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Cervical cancer is diagnosed usually in a gynecologist office and the usual course of
events where cervical cancer is diagnosed, it is usually picked up on a screen Pap smear
which shows an abnormality which then results in examination by gynecologist called colposcopy
wherein an examination in their office is performed where with binocular microscopy,
we evaluate the *** and take directed biopsies of abnormalities that we observe. These biopsies
are then looked at by a pathologist under microscope and then render a diagnosis as
cervical dysplasia otherwise known as the precancer or precursor lesions of cervical
cancer. Sometimes unfortunately is diagnosed as an invasive cervical cancer and when we
see that the examination done by the physician is really the first and most important means
of dictating how we take care of a patient. Cervical cancer still staged basically by
an exam which is observation of the ***, palpation or a physical exam of the ***
may help that the cancer is just as involve other adjacent structures and then we do use
some radiologies such as CT scans, chest x-rays, etc., to help us guide how we take care of
the patient and manage such cervical cancer.
Cervical cancer when we catch it in its early stages, stage 1 and sound specific stage 2s,
we tend to use surgery for those treatments and that can be anything from a conservative
operation meaning where the uterus is left in place such as what is called a conization
where we excise the abnormality only on the *** and leave the remaining *** and
leave the uterus in place. There are other options for that which is called a trachelectomy
which is a procedure where the surgeon removes the *** but leaves the uterus and we use
that treatment modality in patients that have invasive cervical cancer that desire a future
fertility. Furthermore, as we get into more advanced stages or in patients that fertility
is not desired, a hysterectomy is performed and based upon complicated issues with regards
to what the stage is and the cell type, sometimes a traditional what we call a simple hysterectomy
is performed which is one that a general OB/GYN performs. However as the stage becomes more
progressed what is called a radical hysterectomy is required and that is performed by a gynecologic
oncologist.
In a radical hysterectomy is removal of the uterus and *** in some of the adjacent
structures called the parametrium. We also remove the lymph nodes at the time of that
surgery to help dictate whether what is called adjuvant treatment is required and for some
patients, depending upon certain issues on the pathologic specimen, chemotherapy and/or
radiation maybe required depending upon certain pathologic events. As the stage gets more
advanced such as certain stage 2 cancers even certain stage 1 cancers require radiation
meaning that a hysterectomy is not the best first treatment. There are a lot of patients
with cervical cancer that we do recommend radiation in lieu of hysterectomy because
we know that the radiation is going to work as effective with less complications and the
way that radiation is prescribed for patients with cervical cancers, we do use a combination
of a very small dose of chemotherapy in conjunction with radiation. The chemotherapy is not a
chemotherapy where patients lose their hair, no one will really know you are receiving
the chemotherapy because it is such a small dose. That small dose of chemotherapy has
actually been shown to help the radiation work better more effectively and cure more
patients but the radiation is really the curative treatment for certain types of cervical cancer.
That’s administered by a radiation oncologist, who is a doctor that treats cancer with radiation
and they work in concert with the GYN oncologist with the chemotherapy. That course of treatment
usually take somewhere between seven to eight weeks depending upon certain pathologic and
radiologic findings. There is a combination of what is called external beam radiation
where a patient lies on a table and the radiation comes just like if you are receiving an x-ray
and then there is also a portion of what we call internal or Reiki therapy radiation which
is one the radiation oncologist puts the radiation right on the ***.