Cancer Treatment

What are the treatment choices?

Surgery, chemotherapy and radiotherapy are the key treatments for cancer. These can be used alone or in combination depending on the type and size of the cancer as well as how much the cancer has grown. There is always a risk with treatment as well as benefit but your specialist will discuss with you the options they consider best, why they are suggesting that for you including the advantages, disadvantages and risks so you will know what to expect. The best choice of treatment will also depend on your age, general health, personal needs and attitude. These are all discussed during your consultation and your doctor will take them into consideration when recommending treatment.

SURGICAL TREATMENT

What is it used for?

Surgery means treating illness by cutting away body tissue and is one of the main treatments for cancer. Surgical treatment is tailored depending on the site and extent of the cancer and can be used for a number of purposes:

  • Diagnosis
    To confirm the diagnosis of cancer and find out about the type of cancer and its spread, the doctor may remove a small piece of tissue which is then sent to the laboratory to be examined by pathologists. This is called a biopsy.
  • Treatment
    Where possible, surgery is used to remove the tumour and nearby tissues that might contain cancer cells. If the cancer has spread and cannot be totally removed by surgery, you may still have surgery to remove the primary tumour.
  • Staging
    This is the process that doctors use to work out the stage of the cancer and whether it has spread to other parts of the body. It can be done at the same time as surgery to remove a tumour. Information about the stage of the cancer is used in planning treatment.
  • Reconstruction
    Surgery can be used to restore a part of the body.
  • Debulking
    If the cancer cannot be completely removed or cured, surgery can sometimes still help by removing a lump to reduce its effects, such as blockage, discomfort, or other complications.

If a need for an operation is indicated, your doctor at the Women’s Cancer Centre will discuss why they are recommending it and the procedure itself in detail with you and, if you wish, with your family and/or friend/s. Sometimes surgery is not an option for a variety of reasons which your doctor will explain to you during your appointment.

Types of Surgery

Most gynaecological cancer operations will take at least an hour. Your doctor will explain to you the particular operation they recommend for you at your consultation, but some of the main procedures could involve one or a combination of the following:

Colostomy surgery for most gynaecological cancers does not require a colostomy except for advanced ovarian cases or when bowel obstruction occurs when the doctor has no option but to remove or divert part of the digestive system, which may be damaged due to the spread of the cancer beyond the ovaries. This means the body cannot rid itself of waste in the nature way and needs a surgical opening (a stoma) to help do this.

Hysterectomy is an important treatment of gynaecological cancers and is an operation where the uterus is removed. The main types of hysterectomy are:

  • Abdominal hysterectomy which is the surgical removal of the uterus leaving part or all of the cervix which is carried out by the means of an incision in the lower part of the abdomen.
  • Total Abdominal Hysterectomy is the surgical removal of the entire uterus including the cervix, but not the ovaries or the fallopian tube. This procedure is also referred to as TAH.
  • Total Abdominal Hysterectomy with Bilateral Salpingo-Oophorectomy includes the complete removal of the cervix, uterus, ovaries and fallopian tubes. This procedure is also referred to as TAH + BSO.
  • Subtotal abdominal hysterectomy involves the removal of the upper portion of the uterus leaving the cervix attached to the vagina.
  • Radical Hysterectomy or Wertheim’s Hysterectomy involves the removal of the uterus including the cervix, upper 1-2cm of vagina and most of the tissue surrounding the cervix in the pelvic cavity.

Laparoscopy is a surgical procedure, which involves the use of a telescope attached to a television screen. It is used to look at the internal organs under a general anaesthetic. A tiny incision is made in the umbilicus and the abdomen distended with gas. The telescope is then put in and provides your surgeon with an excellent, magnified view of the uterus, tubes and ovaries (and other abdominal organs) seen with the aid of a camera and video screen. Other instruments to hold tissues and perform biopsies or surgery itself are inserted via small channels placed through the skin in the lower abdomen.

Laparotomy an operation in which a long cut is made in the abdomen.

Lymph node resection remove the main lymphatic vessels and lymph nodes that are nearest to the cancer, or the organ where the cancer is. This is because the main draining lymph nodes and vessels are the most likely place for cancer cells to spread.

Omentectomy is the removal of the omentum.

Salpingo-Oophorectomy is the surgical removal of both ovaries and fallopian tubes. The different types of this procedure are:

  • Right Salpingo-Oophorectomy (RSO) removal of the right ovary and fallopian tube
  • Left Salpingo-Oophorectomy (LSO) removal of the left ovary and fallopian tube
  • Bilateral Salpingo-Oophorectomy (BSO) removal of both left and right ovary and fallopian tubes

Vulvectomy is the surgical removal of part or all of the vulva. There are several different types of vulvectomy the type of which used depending on where the cancer is, and how easy it is for your doctor to take a border of healthy tissue away as well as the cancer:

  • Partial vulvectomy This means removing part of the vulva. You may be able to have just the inner or outer labia removed. Or the labia removed from one side only
  • Simple vulvectomy is the removal of the whole vulva – both the inner and outer lips of the vagina. The clitoris may have to be removed as well.
  • Radical vulvectomy is performed when the whole of the vulva is removed as well as the lymph nodes on one or both sides of your groin. The lymph nodes in the groin are usually the first place where cancer cells spread from the vulva. Removing them makes it less likely that the cancer will come back.

Where is the surgery performed?

 At the time of your consultation your doctor will discuss with you the surgery recommended and complete the consent forms for this with you. You will be given an information pack which will include the name(s) of your procedure, any specific prior surgery preparation, instructions regarding any medication you may be currently taking, expected stay in hospital as well as the date and time of admission to the hospital and where to come to on the day. Generally speaking, you will need a few weeks to recover prior to undergoing any additional therapy (if needed) and your doctor should give you detailed instructions on how to take care of yourself during that time. Other further possible treatment options could include radiotherapy and/or chemotherapy. Your doctor will discuss with you during your post operative visit if this is to be recommended. Coming into hospital can be an anxious time for you and those close to you. If you have any concerns or questions, please do not hesitate to phone the reception at the Women’s Cancer Centre or any of the team caring for you. They will be happy to listen to you and to help or advise you.

Columba Women’s Healthcare
Day stay surgery facilities at the Columba Women’s Healthcare are used for minor surgical procedures.

What to expect
Columba Women’s Healthcare is located on the 2nd floor of Ascot Hospital. Every care is made by the staff to make sure that your visit to the clinic is as pleasant as possible. It is suggested that you arrive 10-15 minutes prior to your procedure to allow time for check-in with the reception staff and for the nurses to prepare you for your procedure. Please ensure that you wear comfortable, easy-to-fold clothing and leave any valuables including all jewellery at home. If you are having a general anaesthetic it is important that you have nothing to eat or drink four-six hours prior to your surgery. Arrangements should be made with a friend or family member to drive you home after your procedure.

Ascot Hospital
Major surgical procedures are carried out at Ascot Hospital operating theatres.

What to expect
You will usually be asked to check in at the main foyer reception located on the ground floor of Ascot hospital an hour prior to your procedure. The staff on reception will be advised to expect you and take care of you from there. If you are staying overnight or longer, you should bring with you: bed attire, dressing gown, comfortable leisurewear, slippers/footwear, personal toiletries and reading material. The inpatient beds are comfortable, hotel style accommodation based on the fourth floor of the hospital. Your friends and family members will be able to visit you there after your surgery. Visiting hours are usually from 10.00am-8.00pm, but the nursing staff would be happy to arrange for visits when you prefer. For more information about Ascot Hospital please visit their website.

RADIOTHERAPY

What is Radiotherapy used for?

Radiotherapy is treatment involving the use of high energy rays to kill cancer cells and stop them from growing and multiplying. Radiotherapy can be used to:

  • Shrink a cancer before surgery
  • Reduce the risk of a cancer coming back after surgery
  • Cure a cancer by itself or in combination with chemotherapy
  • Control symptoms and improve quality of life when a cancer is too advanced to cure

Types of Radiotherapy

There are many different types of radiation therapy but your radiation oncologist will explain to you what they recommend for you and the type of cancer you have as well as explaining the risks and the benefits of receiving the treatment. Because the radiation beam can pass through normal tissues, side effects to the treatment of the cancer can occur. Some of these can be long lasting and it is important to ask your doctor how long these side effects usually last and what you can do to help minimise them. Treatments can vary from one single dose to between 30-35 doses. The term for radiation dosage is the Gray. The total dose is divided into smaller doses known as fractions. The treatment period may last up to 6-7 weeks. Your doctor will explain to you in detail the particular treatment they recommend for you at the time of your consultation. There are two main types of radiation treatment which can be used alone or in combination. These are:

  • External Radiation which is electronically procedued by a linear accelerator, deep therapy or superficial therapy machine.
  • Internal Radiation, also known as brachytherapy involves placing an implant of radioactive material such as caesium or iridum into the body, close to the cancerous tissue.

You can learn more about Radiotherapy at our recommended web links listed below.

Disclaimer:The Internet provides a lot of information on further reading and resources that are available from organizations and institutions around the world. This section provides a list of such sites, which are either New Zealand based or overseas. The information provided here is for extra reading and information and should not be used to make self-diagnoses or used as a substitute for advice from your doctor. The benefits and risks of treatments will depend on your personal medical condition and may vary from person to person. Always check with your doctor if you have queries or concerns. Please also be aware that the information contained in the websites listed below may not necessarily be relevant to you and your needs. Or you may read information which is contrary to what your doctor has recommended to you. If you read anything which you are not sure about or which is contrary to what is recommended, please ensure you discuss any concerns at the time of consultation with your doctor.

Chemotherapy

What is Chemotherapy used for?

Chemotherapy is a treatment involving the use of anti-cancer drugs. Chemotherapy stops cancer cells from dividing and multiplying. It travels through the bloodstream and kills cancer cells in different parts of the body. Chemotherapy can be used to:

  • Shrink a cancer before surgery
  • Reduce the risk of a cancer coming back after surgery
  • Reduce the risk of a cancer coming back after surgery
  • Cure a cancer by itself or in combination with radiotherapy
  • ontrol symptoms and improve quality of life when a cancer is too advanced to cure

What are the different types of chemotherapy?

There are many different types of chemotherapy but your doctor will explain to you what they recommend for you and the type of cancer you have as well as explaining the risks and the benefits of receiving the treatment. Some of the drugs are stronger than others and can cause side effects such as hair loss and it is important to talk to your doctor and discuss the possible side effects of your proposed treatment and what you can do to minimize them. Sometimes one type of chemotherapy drug is given by itself either as tablets, capsules, injection or IV infusion or ‘drip’. More often, two or more drugs are given together.

You can learn more about Chemotherapy at our recommended web links listed below

Disclaimer:The Internet provides a lot of information on further reading and resources that are available from organizations and institutions around the world. This section provides a list of such sites, which are either New Zealand based or overseas. The information provided here is for extra reading and information and should not be used to make self-diagnoses or used as a substitute for advice from your doctor. The benefits and risks of treatments will depend on your personal medical condition and may vary from person to person. Always check with your doctor if you have queries or concerns. Please also be aware that the information contained in the websites listed below may not necessarily be relevant to you and your needs. Or you may read information which is contrary to what your doctor has recommended to you. If you read anything which you are not sure about or which is contrary to what is recommended, please ensure you discuss any concerns at the time of consultation with your doctor.

Oncolink

Hormone Therapy

Hormone Therapy can be used in certain cancers that have “hormone receptors” that make them respond to such treatments. This mode of treatment can be used to prevent the cancer returning eg after surgery. In some cancers which are not curative it can be used to stabilize the disease enough to provide good quality of life.

You can learn more about Hormone Treatment at our recommended web links listed below

Disclaimer:The Internet provides a lot of information on further reading and resources that are available from organizations and institutions around the world. This section provides a list of such sites, which are either New Zealand based or overseas. The information provided here is for extra reading and information and should not be used to make self-diagnoses or used as a substitute for advice from your doctor. The benefits and risks of treatments will depend on your personal medical condition and may vary from person to person. Always check with your doctor if you have queries or concerns. Please also be aware that the information contained in the websites listed below may not necessarily be relevant to you and your needs. Or you may read information which is contrary to what your doctor has recommended to you. If you read anything which you are not sure about or which is contrary to what is recommended, please ensure you discuss any concerns at the time of consultation with your doctor.

 WHAT HAPPENS AFTER TREATMENT?

Post-operative and follow up visits

Your doctor will also ask you to make an appointment during the week following your discharge from hospital to discuss the histology results and recommendations from the Multi Disciplinary Meeting. You will also have a postoperative appointment usually 5-6 weeks from the date of your surgery. Please ensure that you telephone the reception to make these appointments. Post-operative appointments are usually 15 minutes but may be longer if you wish the doctor to go into more detail, explanation or to discuss any issue you wish to raise. At the time of these appointments your doctor will discuss with you the results from your surgery and any possible further treatment options if applicable. You will be given your patient folder containing information of your condition, all notes, operation, histology etc carried out to date. This is to help you learn and understand your disease, treatment options, management and ongoing support.

Supervision of Clinical Management

All cancer cases are discussed at a weekly Multi Disciplinary Meeting. This meeting is made up of a team of gynaecological oncologists, pathologists, medical and radiation oncologists, as well as radiologists to ensure the best and most appropriate plan for further management and follow up care is mapped out. The strength of this multidisciplinary group of specialists is that it allows your case to be looked and discussed at from various viewpoints. This means that the management of your cancer is based on a group decision rather than on an individual bases.

Ongoing Management

Different types of cancers behave differently from each other and how they affect you will not necessarily be the same as how they affect another woman. Because of this you may need to have further ongoing management. As part of the ongoing management and support your specialist here at the Women’s Cancer Centre will discuss any further recommended management with you and refer you to other specialists if further treatment is required. You will also receive a copy of any correspondence written by your doctor. Please ensure that you keep this in your patient folder given to you at the time of your post-operative visit.

Follow Up Care During Further Treatment

As part of the service and care provided by the doctors at the Women’s Cancer Centre further management will continue to be followed through even if you are referred to other specialists or hospitals. We will also keep in touch with you during any further treatment you might require such as the chemotherapy and radiotherapy. A visit to your doctor at the Women’s Cancer Centre is recommended during the first 3-4 months of any further treatment you may receive. The doctors are aware that this is a busy time for you with perhaps daily visits to other specialists, not feeling well combined with the emotional turmoil you and those close to you may be feeling; but they do recommend the visit to see your doctor at the Centre to ensure that all is going well with you gynaecologically.

Long Term Management

There are many different types of cancers that behave quite differently from each other. Whilst you may have received treatment and are free of disease you will also be recommended to have long term follow up to ensure that no recurrence of the cancer happens. Some cancers require follow up after treatment for up to 5 years, some for 10 years and some need to be followed up for life. Your doctor will explain to you the most appropriate long-term follow up care they would suggest for you.