Elimination of pre-cancerous alterations in the cervix
When a precancerous alteration is diagnosed, an evaluation is made as to whether it should be removed with a small operation (usually under local anaesthesia), based on the type and duration of its persistence. The elimination of precancerous alterations occurs in different ways. At the IEO, laser is available which makes not only the vaporisation of alterations possible, but also their excision (laser conisation) in order to obtain the histological examination of the visible alteration. Otherwise, the excision can be performed using a diathermic loop and subsequently defined with laser, always under colposcopy guidance.
The methods used for the elimination of alterations are guided by colposcopy that allows the elimination of the visible alteration. On the contrary, interventions without a direct and enlarged view, such as cold knife conisation (by means of a scalpel), are less precise and generally require further treatments.
Treatment of cervical cancer and metastases symptoms
When an invasive carcinoma is diagnosed, treatment options vary according to the degree of invasiveness, the stage and the extension of the cervical cancer. The stage is one of the most important factors in deciding how to treat the cervical cancer and determining how successful treatment might be. Cervical cancer stage ranges from stages I (1) through IV (4). In cases of only initially-invasive cervical cancer - carcinomas, with infiltration of less than 7 mm, detection is performed through the histological examination of the pre-cancerous alteration excised. The excision of the alteration through laser conisation can be considered as treatment for a minimally-invasive carcinoma, especially in cases of squamous cell carcinoma, even if in some cases the surgical evaluation of the lymph nodes must be added.
In cases when an adenocarcinoma is found, although minimally-invasive, only laser excision of the cervical cancer can be considered in young patients who still desire pregnancy, otherwise it is better to consider a surgical removal of the uterus.
Distant metastasis was defined according to the International Federation of Gynecology and Obstetrics and included non-regional lymph nodes (including inguinal lymph nodes for endometrial cancer) as well as lesions in the peritoneum, liver, lung and bone. The diagnosis is based on signs, symptoms and imaging. New classes of drugs and new interventions have given patients a better quality of life and improved their life expectancy. It is necessary to use a multidisciplinary approach to treat patients with metastasis, in particular bone metastasis. Bone metastases are classified as osteolytic, osteoblastic or mixed, according to the primary mechanism of interference with normal bone remodeling. Bone metastases symptoms are characterized by severe pain, impaired mobility, pathologic fractures, spinal cord compression, bone marrow aplasia and hypercalcemia. Treatment decisions depend on several parameters, for example, whether bone metastasis are localized or widespread, whether there is evidence of extraskeletal metastases, the kind of cervical cancer and its features, prior treatment history and disease response, symptoms and the general state of health. Treatments can often shrink or slow the growth of bone metastasis and can help with the related symptoms but they are not curative. Distant metastasis guides treatment strategy, triggering initiation of chemotherapy or radiation therapy regimens aimed at controlling hematogenous spread of disease and/or targeting individual metastatic lesions for palliation. Thus, pain management with analgesic and radiation should be utilized as indicated during the initiation of these therapies. Radiotherapy is the treatment of choice for both localized bone pain and in the presence of poorly localized bone pain or recurrence of pain in previously irradiated skeletal sites.