Dr Chia Yin Nin, a Senior Consultant Gynaecologist at Gynaecology & Oncology Specialists, explains the new gold standard in treating locally advanced cervical cancer.
Neoadjuvant chemotherapy is the use of chemotherapy to shrink a tumour before either surgery or radiation.
Cervical cancer, which affects the junction between the vagina and the uterus, is the 10th most common cancer among women in Singapore and an average of 200 women are diagnosed with it every year. About 70 die from the disease each year.
The current treatment for locally advanced cervical cancer is radiotherapy. Low doses of chemotherapy are often added to the radiotherapy regimen to enhance the effects of radiation. However, such low doses are not sufficient to control the potential spread of cancer cells beyond the cervix.
Based on current technologies available, it may not be possible to detect the spread of cancer cells, which may explain why there is a relatively high recurrence rate for locally advanced cervical cancer.
Despite improvements in the drugs used in chemotherapy and in radiation technology, the recurrence rate is still as high as 30 to 50 per cent.
Between 30 and 80 per cent of women who have undergone treatment survive beyond the five-year mark, which is a very wide range. This is especially so for bulky tumours, where newly-formed tumours may have spread to other parts of the body but are too small to be detected.
The new way forward
The new way forward could be to offer chemotherapy first before radiation therapy.
These chemotherapy sessions are of a high dose and aim to sterilise cancer cells that have spread beyond the cervix. Giving chemotherapy first may allow for surgery which is often not feasible for patients with locally advanced cervical cancer. Cervical cancer was previously thought to be resistant to chemotherapy as the response rates were not good.
However, new chemotherapy agents are proving more effective in cervical cancer and have been shown to reduce the size of the tumour significantly.
Chemotherapy can now transform a previously inoperable tumour into one which could be operated on. Reducing the size of the tumour is important as it greatly simplifies the surgery.
If surgery cannot be done, it also helps facilitate radiation and improves the outcome. By reducing the tumour, radiation works better as radiation penetration is better.
Benefits of neoadjuvant chemotherapy
Studies of patients who undergo neoadjuvant chemotherapy have shown that it helps to improve overall survival rates of people with cervical cancer.
The cure rate, which is defined as a patient who survives more than five years, increased by 30 per cent. At the same time, the relapse rate within five years dropped by 30 per cent.
1. Young women with cervical cancer can still have children
In the past, women with cervical cancer invariably lose their fertility after the cancer treatment. Those with early cancer are often treated with surgery to remove the womb while those with the advanced disease are treated with radiation to the entire womb, which will make the womb unsuitable for pregnancy.
Neoadjuvant chemotherapy may be able to shrink the cervical cancer down to allow a new surgical technique to just remove the cervix with the cancer but preserve the womb. This new technique is called radical trachelectomy and only small cervical cancer (of less than 2 cm) can be treated this way to preserve fertility.
2. Minimise side effects of radiation
By using chemotherapy and then surgery to treat cervical cancer, the need for post-surgery treatment such as radiation is greatly reduced.
Long-term radiation in the pelvic area can have serious side effects for women. For example, it could lead to the shortening or shrinking of the vagina, which would mean the patient cannot have sexual intercourse any more.
3. Good gauge of recovery
How a patient’s body responds to neoadjuvant chemotherapy is a good indicator of how well she will recover from the illness. It tells doctors whether the tumour in the patient’s body is responsive or resistant to treatment and that will show us how likely she is going to outlive the cancer.
Who is suitable?
Anyone with Stage 1B2 to Stage 4A cervical cancer who is fit can qualify for this new treatment.
Side effects of neoadjuvant chemotherapy
The side effects are no different from all other types of chemotherapy – hair loss, nausea and vomiting (medication can now usually control this), mild diarrhoea, suppression of bone marrow with temporary decrease in red blood cells, white blood cells and platelet which could increase one’s risk of suffering an infection.
By Ben Tan
Tags: cancer hair loss, cervical cancer, chemotherapy, common side effects of cancer treatment, dr chia yin nin, neoadjuvant therapy