Says, Dr. Tanvi Tuteja , DNB – Obstetrics and Gynecology , Diploma in Obstetrics & Gynaecology, Gynaecologist , Infertility Specialist , K J Somaiya Hospital Super Specialty
In India, 122,844 women are diagnosed with cervical cancer and 67,477 die from the disease (acc to ICO Information Centre on HPV and cancer). How do you see the situation? You treat cancer cervix, uterus& ovary at all stages. Is there any chance of curing patients in the fourth stage of the disease?
Yes definitely; we do treat cervical, uterus and fallopian tube cancer. Stage four cancers is when cancer has spread beyond the primary organ to the pelvis (localised spread) or distant organs (metastasis). The Treatment alternative of stage IV cancer is relieving the symptoms, chemotherapy and radiotherapy with a five-year survival of approximately 60 % and a recurrence rate of 20-40%. Cancers with a distant spread have been considered incurable and rarely survive more than a year or two.
You are in charge of the treatment of cervical cancer diagnosed in young women. What is the level of morbidity in the world?
Cervical cancer is most common women related cancer followed by breast cancer. It is second common cancer among women is the primary cause of cancer-related deaths in developing countries. Early detection through regular screening has aided to significantly control the prevalence of disease; thereby lowering its incidence mostly affects middle-aged women, especially lower socio-economic class, who fail to continue regular check-ups.
Is there any difference in the treatment of women under 40 and that of the oldergenerations?
Yes, there is a difference between young patient is concerned about fertility preservation and sexual function.
Treatment depends on the type of cancer and its stage. Treatment includes surgery, chemotherapy and or radiotherapy depending upon the stage. Surgery involves removing of the uterus (hysterectomy) along with the removal of tubes and ovary. Radical trachelectomy is to remove the cervix leaving uterus intact with pelvic lymph node dissection for young patients who need to preserve fertility. It has gained acceptance as an alternative to hysterectomy for some patients.
If extensive surgical procedures have affected sexual function, other surgical procedures can be used to make an artificial vagina.
What kind of therapy do you administer during pregnancy?
Of all women with cervical cancer, 1-3% are pregnant or in postpartum at the time of diagnosis cancer. During pregnancy, treatment depends on the type of cancer, the spread of cancer, weeks of pregnancy and patient’s wishes. The Early stage of cancer is left alone till pregnancy is completed. Delivery is done by caesarean and depending on stage uterus removed with radiotherapy and chemotherapy. During pregnancy is experimental as there are few cases for large trials. If you have invasive cancer less than three months, pregnancy termination recommended avoiding delay in treatment. For small tumours cone biopsy or trachelectomy possible. For large chemotherapy treatment to shrink or control cancer till the baby is born.
In your opinion, which of the preoperative treatment of cervical cancer showed the best results?
Preoperative exterior beam radiotherapy plus reduced dose brachytherapy, causes a pelvic pathological response with improved outcome.
What is the most accurate diagnostic protocol for the early detection of cervical cancer?
American Cancer Society recommends the following guidelines. All women should begin cervical cancer testing (screening) at age 21. Women age 21 to 29, should have a Pap test every three years. HPV testing should not be used for screening in this age group. Beginning at age 30, preferred way to screen is with Pap test along with HPV test every five years and continue until age 65. Another option Age 30-65 is pap every three years. Women over 65 with regular screening in previous ten years should stop testing unless found to have a precancerous lesion in last 20 years. Women who have had a hysterectomy (removal of the uterus) should stop screening unless hysterectomy was done for a pre-cancerous lesion of the cervix. Women of any age should not be screened every year by any method, unless abnormal screening results noted. Women who have been vaccinated for HPV follow same guidelines.
How can women prevent the development of cervical cancer?
Avoiding risk factors and increasing protective factors help prevent cancer
Avoid: multiple child births, long-term use of birth control pills, smoking, immunocompromised diseases (HIV, Diabetes), Multiple sexual partners, early age of sexual intercourse ( these increase chances of human papillomavirus ) Protective factors include avoid sexual activity, HPV vaccination, barrier protection.
You are managing various clinical studies. Do you expect a revolution in the treatment of cervical cancer?
The first revolution is chemotherapy and its advancing mechanism of action. The second revolution is targeted therapy where cancer-related genes and their ensuring patients can be targeted either with a drug which hopes to restore normal cell behaviour or an antibody against the cancer cells other targeted therapies affect the blood vessels that supply nutrients to the tumour. The third revolution is immunotherapy where immune system boosted to fight cancer.
What has changed in the mechanism of action of drugs?
Various pathways of action of medicines used to treat cervical cancer have changed making them highly reactive and drug binds to DNA causing its damage beyond repair and cervical cells undergo apoptosis and die.
Are there instances when women with cervical cancer cannot be helped?
Stage IV cervical cancer with distant metastasis especially in patients of older age, immunocompromised is very difficult to treat.
How do you achieve victory?
Cervical cancer is second most common women related cancer and fourth most common cause of death in women. While the routine Pap test has reduced cervical cancer deaths in developed countries, the disease remains a major cause of death for women in developing countries. A safe effective, easy screening method like Pap smear is very useful in screening, and early diagnosis of cervical cancer and would prevent the psychological, physical and financial burden affecting women and her family in cases of progressed disease.