GYNECOLOGIC CANCERS
Cervix
The treatment approach for cancer of the uterine cervix usually depends on the size of the tumor, the location of the tumor relative to other pelvic tissues (like bladder, rectum, and pelvic side wall). The size and location of a cervix cancer is often described by a system called the FIGO staging system.
Small cervix cancers (small FIGO stage IB) that develop in healthy patients are usually treated surgically with an operation called a radical hysterectomy. After the operation the uterus and other tissues are examined under a microscope by a pathologist. If microscopic examination suggests that the patient is at high risk for cancer recurrence, radiation therapy is usually recommended. Radiation therapy in this setting usually involves 5 weeks of external beam radiation therapy (treatments given 5 days per week) and three separate internal implantation radiotherapy treatments to the vagina. Internal implantation treatments are usually given once a week during the course of external beam radiotherapy.
Moderately advanced cervix cancers (FIGO stage IB, II, or IIIA) are usually treated with a combination of radiation therapy and chemotherapy (medication that helps to cure the cancer). Chemotherapy is usually given as an intravenous injection every 3 weeks during radiotherapy. In most cases the radiation therapy involves 5 weeks of external beam radiotherapy (treatments given 5 days per week) followed by two internal implantation radiation therapy treatments with tandem and ovoid applicators. The patient stays in a private room in the hospital for approximately 3 days with each internal implantation treatment. The two internal implantation procedures are separated by 1 or 2 weeks. Therefore, radiation therapy for this stage of cervix cancer usually takes a total of 8 to 10 weeks to complete both external beam and internal implantation portions of the radiotherapy program.
Advanced-stage cervix cancer (FIGO stage IIIB or IV) is usually treated with a combination of radiation therapy and chemotherapy. The exact schedule of radiotherapy depends on multiple factors. Some patients receive a program involving 5 weeks of external beam radiation therapy with treatments given twice a day, 5 days per week. Following the completion of external beam radiotherapy, 1 or 2 internal implantation procedures are done depending on the extent of the cancer. A variety of internal implantation techniques are used. Some patients receive internal implantation radiotherapy with a tandem and ovoid applicator as described above; other patients require different approaches.
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