Cervical Cancer On The Rise: Late-stage Treatment Options

Cancer of the cervix, also referred to as cervical cancer, is one of the most widespread types of gynaecological cancers affecting women. In India, every year, around 1,24,000 women are diagnosed with cervical cancer, and around 77,000 succumb to the disease.

Cervical cancer occurs when the normal cells in the cervix turn abnormal and start growing uncontrollably. The prognosis of cervical cancer is influenced by two crucial factors: the timing of its detection and the extent of its spread. Cervical cancer is highly treatable when detected at an early stage, especially during the precancerous stage.

Late-stage cervical cancer or 4th stage cervical cancer is when the cancer is in the advanced stages and has metastasised or spread to other organs in the body. Late-stage cervical cancer is associated with lower survival rates in women and is one of the primary causes of cancer-related deaths in women.

Factors Contributing to Late-Stage Cervical Cancer Diagnosis

A late-stage cervical cancer diagnosis can be attributed to multiple factors, including:

• Lack of awareness
• High illiteracy levels
• Low socioeconomic status
• Limited healthcare access
• Absence of regular screening programmes
• Inadequate employment of regular screening programmes, especially in low resource settings

Conventional treatment approaches for late-stage cervical cancer

Cervical cancer treatment depends on many factors, including the stage of cancer, the patient's age and overall health and if they plan to have kids in the future. Late-stage cervical cancer is typically treated using therapies like surgery, radiation therapy, chemotherapy, immunotherapy or a combination of these treatments.

Usually, cancer that has metastasised or relapsed is treated with therapies such as chemotherapy or radiation therapy. Sometimes, chemotherapy and radiation therapy may be used before surgery or after it.

Surgery

Common surgeries for cervical cancer treatment include:

• Laser surgery: Destroys cancer cells using a laser beam.
• Conisation: Removes tissue from the cervix in the shape of a cone.
• Cryosurgery: Destroys the cancer cells by freezing them.
• Trachelectomy: Removes the upper vagina and cervix while retaining the uterus.
• Pelvic exenteration: Removes the cervix, uterus, vagina, bladder, and portion of the colon in case the cancer has metastasised.

Radical hysterectomy

Late-stage cervical cancer may be treated with radical hysterectomy or modified radical hysterectomy.

• Radical hysterectomy: In this procedure, the uterus, cervix, portions of the vagina and a wide area of tissues and ligaments surrounding these organs are removed.
• Modified radical hysterectomy: Here, the cervix, uterus, upper portion of the vagina and tissues and ligaments surrounding the organs are removed. The surrounding lymph nodes, fallopian tubes and ovaries may also be removed.

Radiation therapy

A common cervical cancer treatment, radiation therapy uses high-energy beams like X-rays, electrons or protons to target the DNA of the cancer cells and destroy them. Two types of radiation therapy exist in external [external beam radiation therapy (EBRT)] and internal (brachytherapy) radiation therapy.

Not only is radiation therapy used to treat cervical cancer, but at times, it is also used in palliative therapy for cancer, where it aids in alleviating symptoms and enhancing the quality of life of people suffering from late-stage cervical cancer.

Brachytherapy

This is an internal radiation therapy method that uses solid radiation sources like seeds, ribbons, catheters or capsules, which are placed close to or within the tumour to deliver targeted cervical cancer treatment. Brachytherapy is a localised approach that focuses on a specific area, destroying cancer cells effectively in a specific part of the body.

Chemotherapy

In chemotherapy, drugs are administered orally or via the veins to destroy cancer cells. The drugs enter the bloodstream and target cancer cells throughout the body. Often administered in cycles, chemotherapy uses different types of drugs, which may sometimes be combined. The location of the tumour and the type of drugs used determine the length as well as the frequency of chemotherapy.

Emerging treatment options for late-stage cervical cancer

Emerging treatment options for late-stage cervical cancer show promise in improving patient outcomes. These include but are not limited to, immunotherapies that enhance the body's immune response against cancer cells, targeted therapies that inhibit specific molecular pathways and combination therapies that utilise multiple treatment modalities.

Immunotherapy

Immunotherapy includes therapies like T-cell transfer therapy, monoclonal antibodies, immune checkpoint inhibitors and immune system modulators. Immunotherapy makes use of medications to stimulate the immune system to recognise cancer cells and destroy them. It enables the immune system to identify the cancer cells by recognising them as abnormal cells by targeting the signals emitted by the cells and eliminating them.

Immunotherapy encompasses various approaches, such as T-cell transfer therapy, monoclonal antibodies, immune checkpoint inhibitors and immune system modulators. It utilises medications to stimulate the immune system, enabling it to recognise and destroy cancer cells by targeting their abnormal signals.

Therapeutic vaccines

Therapeutic vaccines, such as the human papillomavirus (HPV) vaccines and experimental vaccines targeting specific tumour antigens, are being explored for the treatment of late-stage cervical cancer. These vaccines aim to activate the immune system against HPV or cancer-specific antigens, potentially enhancing the body's ability to fight the disease and improve treatment outcomes.

Targeted therapy

Targeted therapy is a precision-based cervical cancer treatment. The treatment uses drugs to fight cancer by targeting and blocking the proteins that control the growth and spread of cancer cells.

Targeted therapy kills the cancer cells or delays their growth. The types of targeted therapy include treatment using monoclonal antibodies and small-molecule drugs. Usually used as treatment for late-stage cervical cancer, targeted therapy is often used along with chemotherapy to combat the disease.

Palliative care

Palliative care and supportive treatments for late-stage cervical cancer

Palliative care is a supportive care treatment that can play a vital role in improving the quality of life of late-stage cervical cancer patients. Palliative care can be given independently or along with cervical cancer treatment. Not only is it used as a curative treatment for cancer, but it can also help to reduce the symptoms of the disease, as well as manage the side effects of the cancer treatment.

Palliative care manages the physical symptoms and tackles the emotional, social, psychological and spiritual aspects, thereby improving the overall well-being of late-stage cervical cancer patients. Palliative care and supportive treatments for late-stage cervical cancer include:

Pain management

Pain management is an essential component of palliative care for late-stage cervical cancer. It involves a comprehensive approach that may include pharmacological interventions, such as opioids, NSAIDs, and adjuvant analgesics to alleviate pain. Non-pharmacological methods, including physical therapy, relaxation techniques, and counselling, are also employed to enhance pain relief and provide supportive care for patients.

Symptom control

Symptom control is a crucial aspect of palliative care for late-stage cervical cancer. It encompasses managing various symptoms such as nausea, vomiting, fatigue, loss of appetite and bowel or bladder dysfunction. Medications, lifestyle modifications and supportive therapies are

employed to address these symptoms and enhance the patient's comfort and quality of life.

Frequently Asked Questions

1. Can late-stage cervical cancer be cured?

Cervical cancer has a higher chance of being cured when detected and diagnosed early. However, in advanced stages, particularly cervical cancer staging 4B cervical cancer, the chances of a complete cure are significantly reduced.

2. Are there any alternative or complementary treatments for late-stage cervical cancer?

Often, complementary and alternative medicine (CAM) therapies are used for the treatment of cervical cancer along with modern allopathic treatments. Popular therapies include acupuncture, nutraceuticals, aromatherapy, yoga, meditation, massage therapy etc.

3. What are the benefits of palliative care in late-stage cervical cancer?

Palliative care is a holistic approach that helps to reduce pain and suffering among late-stage cervical cancer patients. The care helps to reduce and manage pain, discomfort, stress and symptoms of cervical cancer. It also offers psychological, emotional and spiritual support to patients, enhancing their quality of life.

4. How is late-stage cervical cancer diagnosed?

Cervical cancer is usually diagnosed using tests such as a pap smear or pap test, HPV test or biopsy using conisation or punch biopsy to get tissue samples. If confirmed, cervical cancer staging tests like blood, urine, kidney and liver function tests and X-rays help to determine the metastasis of the cancer.

5. What are the common symptoms of late-stage cervical cancer?

Some of the common symptoms of late-stage cervical cancer include heavy, unpleasant smelling, bloody, watery vaginal discharge; pelvic pain; pain during sex and vaginal bleeding after menopause, between periods and after sex.