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 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. 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.