SCCs make up 90% of all cervical cancers while Adenocarcinoma comprises the remaining 10%. Studies have shown that SCCs respond better to radiotherapy than adenocarcinomas, and also have better outcomes. Therefore, a lot of research has gone into whether patients with adenocarcinoma of the cervix should undergo more extensive treatment ie more chemotherapy/immunotherapy, or whether they should undergo surgery instead. However, these studies have so far NOT shown any benefit with these alternative strategies, and in some cases, have in fact shown worst outcomes. Therefore, at this moment, international guidelines continue to recommend that both SCC and Adenocarcinoma of the Cervix are treated in the same way.

All cancer treatments including surgery, radiotherapy and chemotherapy can remove tumours, except through different mechanisms. While surgery physically takes the tumour out of the body, radiotherapy destroys tumour cells where they are by specifically targeting the DNA of those cells and causing them to die off. The body then clears away the dead cells on its own, resulting in the same outcome as surgery.

The pelvis is a narrow space with numerous critical organs, nerves and muscles within it. 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. These above reasons are why surgery is only recommended for early-stage cervical cancer.

Radiotherapy on the other hand, does not have the same limitations as surgery, and can be directed safely at tumours that have spread beyond surgical boundaries. Nerves and muscles are very resistant to radiotherapy and will not be damaged even if radiation dose is directed at those areas. Thus, radiotherapy is most effective in locally advanced disease, where it can comprehensively cover all extent of disease while preventing damage to the critical structures. The use of advanced radiotherapy techniques further facilitates this process, allowing the radiation oncologist to sculpt the doses accurately, thus maximally avoiding the critical organs.

Brachytherapy refers to internal radiotherapy where applicators are inserted into the body and next to the tumour to deliver radiation directly to the target. It is usually performed in tumour sites which are assessable from the outside of the body i.e., cervix, prostate, breast. Brachytherapy is an essential component in the radiotherapy treatment of cervical cancer as it allows a high dose boost to the tumour. Without brachytherapy, it will be almost impossible to deliver the total doses necessary to effect a cure. Brachytherapy is a procedure that only certain specially trained radiation oncologists can perform. Skill and technique are required to ensure accurate placement of applicators and ensuring the right amount of dose is delivered safely to the tumour. Click here to find out more about the brachytherapy procedure.