancer has spread beyond the tumor or if the cancer returns after initial treatment. Studies show that low-dose chemotherapy, when combined with radiation therapy, improves survival rates in women who have advanced cervical cancer.
Reconstructive surgery
At DHRC, Gyneconcologist and a plastic surgeon work together to restore as much anatomy and function as possible through reconstructive surgery. This teamwork is especially important in radical cancer surgery that includes surgical reconstruction as part of the treatment plan. Reconstructive surgical procedures include:

Rebuilding the vagina. Surgeons may rebuild the vagina after radical cancer treatment.
Skin grafts. The doctor may recommend skin grafts to cover large treated areas after radiation therapy or radical surgery for recurrent cancer in the vulva or groin.
Rebuilding vital organs. Gyneconcologist may rebuild vital organs (such as a urinary bladder, vagina or pelvic floor) that were removed to treat advanced cancer or were damaged during radiation therapy. In the case of bladder reconstruction, for example, Gyneconcologist may be able to create a pouch that holds the urine internally, eliminating the need for an external collection bag.
Pelvic floor reconstruction. Reconstruction of the pelvic floor can correct pelvic prolapse and urinary or rectal incontinence.

Oncologists will discuss the concerns and expectations as well as possible approaches to treatment and reconstruction and work with you to determine the most appropriate treatment. Reconstructive surgery techniques can produce cosmetically pleasing and functional results that improve the quality of life.
Prevention
Two new vaccines are available in the United States that offer protection from the most dangerous types of human papillomavirus (HPV), the virus that causes most cervical cancers. Although the vaccines could prevent up to 70 percent of cervical cancer cases, they can't prevent infection from every virus that causes cervical cancer. Routine Pap tests to screen for cervical cancer remain important