Your Complete Cervical Cancer Care Centre
Cervical cancer is a disease most commonly diagnosed in women between 30-50 years of age. It is a serious diagnosis that requires prompt and urgent attention.
The treatment of cervical cancer is complex and should be managed by a gynae-oncologist who will work closely with a multi-disciplinary team
To help you better understand your treatment, here are a few important points we have put together for you.
Understanding Your Options
The 2 pillars of curative treatment in cervical cancer are surgery and radiotherapy. International guidelines recommend surgery in early stage cancers, and radiation therapy in later stages. In general, surgery is used to treat early cervical cancers from stages 1-2A, while radiation treatment is used for locally advanced cancers i.e. Stages 2B-4A. Sometimes radiotherapy +/- chemotherapy may still have to be added on after surgery in high-risk early-stage cases. Low dose chemotherapy is usually added to radiation in locally advanced cancers to improve the effectiveness of radiotherapy.
Is chemotherapy and surgery an option in locally advanced cervical cancer?
Some surgeons still recommend surgery in locally advanced cervical cancers. They usually offer some chemotherapy pre-operatively to shrink the tumour, followed by surgery after. Such recommendations are based on outdated practices and do not have a sound scientific basis. 2 recent international studies have specifically tested this practice and compared it to the standard of radiotherapy & chemotherapy: -One study showed no difference in outcomes between the 2 groups; however, in the surgery group, more than 1/3 of patients still required radiotherapy and chemotherapy after surgery, exposing them to the side effects of all 3 treatments. -The second study demonstrated a clear difference in the 2 treatment approaches, with patients receiving the standard radiotherapy treatment having better survival rates than those who underwent the experimental surgery treatment - 5-year disease-free survival rates of 77% (radiotherapy) vs 69% (surgery). Based on the above 2 studies, radiotherapy and chemotherapy remains the standard of care in locally advanced cervical cancer as it provides the best outcomes possible in this group of patients. This is also reflected in all major international guidelines on cervical cancer treatment.
2022 NCCN Practice Guidelines for Cervical Cancer
*The National Cancer Comprehensive Network (NCCN) guidelines are written by experts from 30 leading cancer centres in the U.S and are widely regarded as the gold standard for cancer treatment worldwide.
The summary flowchart shown above illustrates the role of each of these treatments according to stage. These guidelines are widely adopted as standard of care worldwide.
Time is of the Essence
In cervical cancer, it is critical to start on the right treatment promptly as these cancers are aggressive and grow very fast. Patients should aim to commence treatment within 1-2 weeks of diagnosis as further delay could compromise outcomes. For example, studies have shown that once radiotherapy is commenced, it should be completed within 7-8 weeks, as prolonging this overall treatment time will result in a 1% decrease in cure rate per additional day of treatment. As such, we strongly recommend that patients diagnosed with cervical cancer should commence their treatment within 1-2 weeks of diagnosis. Once treatment is started, there should also be minimal delays allowed.
Not all Treatments are Equal
Advanced Treatment + Expertise = Best Outcome Even within Singapore, there are a variety of practices adopted by different doctors who treat cervical cancer. This can have a large impact on patient outcomes. For example, advanced radiotherapy techniques (IMRT) have been shown to reduce side effects by 50% compared to conventional methods (CRT). Such techniques must be executed by experts who are well-versed in the technologies to ensure best chances for cure & long-term quality of life.
CT scan images demonstrating the difference between advanced radiotherapy techniques (IMRT, left)2 and conventional methods (CRT, right) – still used in many centres today.
The coloured shades represent the radiotherapy doses delivered in the body to the tumour regions outlined in red and green lines. Using advanced radiotherapy techniques, the doses entering the normal organs such as bladder, small intestines and rectum can be sculpted specifically to avoid them, whereas conventional methods are unable to do so, resulting in the entire squarish area being bathed with radiation dose.
Multi-Disciplinary Care in Cervical Cancer
It is important that cervical cancer is managed by a team of experienced gynaecological cancer specialists. The gynae-oncologist coordinates the entire care of the patient, working closely with his other colleagues to ensure timely and integrated treatment. A compassionate and responsive team of nurses, therapists and clinic staff is also essential to ensure that patients receive close support during this vulnerable period of their lives.
Dr David Tan Boon Harn
SENIOR CLINICAL ONCOLOGIST
MBBS (SIN), FRCR (CLINICAL ONCOLOGY, UK), FAMS (RADIATION ONCOLOGY)
View Dr David's profile here
Deng, X., Han, C., Chen, S., Xie, C., Yi, J., Zhou, Y., Zheng, X., Deng, Z. and Jin, X. (2017), Dosimetric benefits of intensity-modulated radiotherapy and volumetric-modulated arc therapy in the treatment of postoperative cervical cancer patients. J Appl Clin Med Phys, 18: 25-31. https://doi.org/10.1002/acm2.12003