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| Photo from mayoclinic.org |
Cervical cancer develops in the cervix, the lowest, narrow section of the uterus. During pregnancy, the uterus protects the developing fetus. The cervix connects the lowest section of the uterus to the vagina and creates the birth canal with the vagina.
Abnormal cervix cells that can develop into cancer
Cervical cancer develops when healthy cells on the cervix’s surface alter or become infected with the human papillomavirus (HPV) and grow out of control, causing a lump known as a tumor. Long-term HPV infection of the cervix can progress to cancer, resulting in a lump or tumor on the cervix. A tumor might be malignant or noncancerous. A cancerous tumor is malignant, which means it has the potential to spread to other parts of the body. A benign tumor is one that will not spread.
Initially, the alterations in a cell are abnormal, but not malignant, and are referred to as “atypical cells.” Some of these aberrant alterations, according to researchers, are the initial step in a sequence of gradual changes that can lead to cancer. Some of the abnormal cells go away on their own, but others can develop into cancer. This stage of precancerous condition is known as cervical dysplasia, which is characterized by aberrant cell proliferation. To prevent cancer from forming, the dysplasia tissue may need to be removed in some cases. Often, dysplasia tissue can be removed or destroyed without causing injury to healthy tissue; nevertheless, in some circumstances, a hysterectomy is required to prevent cervical cancer. The uterus and cervix are removed during a hysterectomy.
Treatment of a lesion (a precancerous area) is dependent on the following factors:
- The size of the lesion and the sort of cell alterations that have happened
- The urge to have children later in life
- Age
- General well-being
- The patient’s and the doctor’s preferences
If the precancerous cells develop into cancer cells and move deeper into the cervix or to other tissues and organs, the condition is known as cervical cancer or invasive cervical cancer.
Cervical cancer
Cervical cancer can develop from the surface of the cervix visible in the vagina, known as the ectocervix, or from the canal connecting the vagina and the uterus, known as the endocervix. Cervical cancer is classified into two categories based on the type of cell in which the disease began. Cervical cancers of other forms are uncommon.
Squamous cell carcinoma: Squamous cell carcinoma accounts for roughly 80% to 90% of all cervical cancers. These cancers begin in the cells that cover the cervix’s outer surface.
Adenocarcinoma: Adenocarcinoma accounts for 10% to 20% of all cervical cancers. These tumors begin in the glandular cells that line the lower birth canal in the cervix’s interior section.
The squamous and glandular cells meet at the cervix’s opening at the squamocolumnar junction, which is where most cervical cancers begin.
SYMPTOMS OF CERVICAL CANCER
Precancer frequently has no visible indications or symptoms. Symptoms of early-stage cervical cancer are common. The symptoms of advanced cancer or cancer that has spread to other parts of the body may be more severe, depending on the tissues and organs affected. A symptom’s cause could potentially be a different medical issue other than cancer, which is why patients should seek medical attention if they notice a new symptom that does not go away.
Cervical cancer symptoms could include any of the following:
- Between or after periods, there may be blood spots or minor bleeding.
- Menstrual bleeding that is thicker and lasts longer than usual.
- Bleeding following sexual activity, douching, or a pelvic examination.
- Increase in vaginal discharge .
- During sexual intercourse, there is pain.
- Bleeding following menopause
- Mysterious, persistent pelvic and/or back pain.
You should notify your doctor if you experience any of these symptoms. If these symptoms arise, it is critical that you consult your doctor, even if they appear to be indications of other, less serious disorders. The earlier precancerous cells or cancer are detected and treated, the higher the chances of preventing or curing the cancer.
Please consult your doctor if you are concerned about any changes you are experiencing. In addition to other questions, your doctor will inquire as to how long and how frequently you have been experiencing the symptom(s). This is done to assist in determining the cause of the condition, which is referred to as a diagnostic.
If cervical cancer is found, symptom relief is an important element of cancer care and treatment. This is known as palliative care or supportive care. It is frequently initiated shortly after diagnosis and continues throughout treatment. Make an appointment with your health care provider to discuss your symptoms, especially any new or changing symptoms.
STAGES OF CERVICAL CANCER
Staging describes where the cancer is present, whether or not it has spread, and whether or not it is impacting other sections of the body.
Doctors employ diagnostic tests and physical examinations to determine the stage of cancer, therefore staging may not be complete until all tests are completed. Knowing the stage assists the doctor in determining the best course of treatment and can help estimate a patient’s prognosis, or possibility of recovery. Distinct forms of cancer have different stage descriptions. The staging method devised by the International Federation of Obstetrics and Gynecology (Federation Internationale de Gynecologie et d’Obstetrique, or FIGO) is used for cervical cancer.
FIGO STAGES FOR CERVICAL CANCER
Doctors determine the cancer stage by examining the tumor and determining whether the cancer has spread to other places of the body.
The results of a physical exam, imaging scans, and biopsies are used to determine staging.
Stage I: The cancer has spread from the cervical lining into deeper tissue but is still limited to the uterus. It hasn’t spread to the rest of the body. This stage may be subdivided into smaller groups to better characterize the cancer.
- Stage IA: The cancer is diagnosed solely by the examination of cervical tissue or cells under a microscope. Tumor size can also be determined using imaging tests or tissue samples.
Stage IA1: A malignant region measuring less than 3 millimeters (mm) in depth.
Stage IA2: A malignant region 3 mm to less than 5 mm deep.
- Stage IB: The tumor is bigger but remains limited to the cervix at this stage. There is no long-distance spread.
Stage IB1: The tumor is at least 5 mm deep and less than 2 centimeters (cm) broad. A centimeter is approximately the width of a normal pen or pencil.
Stage IB2: The tumor is at least 2 cm deep and less than 4 cm broad.
Stage IB3: The tumor is 4 cm or larger in breadth.
Stage II: The cancer has spread outside the uterus to surrounding sites such as the vagina or tissue around the cervix, but it is still contained inside the pelvic area. It hasn’t spread to the rest of the body. This stage may be subdivided into smaller groups to better characterize the malignancy.
- Stage IIA: The tumor has spread to the top two-thirds of the vaginal wall. It has not spread to the tissue next to the cervix, known as the parametrial area.
Stage IIA1: The tumor is less than 4 cm in diameter.
Stage IIA2: The tumor is at least 4 cm wide.
- Stage IIB: The tumor has progressed to the pelvic region. The tumor does not make it all the way to the pelvic wall.
Stage III: The tumor has spread to the pelvic wall and/or includes the lower third of the vagina; causes swelling of the kidney, known as hydronephrosis; prevents a kidney from functioning; and/or involves nearby lymph nodes. Lymph nodes are small, bean-shaped structures that aid in the fight against infection. There is no long-distance spread.
- Stage IIIA: The tumor has spread to the bottom third of the vagina but has not yet spread to the pelvic wall.
- Stage IIIB: The tumor has spread to the pelvic wall and/or is affecting a kidney.
- Stage IIIC: The tumor has spread to the lymph nodes in the region. Imaging tests and pathology can be used to detect this. The addition of a lowercase “r” denotes that imaging studies were utilized to confirm lymph node involvement. Pathology results were used to identify the stage, as indicated by a lowercase “p.”
Stage IIIC1: The cancer has progressed to the pelvic lymph nodes.
Stage IIIC2: The cancer has migrated to the para-aortic lymph nodes at stage IIIC2. These lymph nodes are located in the abdomen near the base of the spine and near the aorta, which is a significant artery that goes from the heart to the belly.
Stage IVA: The cancer has spread to the bladder or rectum but not to the rest of the body.
Stage IVB: Other regions of the body have been affected by the cancer.
Recurrent: Cancer that recurs after therapy is referred to as recurrent cancer. Cervical cancer can recur in the pelvis where it first appeared or spread to other parts of the body such as the lungs, lymph nodes, and bones. If the cancer returns, more tests will be performed to determine the degree of the recurrence. These tests and scans are frequently identical to those performed at the time of the first diagnosis.
DIAGNOSIS OF CERVICAL CANCER
Many tests are used by doctors to detect or diagnose cancer. They also perform tests to see whether the cancer has spread to another place of the body from where it began. This is referred as as metastasis. Imaging tests, for example, can reveal whether or not the cancer has spread. Images of the inside of the body are produced via imaging tests. Doctors may also conduct tests to determine which treatments are most likely to be effective.
A biopsy is the only guaranteed way for a doctor to know if a part of the body has cancer in most cases of cancer. During a biopsy, the doctor extracts a small sample of tissue for laboratory testing. If a biopsy is not possible, the doctor may recommend alternative tests to aid in the diagnosis.
This section discusses cervical cancer diagnosis options. Not all of the tests described below will be administered to every individual. Some or all of these tests may be useful to your doctor in planning your cancer therapy. When selecting a diagnostic test, your doctor may take the following variables into account:
- The cancer type suspected
- Your symptoms and signs
- Your age and general well-being
- The outcomes of previous medical tests
Cervical cancer can be diagnosed using the following tests:
Bimanual pelvic examination and sterile speculum examination: The doctor will look for any unexpected changes in the patient’s cervix, uterus, vagina, ovaries, and other adjacent organs during this examination. To begin, the doctor will examine the vulva outside the body for any changes, and then, using a speculum to keep the vaginal walls open, the doctor will look within the vagina to visualize the cervix. A Pap test is frequently performed at the same time. Because some of the adjacent organs are not visible during this exam, the doctor will enter two fingers of one hand within the vagina while gently pressing on the lower abdomen to feel the uterus and ovaries. This checkup usually takes a few minutes and is performed in a doctor’s office examination room.
Pap test: During a Pap test, the clinician gently scrapes the surface and inside of the cervix, collecting cell samples for analysis.
Doctors can now detect malignant cells more easily thanks to improved Pap test technologies. Traditional Pap tests can be difficult to read because cells on the slide can be dried out, coated with mucous or blood, or cluster together.
- After eliminating blood or mucus from the sample, the liquid-based cytology test, also known as ThinPrep or SurePath, deposits a thin layer of cells onto a slide. The sample is kept so that other tests, such as the HPV test, can be performed concurrently.
- Computer screening, also known as AutoPap or FocalPoint, scans the sample for abnormal cells using a computer.
Colposcopy: A colposcopy may be performed by the doctor to look for abnormal spots on the cervix. Colposcopy can also be performed to help guide a cervix biopsy. A colposcope is a unique instrument used during a colposcopy. The colposcope, like a microscope, magnifies the cells of the cervix and vagina. It provides the clinician with an illuminated, enlarged image of the vaginal and cervix tissues. The colposcope is not put into the body, and the examination is performed in the same manner as a speculum examination. It can be performed in the doctor’s office and has no negative side effects. It is also possible to perform it on pregnant ladies.
HPV typing test: A HPV test is comparable to a Pap test. The test is performed on a cervix cell sample. The doctor may perform an HPV test concurrently with a Pap test or after the Pap test results show abnormal alterations to the cervix. Certain varieties or strains of HPV, known as high-risk HPV, are more common in women with cervical cancer and may help confirm a diagnosis. If the doctor reports that the HPV test was “positive,” it signifies that the test detected the presence of high-risk HPV. Because many women have HPV but do not have cervical cancer, HPV testing alone is insufficient for a cervical cancer diagnosis.
Biopsy: A biopsy is the removal of a small sample of tissue for microscopic examination. Other tests can indicate the presence of cancer, but only a biopsy can provide a definitive diagnosis. The material is next examined by a pathologist (s). A pathologist is a medical professional who specializes in interpreting laboratory tests and assessing cells, tissues, and organs to identify disease. If the lesion is small, the doctor may be able to remove it altogether during the biopsy.
Biopsies are classified into numerous categories. Most are performed in the doctor’s office, with a local anesthetic used to numb the area. Following a biopsy, there may be some bleeding and other discharge. There may also be cramping, comparable to menstruation cramping. An tool is used to pinch out small pieces of cervical tissue in one frequent biopsy approach. Other sorts of biopsies are as follows:
- Endocervical curettage (ECC): If the doctor wishes to examine a location inside the cervix that cannot be seen during a colposcopy, he or she will employ ECC. During this treatment, the clinician scrapes a little quantity of tissue from inside the cervical hole with a curette, a small spoon-shaped device.
- Loop electrosurgical excision procedure (LEEP): LEEP works by passing an electrical current through a narrow wire hook. The hook is used to extract tissue for testing in the laboratory. A LEEP can also be utilized to remove a precancer or a cancer in its early stages.
- Conization (a cone biopsy): This procedure involves the removal of a cone-shaped portion of tissue from the cervix. Conization can be used to treat a precancer or an early-stage cancer. It is performed under general or local anesthesia at a doctor’s office or a hospital.
If the biopsy reveals that you have cervical cancer, your doctor will recommend you to a gynecologic oncologist, a doctor who specializes in treating this type of disease. Additional tests may be recommended by the specialist to determine whether the cancer has progressed beyond the cervix.
Pelvic examination under anesthesia: If it is required for treatment planning, the specialist may re-examine the pelvic area while the patient is under anesthesia to see whether the cancer has progressed to any organs around the cervix, such as the uterus, vagina, bladder, or rectum.
X-ray: An x-ray is a technique that uses a small amount of radiation to create a picture of the structures inside the body. An intravenous urography is a sort of x-ray used to examine the kidneys and bladder.
Magnetic resonance imaging (MRI): An MRI produces detailed images of the body by using magnetic fields rather than x-rays. The tumor’s size can be determined via an MRI. To provide a crisper image, a special dye known as a contrast medium is administered before to the scan. This dye can be injected into a patient’s vein or given to them in the form of a pill or liquid to consume.
Computed tomography (CT) scan: A CT scan uses x-rays captured from various angles to create images of the inside of the body. A computer combines these images to create a detailed, three-dimensional image that identifies any anomalies or malignancies. A CT scan can be performed to determine the size of the tumor. To improve image detail, a specific dye known as a contrast medium is sometimes administered before to the scan. This dye can be injected into a patient’s vein or given to them in the form of a pill or liquid to consume.
Positron emission tomography (PET) or PET-CT scan: A PET scan is frequently coupled with a CT scan, resulting in a PET-CT scan. However, your doctor may refer to this technique simply as a PET scan. A PET scan is a technique for creating images of organs and tissues within the body. A radioactive sugar compound is put into the patient’s body in modest amounts. This sugar molecule is absorbed by the cells that consume the most energy. Cancer absorbs more radioactive stuff because it aggressively uses energy. The material is then detected by a scanner, which produces images of the inside of the body.
Molecular testing of the tumor: Your doctor may advise you to do laboratory testing on a tumor to discover specific genes, proteins, and other components that are specific to the tumor. The results of these tests can help you decide on a treatment plan.
If there are signs or symptoms of bladder or rectal abnormalities, the following procedures may be advised and performed concurrently with a pelvic examination:
Cystoscopy: A cystoscopy is a technique in which the doctor uses a thin, lighted tube called a cystoscope to examine the inside of the bladder and urethra (the canal that conducts urine from the bladder). As the tube is placed into the urethra, the patient may be anesthetized. A cystoscopy is performed to see if cancer has progressed to the bladder.
Sigmoidoscopy: A sigmoidoscopy is a procedure that allows the doctor to see the colon and rectum using a sigmoidoscope, which is a thin, illuminated, flexible tube. As the tube is placed into the rectum, the patient may be anesthetized. A sigmoidoscopy is performed to determine whether the malignancy has progressed to the rectum.
TREATMENT OF CERVICAL CANCER
Different types of specialists frequently collaborate in cancer care to develop a patient’s overall treatment plan, which mixes many sorts of therapy. This is referred to as a multidisciplinary team. Other health care professionals on cancer care teams include physician assistants, nurse practitioners, oncology nurses, social workers, pharmacists, counselors, nutritionists, and others.
The following are descriptions of the most prevalent types of cervical cancer therapies. Treatment for symptoms and side effects, which is an important element of cancer care, may also be part of your treatment plan.
Cervical cancer treatment is determined by a number of criteria, including the type and stage of disease, potential side effects, and the patient’s preferences and overall health. Take the time to read about all of your treatment options, and don’t be afraid to ask clarifying questions. Discuss the aims of each treatment with your doctor, as well as what you can expect during treatment. These discussions are known as “shared decision making.” When you and your doctors collaborate to choose therapies that meet the goals of your care, this is referred to as shared decision making. Because there are various treatment choices for cervical cancer, shared decision making is very crucial.
When a woman is diagnosed with cervical cancer, she may be concerned about how her treatment may effect her sexual function and capacity to produce children, which is referred to as fertility. Before beginning treatment, these topics should be reviewed with the health care team. A pregnant woman should consult her doctor about how treatments may affect both her and her unborn child. Treatment may be postponed until after the baby is born.
Surgery
During a surgery, the tumor and some surrounding healthy tissue are removed. A gynecologic oncologist is a specialist who specializes in the surgical treatment of gynecologic cancer. These techniques are frequently performed for cervical cancer that has not progressed beyond the cervix:
- Conization: The removal of all aberrant tissue using the same process as a cone biopsy. It can be used to eliminate microinvasive cervical cancer, which can only be seen under a microscope.
- Bilateral salpingo-oophorectomy: This surgery, if necessary, involves the removal of both fallopian tubes and both ovaries. It is performed concurrently with a hysterectomy.
- Radical trachelectomy: A surgical treatment that removes the cervix but leaves the uterus intact. It comprises the dissection of pelvic lymph nodes. Young people who desire to protect their fertility may benefit from this operation. For certain patients, this treatment has proven an acceptable alternative to a hysterectomy.
- LEEP: The application of an electrical current through a thin wire hook. The hook is used to extract the tissue. It is capable of removing microinvasive cervical carcinoma.
- Hysterectomy: Removal of the uterus and cervix. Hysterectomy can be performed in two ways: basic or radical. The uterus and cervix are removed during a basic hysterectomy. The uterus, cervix, upper vagina, and tissue surrounding the cervix are all removed during a radical hysterectomy. A radical hysterectomy also entails extensive pelvic lymph node dissection, which involves the removal of lymph nodes. This operation can be performed through a big cut in the abdomen, known as a laparotomy, or through tiny cuts, known as a laparoscopy.
- Exenteration: If cervical cancer has spread to these organs after radiation therapy, the uterus, vagina, lower intestine, rectum, or bladder may be removed (see below). Exenteration is rarely advised. It is most commonly used for persons whose cancer has returned following radiation treatment.
Surgical complications or side effects differ depending on the degree of the procedure. Patients may develop substantial bleeding, infection, or damage to the urinary and gastrointestinal systems on rare occasions. Before undergoing surgery, consult with your health care team about the potential adverse effects of the procedure.
Because these surgical treatments have an impact on sexual health, patients should consult with their doctor about their symptoms and concerns before undergoing the procedure. The doctor may be able to help lessen surgery side effects and provide supports for coping with any changes. Other surgical methods can be employed to create an artificial vagina if numerous surgical procedures have compromised sexual function.
Radiation therapy
The use of high-energy x-rays or other particles to eliminate cancer cells is known as radiation therapy. A radiation oncologist is a doctor who specializes in the use of radiation therapy to treat cancer. Radiation therapy can be used to decrease a tumor alone, before surgery, or instead of surgery.
External-beam radiation therapy, which delivers radiation from a machine outside the body, is the most prevalent method of radiation treatment. Internal radiation therapy, also known as brachytherapy, is a type of radiation therapy that uses implants to deliver radiation. A radiation therapy regimen, or schedule, typically consists of a predetermined number of treatments administered over a predetermined time period that combine exterior and internal radiation treatments. This combined strategy is the most successful in lowering the risks of the cancer returning, often known as a recurrence.
A combination of radiation therapy and low-dose weekly chemotherapy is frequently utilized in the early stages of cervical cancer. The purpose of combining radiation therapy with chemotherapy is to improve the effectiveness of the radiation treatment. This combination is used to control pelvic cancer with the goal of curing it without surgery. It may also be used to eliminate microscopic cancer that remains after surgery.
Radiation therapy might cause fatigue, moderate skin responses, upset stomach, and loose bowel motions. Internal radiation therapy can cause abdominal pain and intestinal blockage, albeit these are unusual side effects. The majority of side effects normally fade away once the treatment is completed. Because the vaginal area may lose flexibility after radiation therapy, some women may prefer to use a vaginal dilator, which is a plastic or rubber cylinder that is put into the vagina to prevent narrowing. Women who have received external-beam radiation therapy will lose their capacity to become pregnant, and premenopausal women will enter menopause unless the ovaries are surgically shifted out of the pelvis.
Doctors may urge their patients not to engage in sexual activity while undergoing radiation therapy. If the patient is ready, normal sexual activity can be resumed within a few weeks of treatment.
Chemotherapy
Chemotherapy is the use of medications to eradicate cancer cells, typically by preventing the cancer cells from growing, dividing, and proliferating.
A chemotherapy regimen, or schedule, typically consists of a predetermined number of cycles administered over a predetermined time period. A patient may be administered one medicine at a time or a mixture of drugs at the same time. Chemotherapy is frequently used in conjunction with radiation therapy for women with cervical cancer.
Despite the fact that chemotherapy can be administered orally (by mouth), all medications used to treat cervical cancer are administered intravenously (IV). IV chemotherapy is either injected directly into a vein or administered using a thin tube known as a catheter, which is a tube temporarily inserted into a big vein to facilitate injections.
Chemotherapy side effects vary depending on the individual and the dose used, but they can include exhaustion, infection risk, nausea and vomiting, hair loss, loss of appetite, and diarrhea. These adverse effects normally fade away once the treatment is completed.
Specific medicines may, on rare occasions, cause some hearing loss. Others may harm the kidneys. To protect their kidneys, patients may be given extra fluid intravenously. Discuss with your doctor the potential short- and long-term negative effects of the drugs and dosages you will be getting.
Targeted therapy
Targeted therapy is a type of cancer treatment that targets specific genes, proteins, or the tissue environment that contributes to cancer growth and survival. This method of treatment inhibits cancer cell growth and spread while limiting damage to healthy cells.
The targets of all cancers are not the same. Your doctor may order tests to determine the genes, proteins, and other variables in your tumor in order to find the most effective treatment. This enables clinicians to provide the most effective treatment to each patient whenever possible. Furthermore, research studies are continuing to learn more about specific molecular targets and new treatments aimed at them.
When cervical cancer recurs after treatment, it is referred to as recurrent cancer, or when it spreads beyond the pelvis, it is referred to as metastatic disease, and it can be treated with platinum-based chemotherapy combined with the targeted medication bevacizumab (Avastin). The FDA has approved two medications similar to bevacizumab for the treatment of advanced cervical cancer: bevacizumab-awwb (Mvasi) and bevacizumab-bvzr (Zirabev). These are known as biosimilars.
Furthermore, the FDA granted accelerated approval to tisotumab vedotin (HuMax-TF) in 2021 for the treatment of recurrent or metastatic cervical cancer that progressed during or after chemotherapy. Tisotumab vedotin is an antibody-drug combination that acts by binding to cancer cell targets and then releasing a little amount of the anticancer medicine straight into the tumor cells.
Immunotherapy
Immunotherapy, also known as biologic therapy, is intended to increase the body’s natural defenses against cancer. It employs components created by the body or in a laboratory to enhance, target, or restore immune system activity.
Pembrolizumab (Keytruda), an immune checkpoint inhibitor, is used to treat cervical cancer that has recurred or spread to other regions of the body during or after chemotherapy treatment. In persons with recurrent or metastatic cervical cancer whose tumors express PD-L1, it may also be administered in combination with chemotherapy with or without bevacizumab. Some cancer cells express the PD-L1 protein, which interacts to the T-cell PD-1 protein. T cells are immune system cells that attack and kill other cells, such as cancer cells. The T cell does not assault the cancer cell when the PD-1 and PD-L1 proteins attach. Pembrolizumab is a PD-1 inhibitor, which means it prevents the binding of PD-1 and PD-L1, allowing T cells to detect and destroy cancer cells.
Different forms of immunotherapy might result in a variety of adverse effects. Skin rashes, flu-like symptoms, diarrhea, and weight fluctuations are all common adverse effects. Consult your doctor about the potential adverse effects of the immunotherapy that has been prescribed for you.
Treatment options based on stage
For an early-stage tumor, either radiation therapy or surgery is usually performed. These treatments have been demonstrated to be equally successful in treating cervical cancer in its early stages. Chemoradiation (a combination of chemotherapy and radiation therapy) is usually reserved for women with larger tumors, advanced-stage tumors located only in the pelvis, or cancer cells in the lymph nodes. Radiation therapy and chemotherapy are commonly used following surgery if there is a significant risk of the disease returning or if the cancer has progressed.
Metastatic cervical cancer
Doctors refer to cancer that has spread to another place of the body from where it began as metastatic cancer. If this occurs, it is advisable to consult with specialists who have treated similar cases in the past. Different doctors may have differing views on the optimal conventional treatment strategy. Clinical trials are another possibility.
Chemotherapy, immunotherapy, surgery, and targeted therapy can all be utilized to treat or eliminate newly damaged areas in the pelvic area and elsewhere in the body. Palliative care will also be important in reducing symptoms and side effects, including pain and other adverse effects of radiation therapy.
A diagnosis of metastatic cancer is extremely stressful and challenging for the majority of people. You and your family are encouraged to express your feelings to doctors, nurses, social workers, and other members of the health care team. It may also be beneficial to speak with other sufferers, such as through a support group.
Remission and the possibility of recurrence
When cancer cannot be identified in the body and there are no symptoms, the patient is said to be in remission. This is often known as having “no evidence of illness,” or NED.
Remission can be either temporary or permanent. Many people are concerned that the cancer will recur as a result of this uncertainty. While many remissions are durable, it is vital to discuss the potential of the cancer returning with your doctor. Keeping an eye out for recurrence is a crucial element of follow-up care. Understanding your recurrence risk and treatment options may make you feel more prepared if the cancer returns.
Recurrent cancer occurs when the cancer returns after the initial treatment. Recurrent cancer can reoccur in the same location (called a local recurrence), adjacent (regional recurrence), or elsewhere (distant recurrence).
When this happens, a fresh round of testing begins to discover as much as possible about the recurrence. Following the completion of this testing, you and your doctor will discuss treatment choices. The treatments outlined above, such as surgery, systemic therapy, and radiation therapy, are frequently included in the treatment plan, but they may be administered in a different mix or given at a different pace. Your doctor may recommend that you participate in clinical studies that are looking for new ways to treat this sort of recurring cancer. Palliative care will be essential for reducing symptoms and side effects regardless of the treatment plan you choose.
People suffering from recurring cancer frequently experience emotions such as bewilderment or anxiety. You are urged to discuss these feelings with your health care provider and inquire about support options to assist you in coping.
