Treatment of Pre-invasive and Invasive Cervix Cancer
For pre-invasive disease, the treatment is the local removal of the abnormal lining in the cervix by local excision procedures or ablative procedures. Local excision techniques include knife or laser cone biopsies or loop electrosurgical excision procedures (LEEP). Ablative techniques include laser vaporization or cold coagulation. The technique of choice has to be discussed with the attending doctor. However, the successful treatment of precancer of the cervix almost certainly prevents cancer of the cervix from occurring.
For early invasive cancer of the cervix, cure can be achieved with either surgery (removal of the uterus i.e hysterectomy, and surrounding tissue including lymph nodes) or radiotherapy, which is often given with chemotherapy.
For advance disease where surgery is not possible,concurrent chemo-radiotherapy or radiotherapy is the treatment of choice. Radiotherapy is often given in 2 ways. One is with external beam radiotherapy and the other is internal beam radiotherapy. The external beam radiotherapy is carried out daily on weekdays and may take about 5-6 weeks to complete. The internal beam radiotherapy is given in 2 to 5 sessions.
Prognosis of Cervix Cancer
The prognosis for early stage cervical cancer is very good with 5 year survival between 80 to 95% However for advanced stage cervical cancer, the 5 year survival decreases to less than 40%.
Is prevention possible?
Yes, primary prevention of cervical cancer is now available in the form of vaccines. In Singapore, the two commercially available are Cervarix and Gardasil. Both vaccines have been shown to be efficacious in protection against HPV 16 and 18, which cause up to 70% of cervical cancers. All women of reproductive age are encouraged to vaccinate themselves against this preventable cancer. However, as some women may still develop cervical cancer even after vaccination, screening with PAP smear is still recommended.