‘I just want it cut out Dr Lombe’. This is a request I frequently encounter in clinic. It breaks my heart momentarily because the truth of the matter is as a radiation oncologist when women are sent to my clinic it usually means we are at a point beyond surgery as an intervention. Occasionally we will pick up cases that can be sent back to a gynaecologist oncologist but this is really rare. As we wrap up cervical cancer awareness month I thought to focus on what a woman and her caregivers can do once confronted with an advanced disease.
Lets start with this statement: ‘Just because it can’t be cut out doesn’t mean it can’t be cured’. Locally advanced cervical cancer is a range, which starts from the cancer spreading beyond the cervix into surrounding tissues by centimetres to involving neighbouring organs such as the rectum and bladder. As such it is important to go through all the tests that a specialist has asked for. That being said the tests must be conducted with in a timeframe of less than 3 weeks. I once had a sad encounter with a patient who was requested to obtain scans and blood tests needed to fully stage her cancer. She quietly walked out of the consultation room and came back in over 6 months as she gathered resources and so on for these tests. Once one has a diagnosis of cancer or any health problem for that matter it is important to take ownership of the treatment process. Gone are the days where doctors were gods speaking down on patients. We are partners in this journey. Speak up to ensure you or your loved one is treated in a timely manner. You don’t need to ‘know’ anyone – the system is yours.
I felt especially compelled to share with you how locally advanced cervix cancer is cured as most of the curable patients abandon ship midway. Please bear with me as I take you through the steps and I will attempt to use as much lay language as possible. Feel free to write me on the email below or post a comment on the www.oncocurae.comweekly blog if we need to break it down further.
Most of you may be familiar with the picture of the womb as shown in the diagram. Cervix cancer grows out stage by stage. Other than when it has spread away from the region of the womb does the management fall out of the scope of this article.
The first thing your oncologist would need from you is tests that confirm the cancer is confined to the womb area. If your referring doctor did not ensure you had these, it is mandatory for the oncologist to ask you to do them. Having all this information makes the treatment plan more effective and tailored to you. Most people get frustrated at this point because it may have taken months to get to an oncologist only to be sent out for more tests. Some people may also misrepresent this process as a flicker of hope to dispute the cancer diagnosis. So as a caregiver if you have the information, this may be a good time to jump in and keep the patient focused on the goal.
After the staging of the cancer is complete the next step would be to set you up for treatment. The treatment is called chemoradiation because there are two components of chemotherapy and radiation therapy. The chemotherapy is given once a week usually at the beginning of the week and its function is to make the radiation stronger and also in a part mop up wandering cancer cells. The amount of chemotherapy is small when compared to when it is used alone for cancers like breast and lung so the side effects should be minimal.
Radiation is delivered in two ways, externally and internally. The external radiation is given daily on weekdays only and the number of treatments total between 25 – 28 depending on the features of the scans done. This means the course is 5-6 weeks. Each treatment lasts 15 – 20 minutes considering set up on the machine and changing.
Before the treatment starts the patient must go through a process called simulation. This is where the patient is set up exactly the way they are going to be treated and images are acquired to check and ensure the radiation is going to hit the right spots. These images also allow for another oncologist to give a second eye and really make sure the treatment will be safe for the patient. The nice advancement in this process that has happened is that patients are planned virtually. This means a patient comes gets scanned and is able to go home whilst the team works on the plan on a computer.
Once this process is completed, usually with in 2 weeks, the most tedious and lengthily part of the treatment starts. It requires commitment from the patient to follow through. We cannot also ignore that some logistical planning and resources is needed to ensure the patient is there daily and this is one of the discouraging aspect for most.
The internal treatment is called brachytherapy. This involves putting the radiation close to the tumour as possible to deliver that final blow. The reason it happens towards the end of the course is that the radiation it sends out does not have a long range. As such the tumour must have been downsized by the external radiation for maximum impact. Colleagues have tried to replace brachytherapy with extra-targeted external radiation but this has time and again shown inferiority.
Now once the course of treatment is complete the woman must continue coming back to the oncologist for gynaecological exams. Unless the specialist allows you not to come back because someone else they trust can follow you up please always come for reviews.
A sad situation I find is some women have been divorced or have had relationships break down after treatment for cervical cancer because they believe they cannot function sexually. That is incorrect. The vagina remains fully functional and the cancer clinic offers information to ensure this happens. Cervical cancer is a cancer of relatively young women and the goals of treatment are not only to save your life but also to ensure you have a good quality.
I hope this article has been enlightening to you and not too technical. With this information lets continue contributing to kick cervical cancer deaths out of Zambia!