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- Mon Dec 07, 2009 2:10 am
My mother is 70 years old and she was diagnosed for Cervical Cancer Stage IIIA. She took radiotherapy but she can not take chemotherapy because of her weight. She is 36kgs.
Now she has serious back pain and she can not sleep the whole night.
What can we do to help her?
| Dr.M.Aroon kamath
- Tue Dec 22, 2009 9:02 pm
Invasive cervical cancer accounts for about 6% of all cancers that afflict women in the United States. Stage IIIA (involves lower third of vagina but, not the pelvic side wall) by the criteria of the International Federation of Gynecology and Obstetrics (FIGO), accounts for less than 2% of all cervical cancer cases.
Over 90% of cervical carcinomas are squamous cell carcinomas. About 5-9% start in glandular tissue (adenocarcinoma). Adenocarcinomas are more difficult to diagnose, but the treatment is as for squamous cell carcinomas and the survival rates, stage for stage, are similar.
There are several types of adenocarcinoma. Approximately 60% are the endocervical cell type, 10% each are of endometrioid and clear cell carcinomas, and 20% are adenosquamous carcinomas.
There are two rare types of cervical carcinoma known as small cell carcinoma and cervical sarcoma. Both have a poor prognosis.I am not aware of which histologic type of tumor your mother suffers from.
Management of stage IIIA patients is by a combination of radiotherapy and chemotherapy.The radiation therapy treatment program includes intracavitary and vaginal brachytherapy plus external beam radiation therapy, with a strong emphasis on individualized treatment.Your mother obviously,did not have chemotherapy.
As your mother now has low back pain,several possibilities ought to be considered before one can formulate a treatment plan,
- re-staging to ascertain the current stage (if it has climbed to stageIIIB by involving the pelvic side wall or has distant mets).If indeed it has progressed, ureteric obstruction/hydronephrosis can occur and may help to explain the back pain-
- tumors can involve the pelvic nerves & thus cause back pain.
- secondaries in bone also need to be excluded (although infrequent).
The most frequent site of metastasis is the vertebral column, particularly the lumbar & thoracic spine, followed by the pelvic bones.Management of painful bony mets is usually by radiotherapy and chemotherapy.
Pain management would depend upon first finding out what is presumably causing her pain and generally a team approach is needed in management of cancer pain.