Department of Gynecologic Oncology & Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas 77030, USA.
J Natl Compr Canc Netw. 2013 Mar 1;11(3):348-55. doi: 10.6004/jnccn.2013.0044.
Women should not die of cervical cancer...but they do. Most cases of cervical cancer are preventable and, if caught early, highly curable. Despite this, cervical cancer is the second most common cause of cancer death in women worldwide. Unfortunately, cure is less likely when the disease is diagnosed at an advanced stage. Treatment of locally advanced disease often has serious lifelong side effects, including cystitis, proctitis, intestinal strictures, fistulas, vaginal agglutination/sexual dysfunction, and chronic pain. Unresectable recurrent disease may be associated with all these symptoms, in addition to disturbing malodorous discharge and bleeding and a life expectancy of less than 6 to 10 months. Supportive/palliative care interventions are needed at diagnosis and recurrence. Honest, conflict-free conversations about potential for response and expectations are needed for women with recurrent disease to help preserve and improve quality of life and avoid treatments that offer no benefit. Aims of trial design should include not only molecular targeting but also supportive care objectives, such as reducing pain, anxiety, depression, cachexia, and fatigue. A β-adrenergic blockade could potentially be part of these intervention trials. This article addresses the following questions and issues: whether therapeutic treatment of incurable cervical cancer is ever appropriate, the common symptoms of recurrent cervical cancer, the quantifying benefits of treatment, decision aids in treatment planning, doctor-patient candor, and integrating psychosocial factors into treatment.
女性不应该死于宫颈癌……但她们确实会。大多数宫颈癌病例是可以预防的，如果早期发现，治愈率很高。尽管如此，宫颈癌仍是全球女性癌症死亡的第二大常见原因。不幸的是，当疾病处于晚期诊断时，治愈的可能性较小。局部晚期疾病的治疗通常会产生严重的终身副作用，包括膀胱炎、直肠炎、肠狭窄、瘘管、阴道粘连/性功能障碍和慢性疼痛。不可切除的复发性疾病除了令人讨厌的恶臭分泌物和出血以及预期寿命不到 6 至 10 个月之外，还可能伴有所有这些症状。在诊断和复发时需要进行支持性/姑息治疗干预。对于复发性疾病的女性，需要进行诚实、无冲突的关于反应可能性和期望的对话，以帮助保留和改善生活质量，并避免提供无益的治疗。试验设计的目标不仅应包括分子靶向，还应包括支持性护理目标，如减轻疼痛、焦虑、抑郁、恶病质和疲劳。β肾上腺素能阻断可能是这些干预试验的一部分。本文讨论了以下问题和问题：治疗无法治愈的宫颈癌是否合适，复发性宫颈癌的常见症状，治疗的量化收益，治疗计划中的决策辅助工具，医生与患者的坦诚相待，以及将社会心理因素纳入治疗。
