There are several treatments for patients suffering from cervical cancer: surgery, radiation therapy and chemotherapy may be used individually or together. The stage of disease is the main factor that influences the choice of treatment. Some treatments are considered standard, while others are subject to research. The latter represent treatment options being evaluated in order to obtain useful information for improving the performance of current treatments.
Humanitas Cancer Center provides patients with a multidisciplinary therapy that is tailored to the clinical and biological characteristics of the tumor.
Surgery
Surgery involves the removal of the tumor tissue by means of surgical intervention, through one of the following techniques:
- Conization (fig.1): it is a procedure that involves the removal of a portion of the cervix creating a cone shape and it can be used simultaneously for diagnostic (such as enlarged biopsy) and therapeutic purposes. In situ cancer and smaller tumors (stage |) can be completely removed and thus cured.
- Radical hysterectomy (Fig.2-3): this procedure involves the removal of the uterus (body and neck) together with the surrounding connective tissues (parameters) to the collar and upper vagina. The radical hysterectomy is often accompanied by pelvic lymphadenectomy, a procedure that involves the removal of fat tissue surrounding the blood vessels of the pelvis, which contains the lymph nodes. Relative to the risk factors and the woman's age, it may be recommended to also remove the annexes (tubes and ovaries) during the radical hysterectomy. Traditionally, this surgery is performed through an abdominal incision (laparotomy), but today experienced surgeons can perform radical hysterectomy with a laparoscopic approach.
Radiotherapy
Radiation therapy is a therapeutic modality that involves the use of ionizing radiation, targeted directly at the level of the neoplastic tissue, in order to kill cancer cells. For cancers of the uterine cervix, this treatment can also be used in combination with chemotherapy. In this case, chemotherapy is used to make the cancer cells more sensitive to the effect of the radiation therapy.
There are two main types of radiotherapy: external radiotherapy, in which the radiation comes from a source (specific therapeutic apparatus called linear accelerators) placed outside of the patient; and inner radiotherapy or brachytherapy, where the radiation source is placed directly in contact with the disease by means of a probe. During radiation treatment, the patient follows a program of visits with the radiation oncologist for clinical assessment of on-going treatment.
Chemotherapy
Choice of treatment
Several drugs have been active in the treatment of cervical cancer. The specialists of Humanitas Cancer Center evaluate, taking in consideration the details related to the patient and stage of the disease, the need to administer a single agent (i.e., a single drug) or polychemotherapy (i.e., the association of multiple drugs). In some cases it is appropriate to administer a single agent (ie, a single drug), and in other cases polychemotherapy (ie, the association of multiple drugs) may be more suitable.
Chemotherapy may be used:
- Before surgery to reduce the size of the tumor (neoadjuvant)
- In combination with radiotherapy as exclusive treatment and after surgery (adjuvant)
- In advanced stages of the disease to reduce symptoms and improve quality of life.
The medical team
Humanitas Cancer Center involves several specialists at the department of cervical cancer, including a surgical oncologic gynaecologist, a medical oncologist, a radiation oncologist, a pathologist, and a radiologist. Through a multidisciplinary consultation (MDM, Multidisciplinary Meeting) the characteristics of each patient are discussed in order to customize treatment as much as possible for every woman, as "a skilled tailor who sews a dress made to measure".
