While many surgical procedures cure uterine, ovarian, cervical and vulvar cancer, most oncologists recommend courses of non-surgical therapies to lower the risk of recurrence or kill cancer cells that may have been left behind. The most common non-surgical treatment for invasive and non-invasive gynaecologic cancer is radiotherapy.
Nonsurgical treatments are also offered to those unable to undergo surgery due to low overall levels of health or those who need to keep metastatic or potentially recurring cancer under control.Â
Gynaecological cancer chemotherapy
Early stage cancers are treated with surgery in combination with radiotherapy. Sometimes the advice is given to undergo a course of chemotherapy in cancer types that are known to recur. Chemotherapy may be given to shrink tumours prior to surgery, to treat cancer types with the potential to return, and also to destroy any cancer cells that may have been left behind after surgery.Â
Specific drugs and chemotherapy cycles can be found in the separate treatment sections for ovarian, uterine, cervical and vulvar cancers above.
Where surgery is not indicated, chemotherapy is a primary or secondary (to radiotherapy) cancer treatment usually supported by other non-surgical therapies. Chemotherapy for metastatic gynaecologic cancer can significantly slow tumour growth and spread. Multiple cytotoxic (cell-toxic) combinations exist, all of which can be discussed with a Remedazo oncology specialist.
Chemotherapy drugs are administered intravenously via a portacath, PICCÂ line or central venous catheter. A single cycle usually last for 21 days and, depending on your type of cancer, may be repeated up to 4 times. This can mean up to 4 months of therapy with regular blood tests and follow ups of symptoms and side effects. Ask Remedazo for more information regarding longer-term stays where all of your physical, psychological and emotional needs are catered for during this stressful time. Alternatively, we can arrange similar accommodation and familiar, trusted team members for regular returns to your clinic of choice and cater for your accompanying family members or friends.
Gynaecologic cancer radiation therapy
If you need to have your uterus (and cervix) removed, your oncologist may advise to treat the upper part of the vagina with vaginal brachytherapy. This treatment inserts a source of radiation by way of an applicator into the vagina under the guidance of ultrasound, CTÂ or MRI. The applicator tube feels similar to a tampon. The locally administered radiation affects the area of the vagina that is in contact with the cylinder and is not significantly associated with bladder or rectum exposure. There are 2 types of brachytherapy used for endometrial cancer - low-dose rate (LDR) and high-dose rate (HDR). LDR leaves the applicator in place for up to 4 days and you will need to stay in a hospital bed during this time. After LDR you will also not be able to fly home immediately; this is not to do with radiation but because staying in bed for this amount of time can increase the risk of blood clot formation. Various preventive measures such as medication and special leg cuffs (intermittent pneumatic compression) will be used to lower the risk.
HDR uses higher doses of radiation and each applicator remains in place for less than 20 minutes, after which you can return to your accommodation. This treatment continues at daily or weekly intervals until the total dose has been given. The risk of blood clot formation or deep vein thrombosis (DVT) is significantly reduced and you can fly home after treatment has ended.
Radiotherapy for gynaecological cancer is composed of two main types – external beam radiation therapy (EBRT) and stereotactic body radiation. If cancer has spread to the bone tissue (bone metastasis), patients may be offered radiopharmaceuticals. These are injected drugs that contain radioactive substances that settle in areas of damaged bone. Here, they emit radiation that kills cancer cells. These drugs also relieve bone pain caused by metastasis and can extend life.
Fractionated external beam radiation therapy (EBRT) is usually prescribed to prevent the growth of potentially remaining cancer cells after surgery. This therapy is given over the course of 3 to 5 weeks. More recently, stereotactic body radiation therapy (SBRT) has provided some patients with the option of a higher dose with a shorter course.Â
External beam radiation therapy focuses beams of radiation into the affected area of tissue and requires short (10 to 30 minute) visits to the hospital 5 times a week for several weeks. Long-term stays with all accommodation, home nursing care, catering, transportation and follow ups can be seamlessly arranged by your Remedazo team.
EBRT is a painless treatment and recent technology now enables oncologists to be even more precise with dosage and range. Additional options such as three-dimensional conformal radiation therapy or 3D-CRT use computers to map the area that requires treatment and shape the radiation beams to avoid damaging non-cancerous tissues. The even more advanced intensity modulated radiation therapy (IMRT) machine moves around the patient, shapes the beams and adjusts radiation intensities. This may be done with built-in scanners (image guided radiation therapy or IGRT) or using a more rapid but not necessarily more effective technique called volumetric modulated arc therapy or VMAT. You will be able to discuss all of these alternatives with a Remedazo oncology specialist.
The side effects of radiation therapy often depend on its effects upon healthy tissues that are found close to the uterus including major blood and lymph vessels, intestines, bladder and rectum. In addition, radiation treatments can make you feel tired for weeks to months. At Remedazo, all associated information will be given upon or shortly after your consultation; you can then make an informed decision regarding the types of radiotherapy available to you.
Gynaecologic cancer hormone (endocrine) therapy
As already discussed, gynaecological cancers can use oestrogen (and progesterone) to increase in size. Biopsy reports tell the oncologist whether cancer cells contain receptors for certain substances. If they do, stopping these substances from being used by cancer cells can slow or stop their growth. Hormonal therapy is not used for triple-negative cancer types.
Hormonal treatment is long-term therapy that needs to be taken for 5 to 10 years. These therapies lower the amount of oestrogen in the body or stop oestrogen from connecting with the cancer cells and encouraging them to grow. However, when the uterus and/or ovaries are removed, the body produces much less oestrogen or progesterone. This is why hormone therapies after these surgeries are unlikely to be prescribed.
Tamoxifen is the most well-known anti-oestrogen that stops oestrogen from connecting with cancer cells in the breast; however, it is much less used for hormone-sensitive gynaecological cancer types because it is selective and only blocks the action of oestrogen in the breast tissue, not in other organs that produce oestrogen such as the bones and the womb. It may, however, be prescribed in the treatment of recurrent ovarian cancer.
Drugs that stop oestrogen from being produced in the body are another option. Most oestrogen is made in the ovaries. When surgery or the menopause stops oestrogen production in the ovaries, a small amount is still produced in fat tissue. This is the reason why being obese increases the risk of gynaecological cancers. This small amount can still cause hormone-sensitive cancers in post-menopausal women and in younger women who have had both ovaries removed. When this production is completely stopped through aromatase inhibitor drugs such as letrozole or exemestane, early and advanced uterine and ovarian cancer can be prevented or slowed.Â
Uterine cancer in younger women can also be treated by stopping oestrogen production in the ovaries. Drugs known as luteinizing hormone releasing hormone agonists (LHRH) include goserelin and leuprolide
Uterine cancer immunotherapy
Checkpoint inhibitors allow your immune system to respond to the presence of specific cancer cells and attack them. This response is often absent during tumour growth. It has been shown that some advanced uterine cancers respond well to immunotherapy treatment but this certainly does not apply to all. Ask about immunotherapy options during your free Second Opinion.
Drugs such as atezolizumab block the activity of a protein that prevents your immune cells from recognizing and attacking inflamed tissues and cancer cells. This drug seems to work more effectively in combination with targeted therapy. Oncologists partnered with Remedazo are renowned for their knowledge of the most recent clinical studies and research pertaining to effective and new cancer-fighting drugs.
Each intravenous immunotherapy treatment requires at least a 2 hour stay in a clinical setting and should be repeated every 2 to 3 weeks. Immunotherapy has been shown to increase survival times in metastasised cancer; however, it is rarely offered before other types of therapy have been tried. This may change as research continues.
The side effects of immunotherapy are many and can be serious. Those offered this type of treatment are given in-depth information regarding side effects and the detection of their early signs. Remedazo can put you in touch with one of our specialist oncologists to discuss your eligibility for immunotherapy based upon your personal medical history.
Uterine cancer targeted therapy
New treatment methods are constantly being researched and developed. One of the more recent pharmaceutical cancer breakthroughs is targeted therapy and its many options and combinations. Gynaecologic cancers may respond to various types that have differing actions.
PARP inhibitors
PARP-inhibitors block the natural mechanisms that repair damaged DNA even in cancer cells. Where there are no mutations in BRCA genes (BRCA1 and BRCA2), PARP-inhibitors can be used. This is a very new treatment course offered with oral drugs such as olaparib.
Anti-angiogenesis inhibitors.
Anti-angiogenesis inhibitor drugs block the action of a protein called vascular endothelial growth factor (VEGF). This effect can make cancer more responsive to various treatments and lower recurrence rates. These drugs stop the tumour’s blood supply and starve it of nutrients. Bevacizumab is an anti-angiogenesis inhibitor that seems to be effective in the treatment of ovarian cancer. Another promising drug is lenvatinab.
Benefits of uterine cancer treatment
Uterine cancer surgeries aim to remove cancer in its entirety and so have the potential to be curative procedures. Surgery is always recommended in cases of non-metastatic cancers; however, most treatment pathways integrate multiple therapies. In the case of uterine, ovarian, cervical and vulvar cancer these are most commonly radiotherapy and, for later stage or more aggressive cancer types, chemotherapy. Uterine cancers have benefitted from extensive research and even invasive types can be treated.
Uterine cancer surgery is not linked to high levels of pain and recovery times and hospital stays are usually short. All treatment that removes cancer cells, slows or stops their growth and lowers their risk of returning once treated is of benefit. Hormone replacement therapy can, in many cases, soothe longer-term symptoms.
Disadvantages of uterine cancer treatment
Postoperative infection is a risk with this type of surgery and patients are sometimes administered antibiotics as a preventive measure before surgery commences. Other short-term risks include bleeding, adverse reactions to the anaesthesia, higher risk of blood clots and breathing problems after general anaesthesia.
Long-term complications of uterine cancer surgery are early menopause in younger women with associated infertility and loss of libido. This can be psychologically demanding, especially in combination with a diagnosis of cancer. Visible results of more extensive vulvectomy procedures can also be psychologically upsetting. Damaged pelvic floor muscles through surgery or radiotherapy may lead to urinary incontinence. Where larger numbers of lymph nodes are removed, it is possible that lymphedema will cause swelling in one or both legs.Â
Nearly all surgical procedures require further radiotherapy treatment that can last for a number of weeks, bringing with it a number of unpleasant side effects. Chemotherapy is also a method that is associated with serious health complications. Undesired side effects are also linked to immunotherapy and, in a lesser degree, targeted therapy.
Uterine cancer alternatives
It is possible that you have been given a choice of one or more alternative treatments or have not yet made an appointment for your free e-consult and are simply browsing the possibilities.
The accepted and current uterine, ovarian, cervical and vulvar cancer treatment alternatives have been described in detail above. Recent advances mean that some stage IV cancers can go into remission for significant periods of time. Complementary cancer remedies are unproven and should not take the place of accepted treatment courses. Cancer stem cell therapies are, as yet, insufficiently developed to be used as first-line treatment.
Of course, there is no alternative for professional medical advice. Please call us to arrange your free e-consult and the opportunity to speak personally with specialist surgical oncologists, gynaecologists and radiologists to determine the best treatment type for you. You can discuss all gynaecological cancer treatment alternatives with them, ask for second or third opinions, and take the first step towards your personalised Remedazo holistic care package.
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