Cervical cancer stands as a formidable health challenge among Indian women, ranking as the second most common cancer and comprising a substantial portion, 18.3 percent, of new cancer cases in 2020. The gravity of the situation is further underscored by the estimation that approximately 1 in 53 Indian women will confront cervical cancer during their lifetime. To combat this disease effectively, a multifaceted approach to treatment is essential, incorporating surgery, radiation therapy, chemotherapy, and emerging immunotherapeutic interventions.
Surgery emerges as a cornerstone in the management of cervical cancer, particularly in its early stages, says Dr Kanav Kumar, Surgical Oncologist at the Punyashlok Ahilyadevi Holkar Head & Neck Cancer Institute of India, Mumbai.
According to him, the standard surgical procedure involves a comprehensive approach, entailing the removal of the uterus, ovaries, and regional lymph nodes — a procedure known as hysterectomy and pelvic lymph node dissection. However, in cases where fertility preservation is a concern, alternative approaches such as fertility-sparing surgeries may be considered, which involve removing only the cervix along with a cuff of surrounding tissue.
Despite the potential benefits of minimally invasive techniques like laparoscopy and robot-assisted surgeries, their widespread adoption remains limited due to conflicting reports regarding their long-term efficacy and outcomes.
Radiation therapy
Radiation therapy, either alone or in combination with chemotherapy (chemoradiation), serves as a primary treatment modality for locally advanced cervical cancer, says Kumar.
This therapeutic approach can be administered externally over a period of several weeks or internally through brachytherapy, delivering high-dose radiation directly to the site of the primary tumor. While radiation therapy has demonstrated comparable efficacy to surgery, especially in cases of early-stage cervical cancer, the choice between these modalities may hinge on factors such as age and concerns about long-term side effects.
According to Kumar, technological advancements in radiation therapy, such as intensity-modulated radiation therapy (IMRT) and image-guided radiation therapy (IGRT), enable precise targeting of tumors while minimizing damage to surrounding healthy tissue, thereby enhancing treatment outcomes and reducing treatment-related toxicity.
Chemotherapy
Chemotherapy plays a crucial role in managing advanced cervical cancer, either as a standalone treatment or in combination with radiation therapy, says Kumar.
Cisplatin, a commonly used chemotherapeutic agent, acts as a radiosensitiser when administered concurrently with radiation therapy, thereby augmenting treatment efficacy. However, the emergence of immunotherapy as a promising therapeutic avenue has sparked considerable interest in its potential role in the treatment of cervical cancer. Immunotherapy harnesses the body's immune system to recognize and destroy cancer cells more effectively, with fewer side effects compared to traditional chemotherapy.
While immunotherapy has demonstrated efficacy in certain cases of metastatic cervical cancer, its role in treating locally advanced disease remains an area of ongoing research and debate. Affordability also poses a significant barrier to the widespread adoption of immunotherapy, with costs averaging between Rs 1.5-4.5 lakhs per session.
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