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This week we will continue to discuss cervical cancer, as part of cervical cancer awareness month. This week will pay particular attention to the management, essentially answering the question about what happens after getting diagnosis of cervical cancer.
The management of cervical cancer is complicated and often needs a multi-disciplinary team that may include a gynaecologist, pathologist, oncologist, urologist, physicians. The management often depends on the staging of the cancer, which is a way of assessing the extent or severity of the disease.
The staging is done after clinical examination, and special imaging tests are done. The staging system can also be a bit complicated, however in simplified terms we have stage 1 to stage 4. Stage 1 means the cancer is completely confined to the uterus. Stage 2 on the other hand Implies that the cancer is invades the uterus but has not extended onto the lower third of the vagina or to the pelvic wall. Stage 3 and stage 4 signify advanced disease. In stage 3 the cancer would have spreading involving the lower third of the vagina and may involve the pelvic wall and have some lymph nodes. Stage 4 is the most severe form of the disease. In this stage the disease has advanced beyond the pelvis to surrounding structures and distant structures. It is worth noting that this stages have substages which I have omitted in order to keep it simple.
Early stage cervical cancer which is some substages of stage 1 can be managed surgically for most patients. Patients who cannot have surgery for medical reasons can receive radiotherapy.
Women with locally advanced cervical cancer have a higher rate of recurrence and worse survival than those with early-stage disease. Women with locally advanced cervical cancer, should receive primary chemoradiation. Surgery in this case is not usually curative. In addition to this women will get radiation applied directly to the cervix/vagina, this allows for high doses of radiation to be used without damaging supporting structures. Most guidelines do not recommend removal of the uterus after chemotherapy as there is no evidence of benefit.
Other aspects in the management of this condition to be managed include the psycho-social aspect. Dealing with such a dreadful diagnosis can be mentally challenging and often the patient and the family will need counselling and psychological support. Patients coming from poor socioeconomic backgrounds would also need social support as they may be unable to work and have to make multiple visits to the hospital.
Managing this condition is very difficult and can be emotionally taxing for the patient and family members. A specialised multidisciplinary team with other support structures is needed to manage this condition adequately.