Treatment of cervical cancer depends on several factors. For instance stage of the cancer, patient's age, the desire to have children, other medical conditions that are being faced and treatment options as desired. Deciding how best treatment can be very confusing. Cervical cancer is usually handled by a team of physicians from various specialties. This team will help choose the best way to continue the treatment, but the final decision remains in your hands.
Type of treatment according to the stage of cancer is divided into two. The first is the treatment of early stage cervical cancer, the surgical removal of part or the whole organ womb, radiotherapy, or a combination of both. And the second is the treatment of end-stage cervical cancer, namely radiotherapy and / or chemotherapy, sometimes surgery is also necessary.
If the diagnosis of cervical cancer has been known since the beginning, the possibility of a full recovery are pretty good. But if the cancer has spread, the chances of a full recovery will be reduced. In the case of cervical cancer can not be cured, it can do palliative care. Treatment of this type serves to slow the spread of cancer, prolong the life of patients and reduce symptoms such as pain and vaginal bleeding.
Appointment Procedure Precancerous Cells
Pap smear results may not indicate the presence of cervical cancer, but it can be seen in case of biological changes that could potentially be cancerous in the future. Here are some treatments available:
- Cone biopsy: the removal of the territories where the abnormal tissue through a surgical procedure.
- Laser therapy: the use of a laser to burn the abnormal cells.
- LLETZ or large loop excision of the transformation zone: abnormal cells cut wear thin wire and electric current.
There are three main types of surgery for cervical cancer.
Radical surgery trachelectomy
This procedure is more suitable for cervical cancer is detected at an early stage and will be offered to women who still want to have children. This operation is aimed at lifting the cervix, surrounding tissue, and the upper part of the vagina, without lifting the uterus.
You are still more likely to have children because the uterus is not removed. Postoperatively, uterus and vagina takes time to recover. It would be advisable to wait six months to a year after surgery before deciding to become pregnant.
Operation which involves removal of the uterus
Hysterectomy is the surgical removal of a woman's uterus. Hysterectomies are performed for a variety of reasons, one of them for early stage cervical cancer surgery. So that cancer does not come back again, radiotherapy may also be necessary.
There are two types of hysterectomy. First, a simple hysterectomy, in which these operations, cervix and uterus will be removed. In some cases, the ovaries and fallopian tubes are also removed. Performed for early stage cervical cancer.
The second radical hysterectomy. Cervical, ovarian, surrounding tissue, lymph nodes, ovaries and fallopian tubes, all of them appointed. This operation tends to be done in the advanced stage cervical cancer and stage two in the early stages.
Side effects or short-term complications of a hysterectomy are:
- Bleeding
- Infection
- Risk of injury to the ureter, bladder and rectum
- Blood clotting
- The inability to hold urine.
- The vagina becomes shorter and drier, sexual intercourse can be painful.
- Digestion in the intestine is blocked due to the buildup of scar. It may take longer to open surgery.
- Swelling of the arms and legs due to fluid buildup or lymphedema.
Pelvic exenteration
Pelvic exenteration is a major surgery that is recommended only if the cervical cancer reappeared after having been treated and had recovered. This operation is done if the cancer returned to the pelvic region, but has not spread to other regions.
After surgery, the vagina can be reconstructed wear skin and tissue taken from other body parts. You can still have sex a few months after the operation.
There are two stages that must be passed pelvic exenteration. The first stage, the cancer will be removed along with the bladder, rectum, vagina, and the lower part of the intestine. Then the second stage, the two opening called a stoma will be made in the abdomen to remove urine and excrement. Dirt dumped inserted into the storage bag, called the colostomy bag.
Treatment of Cervical Cancer with Radiotherapy
For the treatment of early stage cervical cancer, radiotherapy can be done alone or in combination with surgery. As for the late-stage cervical cancer, radiotherapy combined with chemotherapy. This combination aims to control bleeding and pain.
Radiotherapy process usually runs about one to two months. However, radiotherapy is not only destroys cancer cells, sometimes radiotherapy also destroy healthy tissue. The side effects can last for months or even years. In some cases, these side effects can be permanent. However, most side effects will disappear within two months after completing treatment.
But the advantages of radiotherapy is often greater than the risks and side effects. For some people, radiotherapy offers the only hope to destroy the cancer. The side effects of radiotherapy are:
- Pain during urination.
- Bleeding from the vagina and rectum.
- Diarrhea.
- Fatigue.
- Nausea.
- Damage the bladder and bowel so that loss of control in defecating and small.
- Narrow vagina so sex becomes a pain.
- The skin was burning in the pelvic area.
- Infertility.
- Damage the ovaries, resulting in early menopause.
Treating Cervical Cancer with Chemotherapy
To treat cervical cancer, chemotherapy can be combined with radiotherapy. For late-stage cancer. Chemotherapy is done to slow the spread and reduce the symptoms. This treatment is often referred to as palliative chemotherapy.
Chemotherapy taking drugs to destroy cancer cells. In contrast to radiotherapy or surgery that affects a certain part, chemotherapy will affect the entire body. These drugs target the cells that grow and multiply rapidly, particularly cancer cells. But the healthy cells that multiply rapidly may also be affected.
Chemotherapy can use a specific drug to kill cancer cells. One drug is commonly called cisplatin. But a combination of chemotherapy drugs can also be applied. Chemotherapy treatment is given intravenously on an outpatient basis. Patients were allowed to go home after receiving treatment as prescribed.
You have to make frequent blood tests when undergoing chemotherapy. Blood tests aim to check the health of your kidneys because some chemotherapy drugs can damage the kidneys.
This treatment can also be damaging healthy tissue. The most common side effects occur are:
- Experiencing thrush.
- Loss of appetite.
- Get tired.
- Nausea and vomiting.
- Hair loss: hair can grow back within three to six months after chemotherapy is completed. But not all chemotherapy causes hair loss.
- The number of red blood cells is reduced: this can lead to fatigue and shortness of breath. You will be prone to infections due to a lack of white blood cells.
Treatment of cervical cancer during pregnancy depends on the stage of the cancer and also the age of your pregnancy. For example you suffer from early stage cervical cancer and are at the age of nine months of pregnancy. Treatment is delayed until you deliver the baby. Cancer treatment can cause premature birth or even miscarriage.
Continued action Post-Treatment
After the treatment of cervical cancer, it is very important to receive further examination, particularly in the vagina and the cervix is needed if the cancer has not been lifted. This examination aims to find a sign for their risk of cancer could return. A biopsy will be performed again if there is anything suspicious. The reappearance of this cancer usually occurs around one and a half years after completion of treatment.
Continued treatment is done every four months, for the first two years after treatment is completed. Then every six months to once a year for the next three years.
Cause of Cervical Cancer
Cervical cancer begins when healthy cells have a genetic mutation or change in DNA. This genetic mutation and then transform normal cells into abnormal cells. Healthy cells grow and multiply at a certain speed, whereas cancer cells grow and multiply uncontrollably.
The number of abnormal cells that continue to grow to form tumors. Cancer cells that appear later invade surrounding tissue. These cells can break away from the initial site and spread to other body regions, a process known as metastasis.
Due Cervical Cancer HPV, or human papillomavirus
There are several risk factors that cause women to develop cervical cancer. But the study found even 99.7 percent of cervical cancers are caused by HPV. HPV is a group of viruses. There are more than 100 types of HPV.
The HPV virus is generally spread by sexual intercourse where there is direct contact between the genital skin, mucous membranes, or the exchange of bodily fluids and through oral sex. After starting a sexual relationship, it is estimated that 33 percent of women will be infected with HPV. Some types of HPV do not cause obvious symptoms, and the infection can disappear without medical treatment.
But there are other types of HPV can cause warts on the genitals. HPV types cause genital warts did not cause cervical cancer. There are about 15 types of HPV that could potentially lead to cervical cancer. Two of the most common types are HPV 16 and HPV 18. These types cause 70 percent of cervical cancer in women.
High-risk HPV types are considered to contain genetic material that could be moved from the cell the virus into the cells of the cervix. This material will begin to interfere with the performance of the cell, until finally the cervical cells that proliferate without control. It is this process that causes the tumor and then turn into cancer.
There are no known drug that could cure HPV infection. The virus itself can remain in the body with or without treatment. But most HPV infections disappear without special handling within a period of about two years. However, as a precaution measure, every woman is advised to receive the HPV vaccination to prevent transmission of the virus types that cause cancer.
Precancerous status - Cervical Intraepithelial Neoplasia
Cervical cancer takes many years to grow healthy cells into precancerous cells and eventually cancer cells. Abnormal changes in cells before cancer is known as cervical intraepithelial neoplasia (CIN) or precancerous cells. Cell changes due to HPV infections, become cancerous CIN and eventually become very slow. This process can occur over a period of 10-20 years.
CIN is the abnormal cell growth conditions before the cancer. This condition usually does not threaten the health of someone directly, but has the potential to become cancerous. Although the risk of CIN cells turn into cancer is small, your doctor will monitor or handle it as a step to prevent cervical cancer. The purpose is to identify the pap smear this stage that CIN addressed before fully turning cancerous.
The level of abnormal cell changes can be divided according to their severity, namely:
- CIN 1 - This condition occurs when changes in the cells of the cervix is still little or not too significant. Can be handled or monitored regularly because the cells at the stage of CIN 1 can become normal again without any medical treatment.
- CIN 2 - There is a change of more than CIN 2; generally abnormal cells removed by a doctor.
- CIN 3 - At this stage, very abnormal cell changes but not cancerous. CIN 3 cells will be removed by a doctor.
There are several factors that can increase the risk of cervical cancer among others:
- Sexual activity too early: Having sexual intercourse at an early age are at increased risk of HPV infection.
- Flit sexual partners: Having multiple sexual partners increases the risk of HPV infection.
- Smoking: Women who smoke are twice as much. This may be caused by harmful chemicals than tobacco appear on the cervix.
- A weakened immune system: This condition may be due to taking certain drugs such as immunosuppressants. These drugs are used so that the body does not reject the donor organ from another person or suffering from HIV / AIDS.
- Childbearing: The more children born to a woman, the higher the risk. Women who had three children are three times more at risk of developing cervical cancer than women who do not have children at all. It is estimated that hormonal changes during pregnancy make the cervix more vulnerable to HPV.
- Oral contraceptive pill or birth more than five years: Taking the Pill for a long time will increase twice the risk of cervical cancer. Although it is still unclear why.
If cervical cancer is not diagnosed and untreated, slowly going out of cancer cells from the cervix and spread to organs and surrounding tissue. Cancer can spread to the vagina and the muscles that support the pelvic bone. Cancer cells can also spread to the upper body. These conditions will obstruct the flow from the kidney to the bladder or ureter is often referred to as.
Cancer can spread to the bladder, rectum, and eventually to the liver, bones and lungs. These cancer cells can also spread to the lymphatic system. The lymphatic system consists of a series of nodes and channels that spread throughout the body in the same way as the circulatory system.
Lymph node generates a lot of specialized cells needed by the immune system. If you get an infection, the nodes in the neck or under the arms will swell. At some early stage cervical cancer, lymph node close to the cervix contains cancer cells. And in some late-stage cervical cancer, the lymph nodes in the chest and abdomen can also be infected with cancer.
Complications of Cervical Cancer
Complications can arise as a result of treatment or due to cervical cancer staging are already at the final stage.
Cervical Cancer Treatment Side Effects
Cervical cancer risk causing few side effects faced by sufferers.
Experiencing early menopause
Menopause is a condition when the ovaries stop producing the hormones estrogen and progesterone. This condition usually occurs in women around the age of 50 years. Early menopause can occur if the ovaries are removed surgically or because the ovaries damaged by side effects of radiotherapy. Some of the symptoms that can arise due to this condition are:
- Vaginal dryness.
- Menstruation stops or irregular.
- Loss of sexual appetite.
- The sensation of heat and sweating (hot flushes).
- Excessive sweating, even at night.
- Loss of control so as to urinate involuntarily when coughing or sneezing; This condition is known as stress incontinence.
- Thinning of the bones that can lead to osteoporosis or brittle bones.
Narrowing the vagina
Treatment with radiotherapy for cervical cancer often causes narrowing of the vagina. Sexual intercourse can be very painful and difficult. There are two treatment options for this. First, applying cream on vaginal hormones to increase moisture in the vagina and sex becomes easier.
The second is to use vaginal dilators. Vaginal dilator can be made of plastic, rubber, or a smooth glass. Shaped like a tube with size and weight vary. This tool serves to restore the flexibility of the vagina. This tool will make vaginal tissue become elastic and sex will feel more comfortable.
Recommended using vaginal dilators for five to 10 minutes regularly for six months to a year.
Many women feel embarrassed to talk about this tool. But this treatment is well known for narrowing the vaginal problems. Ask your doctor about this tool.
The emergence of lymphoedema or accumulation of body fluids
Lymphoedema is a swelling that generally appear on the hands or feet because the lymphatic system is blocked. The lymphatic system is an important part of the immune system and circulatory system.
The lymphatic system may not function normally if the lymph nodes removed from your pelvis. One function of the lymphatic system is to remove excess fluid from the body tissues. Disturbances in this system can lead to accumulation of fluid in body organs. Hoarding is what causes the swelling.
In patients with cervical cancer, usually occurs in the legs. To reduce swelling, could do the exercises and special massage techniques. Special bandages or dressings can also help.
The emotional impact on sufferers
Emotionally, cervical cancer can be very tiring. Eg the patient feels sad when it is diagnosed and feel happy after the cancer is removed. But the patient back feeling sad in the face of adverse effects of treatment. It could trigger a depression. Signs of depression are feeling sad, hopeless, and did not enjoy the things that are usually preferred.
Ask your doctor about this. There are several antidepressants that can be applied. Cognitive behavioral therapy (CBT), focuses on how thoughts and beliefs can affect how you feel and face the problem. You can find information about cervical cancer support group at the hospital or ask the Indonesian Cancer Foundation.
Impact of Advanced Cervical Cancer Stage
The pain caused by the spread of cancer
Severe pain will appear when the cancer has spread to the nerves, bone, or muscle. But some painkillers can normally be used to control the pain. Drugs used ranging from paracetamol, anti-inflammatory drugs or NSAIDs non-steroidal, to morphine. All depends on the level of perceived pain.
If the pain reliever is not much help, ask a drug that may have a more powerful effect. Radiotherapy is also effective for short-term pain control.
Excessive bleeding
Excessive bleeding can occur if the cancer spreads to the vagina, intestine, or the bladder. Bleeding can occur in the rectum or vagina. Bleeding can also occur during urination. Excessive bleeding can be treated with a combination of drugs to lower blood pressure. These drugs can block the flow of blood.
Minor bleeding can be treated with a drug called tranexamic acid. These drugs make blood clot in order to stop the bleeding. Radiotherapy is also effective in stopping bleeding from cancer.
Blood clots after treatment
Like other cancers, cervical cancer can make the blood more 'sticky' or 'lumpy' and tend to form clumps. Increased risk of blood clots after undergoing chemotherapy and post-operative rest. The emergence of a large tumor can suppress the blood vessels in the pelvis. This is slowing blood flow and ultimately resulting in clots in the legs. Symptoms of blood clots in the legs, among others:
- Pain felt deeply in the area of the foot are related.
- The pain and swelling in one leg, usually in the calf.
- Reddened skin, especially on the back of the leg below the knee.
- At the clumping that occurs, the skin will feel warm.
Kidney failure
Kidney function remove waste material from the body. This waste is excreted through urine passed through tubes called ureters. A simple blood test can be done to monitor the performance of the kidney. This blood test is usually referred to as the level of serum creatinine.
In some cases of advanced cervical cancer, ureter cancer can be pressed. This leads to obstruction of the flow of urine out of the kidneys. Accumulation of urine in the kidneys, better known as hydronephrosis. This condition can cause the kidneys to swell and stretch. Hydronephrosis could severely damage the kidneys so that the loss of functionalities. This condition is known as kidney failure.
Treatment for kidney failure is to remove all the accumulated urine in the kidney. Pipe will be inserted through the skin and into each kidney, known as percutaneous nephrostomy. Another treatment option is to widen the channel ureter. This is done by inserting a small metal pipe or stent into the ureter.
Some of the symptoms of kidney failure can be very diverse, namely:
- Hard to breathe.
- Fatigue.
- Nausea.
- Swelling of the ankles, hands or feet due to fluid retention.
- Blood in the urine.
Vaginal fluid can be smelled strange and unpleasant consequence of advanced-stage cervical cancer. The discharge can occur for several reasons, namely:
- Damage to the tissue cells.
- Damage to the bladder or bowel, causing leakage of the contents of these organs that come out through the vagina.
- Because bacterial infection of the vagina organ.
- Treatment for abnormal vaginal discharge using antibacterial gel containing metronidazole. You can also wear clothes containing carbon (carbon). Carbon is a chemical compound that is highly effective to absorb the bad odor.
Fistula
A fistula is an abnormal channel formation or connection between the two parts of the body. In the case of cervical cancer, fistula can be formed between the bladder and vagina. This could lead to endless discharge from the vagina. Sometimes fistula can occur between the vagina and rectum. Fistula including complications are not common. Only occurred in 2 percent of cases of advanced cervical cancer.
To repair the fistula, usually need surgery. But this is often not possible in women with advanced cervical cancer because their conditions are already very weak. If surgery is not possible, creams and moisturizer can be used to reduce discharge. It also aims to protect the vagina and surrounding tissue to prevent damage and irritation.
Palliative Care
Palliative care can be an alternative if the patient does not want to get cancer treatment. Treatment is aimed at controlling the symptoms of cancer and make you feel more comfortable. Check with your doctor so that you are familiar with
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