Cervical cancer is diagnosed usually in a gynecologist office and the usual course of events where cervical cancer is diagnosed, it is usually picked up on a screen Pap smear which shows an abnormality which then results in examination by gynecologist called colposcopy wherein an examination in their office is performed where with binocular microscopy, we evaluate the cervix and take directed biopsies of abnormalities that we observe. These biopsies are then looked at by a pathologist under microscope and then render a diagnosis as cervical dysplasia otherwise known as the precancer or precursor lesions of cervical cancer. Sometimes unfortunately is diagnosed as an invasive cervical cancer and when we see that the examination done by the physician is really the first and most important means of dictating how we take care of a patient. Cervical cancer still staged basically by an exam which is observation of the cervix, palpation or a physical exam of the cervix may help that the cancer is just as involve other adjacent structures and then we do use some radiologies such as CT scans, chest x-rays, etc., to help us guide how we take care of the patient and manage such cervical cancer.
Cervical cancer when we catch it in its early stages, stage 1 and sound specific stage 2s, we tend to use surgery for those treatments and that can be anything from a conservative operation meaning where the uterus is left in place such as what is called a conization where we excise the abnormality only on the cervix and leave the remaining cervix and leave the uterus in place. There are other options for that which is called a trachelectomy which is a procedure where the surgeon removes the cervix but leaves the uterus and we use that treatment modality in patients that have invasive cervical cancer that desire a future fertility. Furthermore, as we get into more advanced stages or in patients that fertility is not desired, a hysterectomy is performed and based upon complicated issues with regards to what the stage is and the cell type, sometimes a traditional what we call a simple hysterectomy is performed which is one that a general OB/GYN performs. However as the stage becomes more progressed what is called a radical hysterectomy is required and that is performed by a gynecologic oncologist.
In a radical hysterectomy is removal of the uterus and cervix in some of the adjacent structures called the parametrium. We also remove the lymph nodes at the time of that surgery to help dictate whether what is called adjuvant treatment is required and for some patients, depending upon certain issues on the pathologic specimen, chemotherapy and/or radiation maybe required depending upon certain pathologic events. As the stage gets more advanced such as certain stage 2 cancers even certain stage 1 cancers require radiation meaning that a hysterectomy is not the best first treatment. There are a lot of patients with cervical cancer that we do recommend radiation in lieu of hysterectomy because we know that the radiation is going to work as effective with less complications and the way that radiation is prescribed for patients with cervical cancers, we do use a combination of a very small dose of chemotherapy in conjunction with radiation. The chemotherapy is not a chemotherapy where patients lose their hair, no one will really know you are receiving the chemotherapy because it is such a small dose. That small dose of chemotherapy has actually been shown to help the radiation work better more effectively and cure more patients but the radiation is really the curative treatment for certain types of cervical cancer. That’s administered by a radiation oncologist, who is a doctor that treats cancer with radiation and they work in concert with the GYN oncologist with the chemotherapy. That course of treatment usually take somewhere between seven to eight weeks depending upon certain pathologic and radiologic findings. There is a combination of what is called external beam radiation where a patient lies on a table and the radiation comes just like if you are receiving an x-ray and then there is also a portion of what we call internal or Reiki therapy radiation which is one the radiation oncologist puts the radiation right on the cervix.
Learn more about Dr. McDonald: http://presbyteriangyncancer.org/?id=5013&sid=123