The treatment is primarily systemic with chemotherapy and/or hormonal therapy;there is little role for surgery. Local treatment to an ulcerating primary may be given(such as radiotherapy or 'toilet' mastectomy), but most will improve with effectivesystemic therapy. However, when previous hormonal therapies have failed to work, or if the patient's disease is rapidly growing and involving vital organs such as liver or lung, effective control is more likely with chemotherapy.
ENDOMETRIAL AND CERVICAL CANCER For many years, a large part of the workload of radiotherapy departments has been thetreatment of cancer of the cervix and endometrium. These are the sites mostcommonly treated with intra-cavitary radioactive isotopes, usually caesium.Applicators may be inserted into the vagina and/or the uterus under a generalanaesthetic to guide placement and maintain the position of the isotope. For reasons of radioprotection, an afterloading technique is usually used whereby the radioactivesources are inserted into the preplaced applicators automatically using a system suchas a Selectron (Fig. 11.11).CARCINOMA OF THE CERVIXThe most common is squamous cell carcinoma. The disease is usually staged usingthe FIGO (Fédération Internationale de Gynécologie et d'Obstétrique) staging system.Investigations include an examination under anaesthetic and cystoscopy to assesslocal extent, as well as staging by intravenous urography (IVU), chest X-ray and blood tests.Figure 11.11
Selectron treatment of cervical cancer.
An X-ray taken after theinsertion of metal applicators into the vaginal vault and endometrium. Radioactivesources will be inserted into the applicators remotely (afterloading technique). Thefine lines are in gauze packing, to keep the applicators in place.Treatment depends on the stage:
(cervical intra-epithelial neoplasia, CIN): local ablationwith laser therapy or diathermy.
: cone biopsy or a simple hysterectomy in older patients past child-bearing age will be curative in the majority of cases.
Invasive but localised disease
: radical surgery with a Wertheim's hysterectomy or radical radiotherapy offers potential cure. There are advantages and disadvantagesassociated with both of these treatments and patient preference is an importantconsideration. Often radiotherapy is offered to older patients and those not fit for surgery.In selected cases where there is a high risk of recurrence, there may be a role for post-operative radiotherapy. Where there is incurable disease, chemotherapy with acombination such as methotrexate and cisplatin may be beneficial.CARCINOMA OF THE CORPUS UTERIThe mainstay of treatment is surgery. An examination under anaesthetic and dilatationand curettage are essential as part of the staging investigations. The FIGO staging