Cervical Cancer Treatment in Bangalore

Most cancers of the cervix can be staged accurately by clinical examination and scan (MRI or PET CT). The most commonly followed staging system for these tumors is proposed by FIGO (International Federation of Gynecology and Obstetrics).

Management of cervical cancer depends on the stage of the disease. All modalities (surgery, chemotherapy and radiotherapy) of treatment are used to manage the disease effectively.

This is the pre-cancer stage where the cancer cells are limited to the surface layer of the cervix. Treatment depends on the need to preserve fertility. For those who plan future pregnancy, the options include cryosurgery, laser surgery, loop electrosurgical excision procedure (LEEP/LEETZ), and cold knife conization. Each of these procedures (surgeries) have their advantages and disadvantages that will be discussed by your surgeon. Hysterectomy though not routine for this early stage can be offered in a few select cases. This surgery can be performed laparoscopically with several advantages to the patient.

At this stage the cancer has invaded beyond the surface layer of the cervix into its substance, but has not reached outside the cervix, invading no deeper than 5 mm. This stage is further divided into stage IA1 & IA2. The management between the two groups varies slightly and your surgeon will discuss this with you.

Broadly, for this stage you have 4 options:

• Standard of care is Conisation or Simple hysterectomy along with sentinel lymph node assessment in the pelvis . This surgery can be performed laparoscopically with several advantages to the patient. (laparoscopic radical hysterectomy). 
• If you still want to be able to have children (early disease only, size < 2cm), first the cancer is removed with a Cone biopsy or Trachelectomy(Simple/Radical) , and then you are watched closely to see if the cancer comes back. If the cone biopsy or Trachelectomy doesn’t remove all of the cancer (or if you are done having children), the uterus will be removed.

Lymph node assessment is now done through sentinel node biopsy . This avoids the complications associated with more radical lymph node dissection surgery, while maintaining equal outcomes in terms of cure. All tissue removed at surgery will be examined microscopically. Further treatment is based on the results of the microscopy findings. 

The disease is larger than stage IA, however, has not spread outside the cervix into vagina or pelvis. This stage is further divided into B1 ,B2& B3 based on the size of the disease. Stage IB1 & IB2 includes all cases that are less than 4cm in diameter and larger ones are categorized as stage IB3. 

Stage IB1&IB2: There are 3 options available: 

• The standard treatment is a Radical hysterectomy with assessment of lymph nodes in the pelvis (Hysterectomy type B / type C1 or Wertheim’s Operation). ● The second treatment option is Radiation therapy. 
• Simple hysterectomy with lymph node assessment for specific tumor characteristics. 
• Radical trachelectomy with assessment of pelvic lymph nodes is an option if the patient still wants to be able to have children. 

The disease is larger than stage IA, however, has not spread outside the cervix into vagina or pelvis. This stage is further divided into B1 ,B2& B3 based on the size of the disease. Stage IB1 & IB2 includes all cases that are less than 4cm in diameter and larger ones are categorized as stage IB3. 

Stage IB1&IB2: There are 3 options available: 

• The standard treatment is a Radical hysterectomy with assessment of lymph nodes in the pelvis (Hysterectomy type B / type C1 or Wertheim’s Operation). ● The second treatment option is Radiation therapy. 
• Simple hysterectomy with lymph node assessment for specific tumor characteristics. 
• Radical trachelectomy with assessment of pelvic lymph nodes is an option if the patient still wants to be able to have children. 

There are 2 options available 

The Standard treatment is the combination of Chemotherapy and Radiation therapy. 

• Another choice is radical hysterectomy (Type C1 Radical Hysterectomy or Wertheim’s Operation) with removal of pelvic lymph nodes. If cancer cells are

found in the lymph nodes removed, or in the margins, radiation therapy may be given, possibly with chemotherapy, after surgery. This will lead to utilization of all 3 modality of treatment hence increasing the complication. So surgery is offered in a few highly selected cases. 

It is divided into stage IIA and stage IIB 

Stage IIA: The cancer is extended into the upper 2/3 of vagina.its further divided based on size to IIA1– less than 4 cm and IIA2 more than 4 cm. Treatment for this stage depends on the size of the tumor. 

• If size is more than 4 cm standard treatment is internal (brachytherapy) and external radiation therapy combined with chemotherapy. Some experts recommend removing the uterus after the radiation therapy is done. 
• If the cancer is less than 4 cm, it may be treated with Chemoradiation or a Radical Type C1 hysterectomy and removal of lymph nodes in the pelvis. If the tissue removed at surgery shows cancer cells in the margins or cancer in the lymph nodes, radiation treatments to the pelvis will be given with chemotherapy. 

Stage IIB III and IVA : Combined internal and external radiation therapy along with chemotherapy is the usual treatment. Neoadjuvant Chemotherapy may be used in some cases. 

Immunotherapy- a new development is also increasingly being offered in this stage with good results.

Stage IVB: At this stage, the cancer has spread out of the pelvis to other areas of the body. Stage IVB cervical cancer is not usually considered curable. Treatment options include radiation therapy to relieve the symptoms of cancer that has spread to the areas near the cervix or to distant sites (such as the lungs or bone). Chemotherapy is often recommended. 

If the cancer is stage IB or higher, it is preferable to terminate pregnancy and treat cancer according to stage. The continuation of pregnancy can only be done after discussing the risks involved.