Cervical cancer treatment

Diagnostic steps for the tumour in the cervix

Necessary diagnosis measures for the detection of cervical cancer are:

• Physical examination: the doctor palpates the cervix and the body of the uterus through the vagina for possible changes.
• PAP test: the cell smear examination to detect malignancy or precancerous conditions in the cervix.
• HPV detection: a test to identify the human papillomavirus in the cervix.

In the case of abnormal findings, oncologist uses the following methods:

• Colposcopy - is the magnifying glass examination of the cervix and the vagina.
• Biopsy - is targeted tissue removal from the cervix for microscope examination.
• Conization - is a procedure of cutting out a cone-shaped piece of cervix tissue with an electric loop or a laser beam under anaesthesia.
• Histology - is the histological, microscopic examination of suspicious tissue, which is crucial to secure the diagnosis.

If a cervix carcinoma is ​​found, further examinations must follow. Above all, they should show how far the tumour has already spread, whether lymph nodes are affected and whether metastases have formed in other body parts. These examination methods include:

The ultrasound examination of the abdomen (abdominal sonography) provides an insight into the internal organs such as the liver, kidneys, ureters, spleen and intestines. With this examination, the gynaecologist can determine whether a tumour has already spread to one of these organs (metastasis formation). X-ray of the chest is the method for lung metastases detection in the advanced stages of the disease. Mammography and breast ultrasound rule out concomitant breast cancer.

Computed tomography (CT) is an X-ray procedure for examining the body layer by layer. Unlike the normal x-ray, it shows a cross-section of the abdomen and is particularly suitable for assessing lymph nodes or distant metastases. Magnetic resonance imaging (MRT) also makes it possible to display the body in layers. The procedure works with magnetic fields. It is suitable for showing cervical tumour size and spreading to the surrounding organs. Your gynaecologist will prescribe a PET-CT scan to check for distant metastases in more advanced stages.

The stages of cervical cancer include:

• I: Malignant process affects the only cervix without damaging vessels and surrounding tissues.
• II: Cancer spreads beyond the cervix and uterus but does not affect the pelvic wall and vagina. There are no metastases.
• III: Tumours can infiltrate the lower part of the vagina, pelvic wall, ureters and nearby lymph nodes.
• IV: Cervical cancer with distant metastases.

Complex cervical cancer treatment

The first group of methods used in treating cervical cancer is divided into two main types: surgery and radiation therapy. The oncologists can use radiation therapy at any stage of the disease. However, surgical treatment is carried out in the early stages when minor intervention is required.

The best choice for treating cervical cancer is surgery to remove the tissue and the lymph nodes affected by cancerous cells, thereby curing the disease. In the case of tiny tumours detected early, a conical excision (conization) can be performed. If it is insufficient and the woman still wants to have children, the surgeon performs partial amputation of the cervix (trachelectomy) with permanent cerclage (closing the cervix). After both procedures, pregnancy is still possible.

There is also a minimally invasive surgical technique using the robotic system. For example, robot-assisted DaVinci cervical surgery ensures minimal trauma and reduces bleeding. And that means less pain, shorter recovery time and hospital stay for patients. But unfortunately, the method is rarely used because it is still not widely available in many clinics.

Chemotherapy attempts to kill cancer cells throughout the body using drugs that inhibit cell growth (cytostatics). Chemotherapy alone affects secondary tumours (metastases) and relieves symptoms in advanced stages of the disease (palliative treatment). But also, there are modern, more targeted types of chemotherapy:

• Transarterial chemoembolization (TACE) - is the injection of drugs into the vessel supplying the cancerous cells. The simultaneous blockage of this artery kills metastatic tumours quickly.
• Transarterial chemoperfusion (TACP) - is the introduction of antitumour drugs into the arteries feeding the malignant neoplasm.

Immunotherapy activates a patient's immune system to fight against cancerous cells in the cervix. Target therapy acts more specifically on cancer cells than on normal cells. For example, drugs prevent the formation of new blood vessels (known as angiogenesis), which cervical cancer needs to survive. It reduces the blood supply, and, as a result, the tumour stops growing and spreading.

Conventional radiotherapy uses radiation to destroy the malignant cells in the cervix. Nowadays, oncologists prescribe more targeted radiation - brachytherapy (internal radiotherapy). During the treatment, a radiation source is introduced into the uterine cavity or vagina and left until the desired radiation dose is reached. The irradiation remains locally limited, so that neighbouring organs are protected as much as possible. Another modern radiotherapy technique is proton beams. Protons treat cervical cancer with the help of high-powered energy. This therapy is safer than conventional radiotherapy because it has minimal effect on surrounding tissues. At the same time, the proton particles are much more powerful and precise.

High-intensity focused ultrasound (HIFU) is the method of mechanical destruction of cervical cancer using focused high-intensity ultrasound. It causes the formation of tiny, nanosized gas bubbles that expand rapidly and then flake, leaving a cavity in the malignant tissue, destroying it.

With successful treatment, women can have an everyday life after cervical cancer. The rehabilitation period includes measures to improve the patient's health and return to working capacity. In addition, women must monitor their diet and weight and regularly perform follow-up examinations.