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Precancerous Lesions of the Cervix: Current Management Approach and Modalities
Aruna Batra (Doctor)*
Sudha Nigam (Consultant Gynecologist)
Delhi University and Safdarjung Hospital, New Delhi*, Shrihari Medical Centre, Lucknow, India
Key Points
- Currently, cervical intraepithelial neoplasia (CIN) is categorised according to its potential for progression to cervical cancer either 'low-grade CIN with human papillomavirus- (HPV) related changes' or 'high-grade CIN'.
- Colposcopy enables categorisation of patients with abnormal Papanicolaou (Pap) smears for further action.
- Once diagnosed, all high-grade CIN lesions must be treated, either with local destruction (ablation) or excision (provided removal of all pathological tissue is assured).
- Hysterectomy for high-grade CIN lesions is mainly indicated in older, non-compliant patients, or those with co-existent uterine pathology.
- All patients treated for premalignant lesions of the cervix require follow-up cytology and colposcopy at 3, 6, and 12 months, and thereafter annually.
Editor's Comments
With the strengthening of cytological screening programmes, pre-malignant lesions of the cervix are being increasingly identified. These need to be treated effectively for any real impact on cervical cancer incidence and mortality to be made. This article reviews current approaches in the management of abnormal Pap smear results and the different modalities available for the treatment of CIN.
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Role of Radiotherapy in Cervical Cancer
G. K. Rath (Professor and Head)
M. Rakshak (Doctor)
S. Chander (Doctor)
Department of Radiotherapy, Institute Rotary Cancer Hospital (IRCH), All India Institute of Medical Sciences (AIIMS), New Delhi, India
Key Points
- Radiotherapy (RT) is an excellent treatment modality in all stages of invasive cancer of the cervix. It also has an important role in palliative care.
- In patients with bulky parametrial disease and/or distorted cervico-uterine anatomy, interstitial RT is preferable to intracavitary radiotherapy (ICRT), as part of the standard protocol of external RT followed by brachytherapy.
- Intra-operative RT provides a treatment option for recurrent disease; pre- and post-operative irradiation is also useful as adjuvant therapy during hysterectomy.
- In a study done at the IRCH, there was no statistically significant difference in survival rates between patients undergoing RT alone compared with those undergoing induction chemotherapy (CT) followed by RT.
Editor's Comment
This article reviews RT in the management of cervical cancer. Unfortunately, due to widespread lack of awareness, 60% of patients with this disease present at an advanced stage, where irradiation remains a primary and sometimes the only treatment option.
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Role of Chemotherapy in Cervical Cancer
Lalit Kumar (Associate Professor)
Department of Medical Oncology, Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
Key Points
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Local recurrence and distant metastasis is an issue following radiotherapy (RT) treatment alone for advanced disease.
- To date, 'induction' or 'neoadjuvant' chemotherapy (CT) prior to RT has demonstrated response rates no better than RT alone, although the design of many of the studies comparing these treatment modalities has been flawed.
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Neoadjuvant CT and surgery has achieved response rates of 75-100% for stage Ib-IIa disease.
- Concurrent chemo-radiotherapy (CT+RT) has been shown to increase survival rates for patients with locally-advanced disease and appears a reasonable treatment option in such cases.
Editor's Comment
Improving 5-year survival rates for women with cervical cancer is dependent on continual review of treatment protocols in the light of existing research data. Adjuvant chemotherapy is herein discussed in this regard.
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