How Does the Stage of Cervical Cancer Impact Treatment and Prognosis?
Early stage versus advanced stage cervical cancer are different, but how does the stage impact treatment and prognosis? Expert Dr. Shannon MacLaughlan from University of Illinois discusses how the diagnosis changes treatment approaches and proactive advice for patient care.
[ACT]IVATION TIP
“…understand with your provider how your stage influences your treatment…ask about if it’s pertinent to you are one, is there a role you are a candidate for surgery, ask what kind of surgery is best for you? Should it be a minimally invasive surgery, or should it be a traditional surgery with a larger incision?…depending on how old you are at the time of diagnosis and where you are in building a family, ask about fertility preservation options…in the case of early disease or early stage, there can be fertility preservation options that you may need to ask about, rather than wait for your oncologist to volunteer the information…if your doctors say that radiation is right for you, please ask them if the radiation doctors also do something called brachytherapy.”
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Transcript:
Lisa Hatfield:
Dr. MacLaughlan, what does it mean to be diagnosed with cervical cancer at an early stage versus advanced cervical cancer?
Shannon MacLaughlan:
So any cancer will be assigned a stage at the time of diagnosis. And the stage construct is really for providers and researchers to put clinical scenarios into boxes. An oversimplification is that a stage I cancer is confined to the organ where it starts. In this case, the cervix is its own organ. Even though it’s technically part of the uterus, it is its own organ for purposes of staging. The highest, it’s always on a scale of I to IV. So stage IV cancer is a metastatic disease where it has spread to multiple locations. In general, a stage I cancer has a higher survival rate than a stage IV cancer. And that’s true for any cancer that you look at.
So in the case of cervical cancer, someone in an early stage, which typically when we’re talking about early stage cervical cancer, it’s usually stage I. We might clump I and II together, but in simpler terms, in simpler normal language, that means that the tumor is small and it’s confined to a specific location, which makes it easier to deal with, frankly. So the difference between being diagnosed at early stage and late stage means one, the chances of cure are higher, and two, how you and your clinical team move forward with treatment is going to be different.
There’s broadly speaking, there are three different tools that we use in cancer care. One is surgery, radiation, chemotherapy, or I shouldn’t say chemotherapy, I should say systemic therapy or treatment that treats the whole body. And there can be a role for any of those things or a combination of those things in treatment. A very small, early stage I cervical cancer may be cured with surgery alone, whereas an advanced cervical cancer is not, that patient is not likely to receive surgical excision as part of their treatment for curative intent.
My [ACT]IVATION tip is to understand with your provider how your stage influences your treatment. The specific things I want you to ask about if it’s pertinent to you are one, is there a role you are a candidate for surgery, ask what kind of surgery is best for you? Should it be a minimally invasive surgery, or should it be a traditional surgery with a larger incision? Related to that, depending on how old you are at the time of diagnosis and where you are in building a family, ask about fertility preservation options. There aren’t options for everyone.
But in the case of early disease or early stage, there can be fertility preservation options that you may need to ask about, rather than wait for your oncologist to volunteer the information. And then the third piece, the third specific question is if your doctors say that radiation is right for you, please ask them if the radiation doctors also do something called brachytherapy. Brachytherapy is a specific kind of radiation that it’s an integral part of successful treatment for cervical cancer.
Lisa Hatfield:
Okay, thank you. So just to follow up on that point that you made about possibly needing systemic therapy, maybe surgery, maybe radiation, for patients watching this, does that mean that a patient could possibly have a medical oncologist, a radiation oncologist, and a surgeon? Could it…is it possible to have a team of doctors working with them on their cervical cancer treatment?
Shannon MacLaughlan:
Not only is it possible, it’s important. A gynecologic oncologist like myself is someone who is trained…we train in obstetrics and gynecology first, and then we do subspecialty fellowship training in gynecologic oncology so that a gynecologic oncologist who is board-certified is trained and capable of doing the surgeries for gynecologic malignancies as well as the chemotherapy or systemic treatment.
Now, oftentimes we partner with a medical oncologist to give the systemic therapy, but the most important piece is that a gynecologic oncologist evaluates you at some point early in your diagnosis before treatment begins. The second part of your question is that radiation oncology is its own subspecialty. And so, oftentimes gynecologic oncologists and radiation oncologists work together. Unfortunately, sometimes that means going to multiple different locations to get the different kinds of doctors, but we do know that a multidisciplinary approach is an important approach for success.
