Locally Advanced

I have been diagnosed with advanced cervical cancer and need help understanding the different treatment options available

Non-Surgical Treatment Options

The treatment of locally advanced cervical cancer is non-surgical as the tumour is too bulky or advanced to be completely eradicated by surgery. Treatment options for this patient group include a combination of radiotherapy, brachytherapy, chemotherapy and immunotherapy.

Time is of the Essence

In cervical cancer, it is critical to start on the right treatment promptly as these cancers are aggressive and grow very fast. Patients should aim to commence treatment within 1-2 weeks of diagnosis as further delay could compromise outcomes.

For example, studies have shown that once radiotherapy is commenced, it should be completed within 7-8 weeks, as prolonging this overall treatment time will result in a 1% decrease in cure rate per additional day of treatment.

As such, we strongly recommend that patients diagnosed with cervical cancer should commence their treatment within 1-2 weeks of diagnosis. Once treatment is started, there should also be minimal delays allowed.

Isn’t surgery a better treatment since it physically removes the tumour?

All cancer treatments including surgery, radiotherapy and chemotherapy can remove tumours, except through different mechanisms. While surgery physically takes the tumour out of the body, radiotherapy destroys tumour cells where they are by specifically targeting the DNA of those cells and causing them to die off. The body then clears away the dead cells on its own, resulting in the same outcome as surgery.

How is radiotherapy suited to treat late-stage cervical cancer?

Radiotherapy on the other hand, does not have the same limitations as surgery, and can be directed safely at tumours that have spread beyond surgical boundaries. Nerves and muscles are very resistant to radiotherapy and will not be damaged even if radiation dose is directed at those areas.

Thus, radiotherapy is most effective in locally advanced disease, where it can comprehensively cover all extent of disease while preventing damage to the critical structures. The use of advanced radiotherapy techniques further facilitates this process, allowing the radiation oncologist to sculpt the doses accurately, thus maximally avoiding the critical organs.

Advanced Treatment + Expertise = Best Outcome

Even within Singapore, there are a variety of practices adopted by different doctors who treat cervical cancer. This can have a large impact on patient outcomes. For example, advanced radiotherapy techniques like Intensity-modulated radiation therapy (IMRT) have been shown to reduce side effects by 50% compared to conventional methods (CRT). Such techniques must be executed by experts who are well-versed in the technologies to ensure best chances for cure & long-term quality of life.

ADVANCED RADIOTHERAPY TECHNIQUE

CONVENTIONAL METHOD

CT scan images demonstrating the difference between advanced radiotherapy techniques (IMRT, left)2 and conventional methods (CRT, right) – still used in many centres today.

The coloured shades represent the radiotherapy doses delivered in the body to the tumour regions outlined in red and green lines. Using advanced radiotherapy techniques, the doses entering the normal organs such as bladder, small intestines and rectum can be sculpted specifically to avoid them, whereas conventional methods are unable to do so, resulting in the entire squarish area being bathed with radiation dose.