Cervical cancer: Therapies that have transformed the treatment landscape

Cervical cancer is the second most common cancer amongst Indian women, comprising 18.3% of the new cancer cases in 2020. It is estimated that 1 in 53 Indian women would develop cervical cancer during their lifetime.

The treatment of cervical cancer includes:

Surgery
Surgery plays a crucial role in the treatment of early stage cervical cancer.

The most common surgery entails the comprehensive removal of the uterus, ovaries and regional lymph nodes known as hysterectomy and pelvic lymph node dissection. This aims to eradicate the disease while maintaining an acceptable quality of life.

In select cases, particularly in young women with early stage disease fertility preserving surgeries maybe performed involving removal of only the cervix with a cuff of surrounding tissue.

Despite the potential benefits, minimally invasive techniques (laparoscopy and robot assisted) have not gained widespread acceptance due to conflicting reports regarding their long term outcomes.

Radiation therapy
Radiation therapy, either alone or in combination with chemotherapy (chemoradiation), stands as the most common treatment for locally advanced cervical cancer.

Radiation may be delivered via external beam radiation (over a period of 5-6 weeks) or via brachytherapy. Brachytherapy (Internal radiation) delivers high dose radiation directly to the site of the primary.

In cases of early cervical cancer, radiation therapy is found to be as effective as surgery, but one tends to favour surgery especially in younger women due to the long term side effects of radiation.

Some women may require radiation therapy as an adjunct to surgery.

Technological advancements, such as intensity modulated radiate therapy (IMRT) and image guided radiation therapy (IGRT), enable precise targeting of tumors while minimising the damage to surrounding healthy tissue, reducing treatment related toxicity and improving survival rates.

Chemotherapy
Chemotherapy plays a crucial role in the management of advanced cervical cancer, either alone or in combination with radiation therapy. Cisplatin is the most commonly used chemotherapeutic drug. When given along with radiation therapy, it acts like a radiosensitizer, enhancing treatment outcomes.

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Immunotherapy
Immunotherapy is the use of drugs to boost one’s immunity to help recognise and destroy cancer cells more effectively. Immunotherapy tends to have lesser side effects than chemotherapy.

While immunotherapy has a recognised role in certain cases of metastatic cervical cancer (Stage 4), its role in the treatment of locally advanced cancers remains unproven and debatable.

Affordability remains the biggest drawback of immunotherapy, with an average cost of Rs 1.5-4.5 lakhs per session.

The 5 year survival for women with cervical cancer is determined by the stage at diagnosis, with survival rates as as low 7.4% for advanced-stage disease as compared with 73.2% for localised disease. Regular screening utilizing clinical examination and Pap smear tests holds promise in reducing mortality through early detection and intervention. By focusing on effective prevention, early detection, and appropriate treatment, the goal is to enhance the quality of life for individuals affected by cervical cancer.

(Author: Dr Kanav Kumar, Surgical Oncologist at the Punyashlok Ahilyadevi Holkar Head & Neck Cancer Institute of India, Mumbai)