TREATMENT

Treatment for cervical cancer depends on several factors, such as the stage of the cancer, other health problems you may have and your preferences about treatment. Treatment options may include: Surgery There are three main types of surgery for cervical cancer. They are:

radical trachelectomy - the cervix, surrounding tissue and the upper part of the vagina are removed but the womb is left in place radical hysterectomy - the cervix and womb are removed; depending on the stage of the cancer, it may also be necessary to remove the ovaries and fallopian tubes pelvic exenteration - a major operation in which the cervix, vagina, womb, bladder, ovaries, fallopian tubes and rectum are removed

The three types of surgery are discussed below. Radical trachelectomy A radical trachelectomy is usually only suitable if you have very early stage one cancer. t is usually offered to women who want to preserve their child-bearing potential. !uring the procedure, the surgeon will ma"e a number of small incisions in your abdomen. #pecially designed instruments will be passed through the incisions and used to remove your cervix and the upper section of your vagina. $ymph nodes from your pelvis may also be removed. %our womb will then be reattached to the lower section of your vagina. The advantage of this type of surgery compared to a hysterectomy or pelvic exenteration is that your womb remains intact, which means that you may still be able to have children. &owever, it is important to be aware the surgeons carrying out this operation cannot guarantee you will still be able to have children. f you do have children after the operation, your child would have to be delivered by caesarean section 'where the baby is removed through an incision in your abdomen(. t)s also usually recommended that you wait six to *+ months after having surgery before trying for a baby so that your womb and vagina have time to heal. ,adical trachelectomy is a highly s"illed procedure. t)s only available at a number of specialist centres in the -., so it may not be available in your area, and you may have to travel to another city to be treated.

Hysterectomy A hysterectomy is usually recommended for advanced stage one cervical cancer and early stage two cervical cancer. #urgery may be followed by a course of radiotherapy to help prevent the cancer coming bac". Two types of hysterectomies are used in treating cervical cancer. They are:

simple hysterectomy - where the cervix and womb are removed and, in some cases, the ovaries and fallopian tubes; this is only appropriate for very early stage cervical cancers. #imple hysterectomy is typically an option if the invasion is less than / millimeters 'mm( into the cervix. radical hysterectomy - where the cervix, womb, surrounding tissue and lymph nodes, ovaries and fallopian tubes are all removed; this is the preferred option in advanced stage one and some early stage two cervical cancers. ,adical hysterectomy is the standard surgical treatment when there)s invasion greater than / mm into the cervix.

As your womb is removed during a hysterectomy you will no longer be able to have children. Also, if your ovaries are removed, it will trigger the menopause if you haven)t already experienced it. ,ead more about the menopause. #hort-term complications of a hysterectomy include:

infection bleeding blood clots accidental injury to your ureter, bladder and rectum

The ris" of long-term complications are small but they can be troublesome. They include:

your vagina becomes shortened and dryer; this can ma"e sex painful urinary incontinence swelling of your arms and legs due to a build-up of fluid 'lymphoedema( your bowel becomes obstructed due to a build-up of scar tissue; this may re0uire further surgery to correct

Pelvic exenteration A pelvic exenteration is a major operation that)s usually only recommended when cervical cancer returns after what was thought to be a previously successful course of treatment. t is offered if the cancer returns to the pelvis but hasn)t spread elsewhere outside of the pelvis. A pelvic exenteration involves two phases of treatment:

the cancer is removed, plus your bladder, rectum, vagina and the lower section of your bowel two holes, called stomas, are created in your abdomen - the holes are used to pass urine and faeces out of your body into collection pouches called colostomy bags

1ollowing a pelvic exenteration, your vagina can be reconstructed using s"in and tissue ta"en from other parts of your body. This means that you)ll be able to have sex after the procedure, although it may be several months until you feel well enough to do so. Radiotherapy ,adiotherapy may be used on its own or combined with surgery for early stage cervical cancer. t may be combined with chemotherapy for advanced cervical cancer, where it can be used to control bleeding and pain. There are two ways that radiotherapy can be delivered. These are:

externally - a machine similar to an 2-ray scanner beams high energy waves into your pelvis to destroy cancerous cells internally - a radioactive implant is placed inside your vagina and cervix

n most cases, a combination of internal and external radiotherapy will be used. A course of radiotherapy usually lasts for around five to eight wee"s. -nfortunately, as well as destroying cancerous cells, radiotherapy can sometimes harm healthy tissue too. -nli"e surgery, significant side effects can occur many months and years after treatment. n spite of side effects, the benefits of radiotherapy outweigh any ris"s in most cases. 1or some patients, radiotherapy offers the only hope of getting rid of the cancer. This means that side effects are common and include:

diarrhoea pain when urinating bleeding from your vagina or rectum feeling very tired 'fatigue( feeling sic" 'nausea( sore s"in in your pelvis region, similar to sunburn narrowing of your vagina, which can ma"e having sex painful infertility damage to the ovaries, which will usually trigger an early menopause 'if you haven)t already experienced it(

bladder and bowel damage, which could lead to incontinence

3ost of these side effects will resolve within about eight wee"s of finishing treatment, although in some cases they can be permanent. t is also possible to develop side effects several months or even years after treatment has finished. f infertility is a concern for you, it may be possible to surgically remove eggs from your ovaries before you have radiotherapy so that they can be implanted in your womb at a later date. &owever, you may have to pay for this. t may also be possible to prevent an early menopause by surgically removing your ovaries and replanting them outside of the area of your pelvis that will be affected by radiation. This is "nown as an ovarian transposition. %our 3!T will be able to provide more information about the possible options for treating infertility and whether you)re suitable for an ovarian transposition. Chemotherapy 4hemotherapy can be combined with radiotherapy to try and cure a cancer. 5r it can be used as a sole palliative treatment for advanced stage four cervical cancer to slow the progression of the cancer and relieve symptoms 'palliative chemotherapy(. 4hemotherapy involves using either a single chemotherapy medication called cisplatin, or sometimes a combination of different chemotherapy medications to "ill cancerous cells. 4hemotherapy is usually given using an intravenous drip on an out-patient basis, so you)ll be able to go home once you have received your dose. As with radiotherapy, these medications can also damage healthy tissue, and side effects are common. They include:

feeling sic" being sic" 'vomiting( diarrhoea feeling tired all the time reduced production of blood cells, which can ma"e you feel tired and breathless 'anaemia( and vulnerable to infection 'due to a lac" of white blood cells( mouth ulcers loss of appetite

hair loss - your hair should grow bac" within three to six months of your course of chemotherapy being completed - though not all chemotherapy medications cause hair loss

#ome types of chemotherapy medication can damage your "idneys, so you may need to have regular blood tests to assess the health of your "idneys. http:66www.nhsdirect.wales.nhs.u"67ncyclopaedia6c6article6cancerofthecervix68Treatment http:66www.mayoclinic.com6health6cervical-cancer6!#99*:;6!#74T 5<=treatments-and-drugs

COMP !CAT!ON
4omplications of cervical cancer can occur in one of two ways:

as a side effect of treatment the result of advanced cervical cancer

Side e""ects# Early menopause f your ovaries are surgically removed, or if they)re damaged during treatment with radiotherapy, it will trigger an early menopause 'if you haven)t already had it(. 3ost women experience the menopause in their early fifties. The menopause is caused when your ovaries stop producing the hormones, oestrogen and progesterone. This leads to the following symptoms:

you no longer have monthly periods or your periods become much more irregular hot flushes vaginal dryness loss of sex drive mood changes stress incontinence - lea"ing urine when you cough or snee>e night sweats

thinning of the bones, which can lead to brittle bones 'osteoporosis(

These symptoms can be relieved by ta"ing a number of medications that stimulate the production of oestrogen and progesterone. This treatment is "nown as hormone replacement therapy '&,T(. Narro$ing o" the vagina ,adiotherapy to treat cervical cancer can often cause your vagina to become narrower. This can ma"e having sex painful or difficult. There are two main treatment options if you have a narrowed vagina. The first is to apply hormonal cream to your vagina. This should increase moisture within your vagina and ma"e having sex easier. The second is to use a vaginal dilator, which is a tampon shaped device that)s made out of plastic. %ou insert it into your vagina and it is designed to help ma"e your vagina more supple. t is usually recommended that you insert the dilator for five to *9 minutes at a time on a regular basis during the day, over the course of six to *+ months. 3any women find discussing the use of a vaginal dilator embarrassing, but it)s a standard and well-recognised treatment for narrowing of the vagina. %our specialist cancer nurse or radiographers in the radiotherapy department should be able to give you more information and advice. %ou may find that the more times you have sex, the less painful it becomes. &owever, it may be several months before you feel emotionally ready to be intimate with a sexual partner. %ou can read more about sexuality and cancer on the 3acmillan 4ancer #upport website. ymphoedema f the lymph nodes in your pelvis are removed, it can sometimes disrupt the normal wor"ings of your lymphatic system. 5ne of the functions of the lymphatic system is to drain away excess fluid from the body?s tissue. A disruption can cause a build-up of fluid in the tissue. This can lead to certain body parts becoming swollen, usually the legs in cases of cervical cancer. This is "nown as lymphoedema. There are a number of exercises and massage techni0ues that can reduce the swelling. @earing specially designed bandages and compression garments can also help. ,ead more about treating lymphoedema. Emotional impact

The emotional impact of living with cervical cancer can be significant. 3any people report experiencing a roller-coaster effect. 1or example, you may feel down when you receive a diagnosis, but feel up when removal of the cancer has been confirmed. Then you may feel down again as you try to come to terms with the after effects of your treatment. This type of emotional disruption can sometimes trigger depression. #igns that you may be depressed include:

feeling down or hopeless during the past month no longer ta"ing pleasure in the things that you enjoy

4ontact your AB for advice if you thin" that you may be depressed. There are a range of effective treatments for depression, including antidepressant medication and tal"ing therapies, such as cognitive behavioural therapy '4CT(. ,ead more about depression and coping with cancer. %ou may also find Do)s 4ervical 4ancer Trust website a useful resource. t)s the -.?s only charity dedicated to women who are affected by cervical cancer. There may also be local support groups in your area for women affected by cancer. %our specialist cancer nurse should be able to provide contact details. Advanced cervical cancer #ome of the complications that can occur in cases of advanced cervical cancer are discussed below. Pain f the cancer spreads into your nerve endings, bones or muscles it can often cause severe pain. &owever, a number of effective pain"illing medications can usually be used. !epending on the levels of pain, they can range from paracetamol and the non-steroidal anti-inflammatory drugs '<#A !s(, such as ibuprofen, to more powerful opiate-based pain"illers, such as codeine and morphine. f the pain"illers you are prescribed aren)t effective in reducing your pain, you should tell your care team because you may need to be prescribed a stronger medication. 3acmillan nurses, who wor" both in hospitals and in the community, can also provide expert advice about pain relief. %idney "ailure

%our "idneys remove waste material from your blood. The waste is passed out of your body in urine through tubes called the ureters. .idney function can be monitored by a simple blood test called serum creatinine level. n some cases of advanced cervical cancer, the cancerous tumour 'abnormal tissue growth( can press against the ureters, bloc"ing the flow of urine out of the "idneys. The build-up of urine inside the "idneys is "nown as hydronephrosis and can cause the "idneys to become swollen and stretched. #evere cases of hydronephrosis can cause the "idneys to become scarred, which can lead to loss of most or all of the "idney)s functions. This is "nown as "idney failure. .idney failure can cause a wide range of symptoms, including:

tiredness swollen an"les, feet or hands 'due to water retention( shortness of breath feeling sic" blood in your urine 'haematuria(

Treatment options for "idney failure that)s associated with cervical cancer include draining urine out of the "idneys using a tube that)s inserted through the s"in and into each "idney 'percutaneous nephrostomy(. Another option is to widen each of the ureters by placing a small metal tube called a stent inside them. &lood clots 4ervical cancer, li"e any other cancer, can ma"e the blood Emore stic"y? and ma"e it more prone to form clots. Ced rest after surgery and chemotherapy can also increase the ris" of developing a clot. $arge tumours can press on the veins in the pelvis, which slows the flow of blood and can lead to a blood clot developing in the legs. #ymptoms of a blood clot in your legs include:

pain, swelling and tenderness in one of your legs 'usually your calf( a heavy ache in the affected area warm s"in in the area of the clot redness of your s"in, particularly at the bac" of your leg, below the "nee

A major concern in these cases is that the blood clot from the leg vein will travel up to the lungs and bloc" the supply of blood into the lungs. This is "nown as a pulmonary embolism, and it can be fatal. Clood clots in the legs are usually treated by using a combination of blood-thinning medication, such as heparin or warfarin, and compression garments that are specially designed to help encourage the flow of blood through the limbs. &leeding f the cancer spreads into your vagina, bowel or bladder, it can cause significant damage, resulting in bleeding. Cleeding can occur in your vagina, rectum 'bac" passage(, or you may pass blood when you urinate. 3inor bleeding can often be treated using a medication called tranexamic acid, which encourages the blood to clot and stop the bleeding. ,adiotherapy can also be highly effective in controlling bleeding caused by cancer. 3ajor bleeding can be treated using a combination of medications that are designed to lower blood pressure. This should help to stem the flow of blood. 'istula A fistula is an uncommon but distressing complication that occurs in around * in F9 cases of advanced cervical cancer. A fistula is an abnormal channel that develops between two sections of the body. n most cases involving cervical cancer, the fistula develops between the bladder and the vagina. This can lead to a persistent discharge of fluid from the vagina. #ometimes a fistula develops between the vagina and rectum. #urgery is usually re0uired to repair a fistula although it)s often not possible in people with advanced cervical cancer because they)re usually too frail to withstand the effects of surgery. n such cases, treatment often involves using medication, creams and lotions to reduce the amount of discharge and protect the vagina and surrounding tissue from damage and irritation. (aginal discharge Another uncommon but distressing complication of advanced cervical cancer is an unpleasant smelling discharge from your vagina. The discharge can occur for a number of reasons, such as the brea"down of tissue, the lea"age of bladder or bowel contents out of the vagina, or a bacterial infection of the vagina.

Treatment options for vaginal discharge include an anti-bacterial gel called metronida>ole, and wearing clothing that contains charcoal. 4harcoal is a chemical compound that)s very effective in absorbing unpleasant smells. http:66www.nhsdirect.wales.nhs.u"67ncyclopaedia6c6article6cancerofthecervix684omplications

PRO)NOS!S
!itentu"an oleh : -mur penderita .eadaan umum Ting"at "lini" "eganasan '#tadium( Aambaran histologi" sel tumor .emampuan ahli atau tim ahli yang menangani #arana pengobatan yang ada

3enurut 1 A5 dari laporan gabungan hasil terapi di */; lembaga, /+.9F+ "asus "an"er servi"s uteri berbagai stadium 'Betterson, *GG*( survival F tahun pasien adalah #tadium H*,:I #tadium :*,/I #tadium /:,;I #tadium J *+,*I Brawirohardjo #. lmu .andungan. +nd 7d. Da"arta: BT Cina Busta"a #arwono Brawirohardjo, +99H; /HG !esen @. Cu"u Ajar 5n"ologi .linis. +nd 7d. Da"arta: 1a"ultas .edo"teran -niversitas ndonesia