Clinical Obstetrics and Gynaecology by Brian A. Magowan Mb Chb Frcog Dipfetmed & Philip Owen Mb Bch Md Frcog & James Drife Md Frcog Frcped Frcsed Honfcogsa

Author:Brian A. Magowan Mb Chb Frcog Dipfetmed & Philip Owen Mb Bch Md Frcog & James Drife Md Frcog Frcped Frcsed Honfcogsa
Language: eng
Format: mobi
Tags: Medical, Gynecology & Obstetrics
ISBN: 9780702042003
Publisher: Saunders
Published: 2009-07-31T14:00:00+00:00

Stage IIB–IV

The treatment of advanced-stage disease usually involves radical radiotherapy in combination with cisplatin chemotherapy. Failure to cure inoperable cervical cancer may result from suboptimal treatment of the central disease or the existence of lymph node metastases. With large lesions, the sensitivity of adjacent structures to radiation may prevent use of curative radiation doses at the tumour periphery, and, furthermore, some tumours may be radio-resistant.

Recurrent disease

Those patients with recurrence have a 1-year survival of around 10–15%. Most recurrences are suitable for palliative care only. If the patient has not been previously treated with radiotherapy, this may be a treatment option, but the majority of patients will have already had radical radiotherapy. Patients with a central pelvic recurrence may be cured by pelvic exenteration (excision of vagina/uterus with the bladder or rectum or both). With careful selection, up to 60% of these cases may survive 5 years, but the operation is associated with major morbidity.

The remaining patients may benefit from chemotherapy to palliate symptomatic recurrence or radiotherapy to palliate recurrence involving bone or nerve roots. The most active chemotherapy agents are cisplatin and ifosfamide, and combinations based on these drugs cause initial tumour shrinkage in up to 70% of cases. The main benefit from chemotherapy is the relief of disease-related symptoms, such as pelvic pain, but chemotherapy itself can cause considerable toxicity and does not improve survival in these women.

Download

Copyright Disclaimer:
This site does not store any files on its server. We only index and link to content provided by other sites. Please contact the content providers to delete copyright contents if any and email us, we'll remove relevant links or contents immediately.