Women suffering from gynecologic cancer receive palliative care which uses multidisciplinary approach to address different health issues. There are a number of gynecologic cancers that produce different symptoms and progress in a different manner. Therefore, palliative care is tailored according to the symptoms and complications caused by a specific gynecologic cancer.
Pain Management
Pain management is the primary goal of palliative care for most untreatable cancers. This commonly involves use of narcotics, nonnarcotic pain relievers and radiation therapy. Surgical treatment is usually used to improve problems related to bowel obstruction and fistulas which arise from progressive gynecologic cancer. Palliative care includes services provided by a gynecologic oncologist, a radiation oncologist, a radiologist, a pain specialist, a palliative care physician and interventional radiologist.
Cancer of the Cervix
Cancer of the cervix, or cervical cancer, typically metastasizes to nearby tissues in the pelvis and regional lymph nodes before it starts spreading distant body organs. While the cancer is regionally confined, it can be treated with chemotherapy, radiation therapy and surgery. However, in advanced stages, cervical cancer is generally incurable and dealt with palliative medicine.
Advanced cervical cancer commonly causes symptoms such as abnormal vaginal bleeding or discharge, back pain, pain in the pelvis, urinary or bowel fistulas, edema in lower legs, deep venous thrombosis (DVT), dyspnea from anemia and uremia from ureteral obstruction.
Palliative Care for Vaginal Bleeding
Palliative treatment for abnormal vaginal bleeding due to cervical cancer, includes vaginal packing, radiation therapy, embolization of the uterine arteries, surgical resection and arterial ligation. Vaginal bleeding is temporary managed by vaginal packing which can be gauze, lamb’s wool or calcium alginate. Ferric subsulfate solution can be applied to gauze before inserting vaginal packing for better results.
Vaginal bleeding can be also slowed or stopped with transvaginal orthovoltage treatment, high-dose fraction teletherapy or brachytherapy. Karnofsky performance status (KPS) of the patient determines the type and duration of the treatment. In patients with relatively high Karnofsky score, vaginal bleeding may be treated with stereotactic radiosurgery.
Anemia caused by hemorrhage is addressed with blood transfusion after the bleeding is stopped.
- IP chemotherapy is delivered through an implanted subcutaneous port that drains into the cavity of the abdomen, allowing direct access for the drug to the peritoneal cavity, where ovarian cancer has spread. Its use, however, can cause more frequent and more severe side effects than IV chemotherapy, including abdominal pain, nausea, and vomiting.
- In 2006, results from a large clinical trial showed that treatment with IP and IV chemotherapy extended median overall survival for patients with ovarian cancer by more than a year, compared with women treated with IV chemotherapy alone.
- IP treatments increased from 0 to 33 percent between 2003 and 2006, and up to 50 percent by 2008, leveling off from that point forward. Use of IP chemotherapy in eligible patients, however, varied substantially by National Comprehensive Cancer Network center, from 4 percent to 67 percent. When IP chemotherapy was used, the treatment was modified in more than 40 percent of patients from the approach used in the definitive phase III clinical trial.
- The 3-year overall survival was 81 percent in women treated with IP/IV chemotherapy (402 women), compared with 71 percent in those treated with IV chemotherapy alone. Nearly 60 percent of women who received IP chemotherapy completed all planned cycles of therapy, and there were no differences in infections or nausea and vomiting between the two groups.
Pulmonary Complications
End-stage cervical cancer can lead to dyspnea due to anemia, heart failure, infections, pleural effusion and lymphangitic spread of the cancer. Dyspnea can be considerably improved with blood transfusions. Symptoms of pleural effusion are managed with thoracentesis with pleurodesis. Oxygen and narcotics are administered to treat lymphangitic spread of cancer. Pneumonia and heart failure are treated with common treatments for these conditions whether they are due to cancer or not.
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