Cervix and Gynecological Cancer
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Cervix and Gynecological Cancer
A preventable cancer in Indian women, strongly associated with HPV infection and poor genital hygiene, but 2nd most common cancer in Indian women
Gynecological Cancers – Cervical Cancer & Radiation Therapy
Common Gynaecological Cancers
- Cervical cancer – most common in India
- Endometrial (uterine) cancer
- Ovarian cancer
- Vaginal and vulvar cancers
Cervical Cancer
- Cervix uteri (ectocervix and endocervical canal)
- May spread to parametrium, uterus, vagina, pelvic lymph nodes, and beyond (bladder, rectum)
Risk Factors
Risk Factor
Explanation
Human Papillomavirus (HPV)
Especially types 16 and 18; present in >90% of cases
Multiple sexual partners
Higher risk of persistent HPV infection
Poor genital hygiene
Associated with chronic infections
Smoking
Synergistic with HPV in promoting carcinogenesis
Immunosuppression (e.g. HIV)
Decreased ability to clear HPV
Low socio-economic status
Limited access to screening and vaccination
Lack of screening (Pap smear)
Delayed diagnosis at advanced stages
Staging (FIGO)
- Stage I: Confined to cervix
- Stage II: Beyond cervix but not to pelvic wall or lower third of vagina
- Stage III: Involvement of pelvic wall, lower vagina, or kidney problems
- Stage IV: Invasion of bladder, rectum, or distant spread
Treatment Modalities
Stage
Primary Treatment
Early (IA1–IB1)
Surgery (radical hysterectomy ± pelvic lymphadenectomy)
IB2–IVA
Definitive Chemoradiation (radiation + concurrent cisplatin)
IVB
Palliative radiotherapy ± systemic therapy
Recurrent
RT if not previously irradiated, or pelvic exenteration if feasible
Radiation Therapy Details
External Beam Radiotherapy (EBRT)
- Field: Whole pelvis (covers cervix, uterus, parametria, upper vagina, and pelvic nodes)
- Dose: ~45–50.4 Gy in 25–28 fractions over 5–6 weeks
- Technique: 3D-CRT, IMRT, or VMAT depending on availability
Brachytherapy (Intracavitary RT)
- Essential component of curative treatment
- HDR most commonly used (e.g., 7 Gy × 3–4 fractions)
- Delivers high dose to cervix and parametrium with rapid fall-off to bladder and rectum
Concurrent Chemotherapy
- Weekly cisplatin (40 mg/m²) is standard during EBRT
- Radiosensitizes tumor and improves survival
Treatment Duration
- EBRT + brachytherapy should be completed within 7–8 weeks for best outcomes.
Side Effects
Acute
Chronic
Fatigue, nausea, diarrhea
Vaginal stenosis, bowel/bladder dysfunction, sexual issues
Cystitis, proctitis
Radiation fibrosis, infertility