Treatment of Cervical cancer

Read Cervical Cancer First.

Treatment of cervical cancers depends on the staging and the depth of invasion. For example for invasion of less than 3 mm (stage IA-1) treatment includes a hysterectomy or the option of cervical conization in women who wish to preserve fertility. The staging of cervical cancer involves the following:

The International Federation of Obstetrics and Gynecology (FIGO). It permits assessment through biopsy, physical examination, cystoscopy, proctoscopy, excretory urography (intravenous pyelography or IVP), and plain film x-ray of the chest and skeletal system. The American Joint Cancer Committee staging is also involved.

Staging in cervical cancer

AJCC	FIGO	Stages
Tx	–	The primary tumor cannot be assessed
T0	–	There is no evidence of primary tumor
Tis	0	Carcinoma in situ
T1	1	Cervical cancer is confined to uterus only. In stage T1a there is an invasive carcinoma diagnosed only by microscopy. The invasion with a maximum depth of 5.0 mm is measured from the base of the epithelium and a horizontal spread of 7.0 mm
T1a	Ia
T1a1	Ia1	There is a visible lesion confined to the cervix or microscopic lesion greater than 3.mm in invasion and greater than 4mm in horizontal invasion.
T1a2	Ia2	There is invasion > 3.0 mm and ≤5.0 mm with a horizontal spread of ≤7.0 mm
T1b	Ib	There is a visible lesion confined to the cervix or microscopic lesion greater than 3.mm in invasion and greater than 4mm in horizontal invasion.
T2	II	The cancer now invades the uterus and grows beyond it but does not reach the pelvic wall or to the lower 1/3 of vagina In stage T2a IIa the tumor does not invade adjacent uterine tissues and stage T2b the tumor invades the uterine adjacent tissues.
T3	III	The cancer now spreads to the pelvic wall, and/or involves the lower third of the vagina, and/or causes hydronephrosis (fluid accumulation in the kidneys and ureters) or nonfunctioning kidney. In stages T3a the tumor goes to lower third of the vagina but not to the pelvic wall while in stage T3b the tumor extends to pelvic wall and/or causes hydronephrosis or nonfunctioning kidney
T4	IVa	Tumor invades mucosa of the bladder or rectum, and/or extends beyond true pelvis (bullous edema is not sufficient to classify a tumor as T4) M1(IVb) the tumor now spreads to the other organs of the body

Treating cervical cancer

• Treatment involves correcting or removing eh causative factors
• Correcting the anemia due to bleeding by vaginal packing or other means, transfusion or both.
• Hysterectomy; A procedure that involves the removal of the uterus and some surrounding tissues. It is recommended for women who have passed the childbearing stage and in premenopausal women. The types of hysterectomy include:

Simple Hysterectomy (Type I)
Simple hysterectomy or extrafascial involves the removal of the cervix, adjacent tissues, and a small cuff of the upper vagina. It is appropriate treatment for stage Ia1 disease. It has less risk of injury to the bladder and ureters.

Modified Radical Hysterectomy (Type II)
Also called the Wertheim’s hysterectomy it is less extensive than the radical hysterectomy that involves the removal of cervix and proximal 1 to 2 cm of vagina, the surrounding cervical and uterine tissues including ureter being removed up to the point of insertion to bladder. Uterine ligaments are also removed.

Radical Hysterectomy (Type III)
Also cal (Meigs’) hysterectomy includes removal of the uterus, cervix, and surrounding cervical and uterine tissues up to the pelvic sidewalls both sides

The proximal one fourth to one third of the vagina and surrounding tissues are removed as well.
There is an additional pelvic lymph node removal. The complications in this procedure include; blood loss, ureterovaginal fistula (communication between ureter and vagina), vesicovaginal fistula (communication between vagina and urinary bladder), pulmonary embolus and small bowel obstruction.

Extended Radical Hysterectomy (Type IV)
In addition to surgery type III, there is the removal of the periureteral tissue, superior vesicle artery, and up to three fourths of the vagina. This procedure is rarely done.

Partial Exenteration (Type V)
Partial exenteration is rarely performed, because radiation therapy should be used for patients with the extent of disease. This procedure involves the removal of the distal ureters and bladder. It may be appropriate initial surgery for patients with FIGO stage IVa cancer

Vaccines for cervical cancer

• The immunogenicity of the human papilloma virus (HPV) allows for the possibility of developing vaccines to HPV DNA. Approximately 70–80{11ed3bfae961ad25f2ea7f7060cde56b368c2442d2a61f9ccd1cb541548eee94} of all cervical cancer implicates HPV type 16 and 18. The HPV-16 L1 virus-like particle vaccine consists of a highly purified virus-like particle of the L1 capsule of HPV-16. The types available include:
• Well-tolerated monovalent HPV-16 vaccine
• A bivalent vaccine containing HPV-16 and 18 virus-like particles. According to protocol analysis, the vaccine efficacy is about 91.6{11ed3bfae961ad25f2ea7f7060cde56b368c2442d2a61f9ccd1cb541548eee94} against incidence infection and 100{11ed3bfae961ad25f2ea7f7060cde56b368c2442d2a61f9ccd1cb541548eee94} against persistent infection with HPV-16/18.
• Quadrivalent vaccine containing HPV-6, 11, 16 and 18 virus-like particles. This helps to prevent newly acquired, type-specific HPV infections and promote significant resolution of preexisting HPV infections. It is estimated that vaccine efficacy lasts for 10 years or longer. The FDA has approved the quadrivalent HPV in girls and women age 9–26

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