Cervical Cancer

• Understanding the disease
• Treatment options
• Side effects of treatment

Stephen Shamp, MD MSEE

David Bloom, MD PhD

Matthew Culbert, MD

Cancers of the Cervix

Lymph Nodes�from the cervix

Cancer that has spread to para-aortic and pelvic nodes as seen on PET scan

Staging

HPV = Human Papillomavirus

Most HPV infections don't lead to cancer but certain types of HPV infection cause cancers. More than 100 varieties of human papillomavirus (HPV) exist.

HPV is a very common virus; nearly 80 million people—about one in four—are currently infected in the United States. 

HPV Types

Vaccine to Prevent HPV

Since mid-2006, a licensed human papillomavirus (HPV) vaccine has been available and recommended

​

CDC analyzed data from the 2007–2013 National Immunization Survey-Teen (NIS-Teen) and national post licensure vaccine safety data among females and males.

​

Vaccination coverage with ≥1 dose of any HPV vaccine increased significantly from 53.8% (2012) to 57.3% (2013) among adolescent girls and from 20.8% (2012) to 34.6% (2013) among adolescent boys.

MMWR July 25, 2014 / 63(29);620-4

www.nccn.org

CT simulation (planning session)

• We will build a cradle to hold you in the same position with each treatment.
• Temporary or permanent marks will be made
• CT images are obtained and then imported into the treatment planning computer
• You bladder should to be full and your rectum empty
• Your PET/CT and/or MRI may be fused to help with radiation targeting

RapidArc IMRT with daily CBCT IGRT

Logistics of Chemoradiation:

• Usually 25-30 daily treatments
• Chemotherapy, if recommended, will often start on the same day
• Treatment days are Monday-Friday 5 days per week, 5-6 weeks in total
• Daily treatment takes 15 minutes or less. You will be given a schedule
• You do not feel anything during treatment, you will not be radioactive, you are allowed to drive yourself to and from treatment if you are currently allowed to drive

• Lasers and/or imaging is used to precisely deliver the daily radiation treatment.
• Expect to be on the treatment table less than 15 minutes.
• You will not feel any immediate effects.

Logistics of Brachytherapy:

• Usually 3-5 outpatient surgical treatments at St. Anthony’s Hospital
• Often 1-2 treatments per week
• Usually scheduled after a majority or all external beam radiation has been completed
• For each treatment
• Often have to be at the hospital by 5:30am
• Will be fully sedated with anesthesia and device will be inserted. You will then wake up
• You will have a new CT scan and a radiation plan will be made
• The radiation will be delivered internally
• The device will be removed and you can go home (usually by lunchtime)

Internal radiation devices

Radiation Fields and Side Effects

Pelvic field

Para-aortic

Node field

Side Effects of Pelvic Radiation

Radiation fields

Radiation may hit the bladder and rectum causing urinary burning or frequency and rectal irritation

In pre-menopausal women, radiation is likely to effect ovarian function and should not be used if the woman is pregnant

Short Term Side Effects: Fatigue and Irritation of vagina, rectum, skin, bladder, bowel

1. Painful or frequent defecation.
2. Urinary frequency or urgency
3. Burning or stinging with urination (drink cranberry juice)
4. Diarrhea or more frequent, softer bowel movements, rectal soreness (take Imodium)
5. Potential irritation of skin near anus or around the pelvis
6. Fatigue is common
7. Irritation of the vagina

Radiation

zone

Radiation

zone

Vaginal Stenosis and Atrophy: Fibrosis and shrinking of the vagina that can make exams and/or intercourse painful. Vaginal dilator after treatment can help prevent this. Vaginal lubricants can be helpful for intercourse

Infertility: Radiation can affect fertility and can affect ovarian function

Chronic radiation proctitis or cystitis: occasional episodes of blood in the urine or with bowel movements, this usually responds to medication. Chronic diarrhea is possible. The risk of serious damage to the bladder and rectum is now less than 1%

Very low risk of rare but serious complications including but not limited to secondary malignancy, small bowel obstruction, ulcer, fistula, incontinence

Long Term Side Effects: Possible irritation of rectum, bowel, bladder, or vagina

Follow-up

• Radiation therapy can continue to work for months after treatment.
• The most important follow-up is cervical exams with your gynecologist
• Further imaging such as PET/CT may be recommended based on your stage and treatment