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Early Stage Cervical Cancer
I have been diagnosed with early cervical cancer and want to know about all the treatment options for cure
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.
How do I Decide Between Surgery or Radiotherapy?
The best outcomes in cervical cancer occur when only one type of treatment ie either surgery OR radiotherapy is delivered, so selection of the right modality is crucial.
Surgery in the pelvis has several limitations as cutting beyond certain boundaries can result in damage of these critical structures resulting in permanent symptoms such as lower limb numbness/weakness and urinary or bowel incontinence. In addition, if surgery is attempted in advanced or bulky cancers which have spread beyond those boundaries, there is a high chance that tumour cells will be left behind, resulting in worst outcomes.
Therefore, surgery is appropriate for early stage cervical cancer only in small tumours that are far from the adjacent normal structures. If attempted in bulky tumours (even if they are early stage), there is a high risk of leaving disease behind, and the patient will not only have worst cure rates, but also require further chemotherapy and radiotherapy after surgery.
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.
Advanced Treatment + Expertise
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 like Intensity-modulated radiation therapy (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.
ADVANCED RADIOTHERAPY TECHNIQUE
CONVENTIONAL METHOD
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.