Treating cervical cancer


Cancer care changes rapidly, and it is hard for the generalist to keep up to date, so referral to a specialist is essential. The needs of an older cancer patient often extend beyond the doctor's office and the traditional services provided by visiting nurses. These needs may include transportation, nutrition, emotional, financial, physical, or spiritual support. When an older woman with cervical cancer is the primary caregiver for a frail or ill spouse, grandchildren, or other family members, special attention is necessary to provide for their needs as well. Older cancer patients cared for in geriatric oncology programs benefit from multi-disciplinary teams of oncologists, geriatricians, psychiatrists, pharmacists, physiatrists, social workers, nurses, clergy, and dietitians, all working together as a team to identify and manage the stressors that can limit effective cancer treatment.


Surgery (hysterectomy or cold knife cone) for cervical cancer is a relatively low-risk operation and the standard of care for all women with very early stage cervical cancer, regardless of age. When cervical cancer is more advanced but still confined to the cervix, surgery and radiation are equally effective and the "right decision" depends on many factors. You and your physician need to discuss the advantages and disadvantages of both approaches. Like other treatment options, surgery in some older women may involve risks related to decreases in body organ function (especially in the heart and lungs), and it is essential that the surgeon and anesthetist work closely with the primary care physician (or a consultant) to fully assess and treat these problems before, during, and after the operation. Because future childbearing is not an issue for older women, most cervical cancer operations (see Chapter 3) will involve removing the cervix and uterus (hysterectomy).


Radiation therapy may be an effective option for some women who have early stage cervical cancers, especially if the patient cannot tolerate surgery. It is also used as an adjunct to surgery (often with chemotherapy) in women who, despite having early stage disease, are at high risk for recurrence (see Chapter 3). Radiation (often with chemotherapy) is also the treatment of choice for most advanced cervical cancers. In addition, radiation therapy is particularly useful in treating recurrent cervical cancer patients who have not received radiation in the past. Healthy older women usually tolerate radiation therapy quite well, and even frail patients may find the side effects acceptable.

Though studies in older women have found no significant increase in the side effects from radiation therapy, the fatigue that often accompanies radiation therapy can be quite profound in the elderly, even in those who are fit. Often the logistic details (like daily travel to the hospital for a 6-week course of treatment) are the hardest for older people. It is important that you discuss these potential problems with your family and social worker prior to starting radiation therapy.

Although radiation therapy may sound more appealing than an operation, surgery is actually quicker and usually has fewer long-term side effects. Radiation therapy may contribute to urinary problems or difficulties with bowel movements and can sometimes make sex difficult or painful by causing scarring or shortening of the vagina. It may be hard for you to discuss these issues with your doctor, but be sure that you do. Many people make the mistake of assuming that sex is not important to older women.


Chemotherapy is usually used as a sensitizer (chemo-sensitization) with radiation therapy in women with more advanced cervical cancer that has not yet metastasized. Chemotherapy can also be given by itself to treat metastatic (stage IV) cervical cancer or certain types of recurrent cervical cancer.

Older cancer patients who are not frail respond to chemotherapy similarly to their younger counterparts. Though the side effects of cancer treatment are never less burdensome in the elderly, they can be managed by oncologists, especially geriatric oncologists, who work in teams with others who specialize in the care of the elderly. With appropriate care, healthy older women do just as well with chemotherapy as younger women.

Advances in supportive care (antinausea medicines and blood cell growth factors) have significantly decreased the side effects of chemotherapy and have improved the safety and the quality of life of older women with cervical cancer. Nonetheless, there is risk, especially in frail patients.

Platinol AQ is usually used when chemotherapy is given with radiation therapy. It serves to sensitize the tumor to the effects of the radiation (see Chapter 3), but this benefit is not without its downsides. Platinol AQ can cause severe side effects in older patients, especially fatigue and problems related to the kidney (nephrotoxicity). Those treated with Platinol AQ chemotherapy require large amounts of intravenous fluid hydration, which can cause congestive heart failure in people with heart problems.

Alone or in combination, Platinol AQ, Paraplatin, Taxol, Hycamtin (topotecan), and Garamycin (gentamicin) are the most commonly used agents for metastatic cervical cancer. Healthy older patients can receive the same regimens as their younger counterparts, including those that are cisplatin-based. Taxol and Paraplatin are often the first regimen chosen for metastatic disease and this combination is usually well tolerated. Older women whose cervical cancers have progressed despite first-line therapy have the same benefit from chemotherapy as their younger counterparts. They should not be excluded from receiving chemotherapy for advanced cervical cancer. Preference should be given to chemotherapeutic drugs with safer profiles, such as weekly taxane regimens and Paraplatin. Single-agent therapy is less toxic and may be a reasonable palliative alternative to combination chemotherapy in some elderly patients.

common treatment complications iN THE elderly

Anemia (low red blood cell count) is common in the elderly, especially the frail elderly. It decreases the effectiveness of chemotherapy and often causes fatigue, falls, cognitive decline (for example, dementia, disorientation, or confusion), and heart problems. Therefore, it is essential that anemia be recognized and corrected with red blood cell transfusions or the appropriate use of erythropoiesis-stimulating agents like Procrit and Epogen (epoetin) or Aranesp.

Myelosuppression (low white blood cell count) is also common in older patients receiving chemotherapy or radiation. Older patients with myelosuppression develop life-threatening infections more often than younger patients, and they may need to be treated in the hospital for many days. The liberal use of granulopoietic growth factors (or

G-CSF, including Neupogen [filgrastim] and Neulasta) decreases the risk of infection and makes it possible for older women to receive full doses of potentially curative adjuvant chemotherapy.

Mucositis (mouth sores) and diarrhea can cause severe dehydration in older patients who often are already dehydrated due to inadequate fluid intake and diuretics ("water pills" for high blood pressure or heart failure). Careful monitoring, the liberal use of antidiarrheal agents (Imodium), and oral and intravenous fluids are essential components of the management of older cancer patients.

Kidney function declines as we age. Some of the medicines that older patients take to treat both their cancer (for example, Platinol AQ, Paraplatin, Zometa [zoledronic acid], NSAIDs) and noncancer-related problems might further worsen kidney function. The dehydration that often accompanies cancer and its treatment can put additional stress on the kidneys. Fortunately, it is often possible to minimize these effects by carefully selecting and dosing appropriate drugs, managing polypharmacy, and preventing dehydration.

Neurotoxicity and cognitive effects (chemo-brain) can be profoundly debilitating in patients who are already cognitively impaired (demented, disoriented, confused, etc.). Elderly patients with a history of falling, hearing loss, or peripheral neuropathy (nerve damage from, for example, diabetes) have decreased energy and are highly vulnerable to neurotoxic chemotherapy like the taxanes or platinum compounds. Many of the medicines used to control nausea (antiemetics) or decrease the side effects of certain chemo-therapeutic agents are also potential neurotoxins. These medicines include dexamethasone (psychosis and agitation), ranitidine (agitation), diphenhydramine, and some of the antiemetics (sedation).

Fatigue is a near universal complaint of older cancer patients. It is particularly a problem for those who are socially isolated or dependent upon others for help with activities of daily living. It is not necessarily related to depression, but can be. Depression is quite common in the elderly. In contrast to younger patients who often respond to a cancer diagnosis with anxiety, depression is the more common disorder in older cancer patients. With proper support and medical attention, many of these patients can safely receive anticancer treatment.

Heart problems increase with age, and it is no surprise that older cancer patients have an increased risk of cardiac complications from intensive surgery, radiation, and chemotherapy. Patients treated with Platinol AQ chemotherapy require large amounts of intravenous fluid hydration, which can cause congestive heart failure in patients with heart problems; they need careful monitoring.

Trusted Resources— Finding Additional Information About Cervical Cancer and Its Treatm ent

National Cancer Institute


This organization provides information about all types of cancer, including excellent information about cervical cancer, what it is, how it is treated, and where various treatment options are provided. You can request free information by calling the toll-free number.

Specific information for patients and family members seeking to learn more about cervical cancer, treatment options, and current clinical trials can be found at http://

American Cancer Society

1-800-ACS-2345 asp?dt=8

National Cervical Cancer Coalition

This Web site provides information, with an emphasis on personal outreach support, for women and their families dealing with cervical cancer.

Women's Cancer Network

This organization provides women information on research, risks, prevention, and treatment for gynecologic cancers, and empowers them to make informed decisions regarding their health care.

Fertile Hope

Fertile Hope is an organization dedicated to providing reproductive information, support, and hope to cancer patients and survivors whose medical treatments present the risk of infertility.

where can I GET HELp wiTH FINANciAL oR LEGAL coNcERNs?

Accompanying any serious illness are questions and concerns related to expenses incurred as a result of treatment, health insurance questions that can be overwhelming to try to understand or resolve alone, and sometimes even legal questions related to employment or financial matters. The following is a list of national resources to aid you in addressing these types of concerns.

Finding Additional Information About Cervical Cancer and Its Treatment

CancerCare http://1-212-712-8.400


Email: [email protected]

CancerCare is a national nonprofit organization that provides free, professional assistance to people with any type of cancer and to their families. This organization offers education, one-on-one counseling, financial assistance for nonmedical expenses, and referrals to community services.

National Coalition for Cancer Survivorship (NCCS)



Email: [email protected]

This network of independent groups and individuals provides information and resources about cancer support, advocacy, and quality-of-life issues as well as helps cancer patients deal with insurance or job discrimination and other related legal matters.

Patient Advocate Foundation (PAF)



Email: [email protected]

This organization provides educational information about managed care/insurance issues and legal counseling on debt intervention, job discrimination issues, and insurance denials of coverage.

information about johns hopkins

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