In the Bahamas, where the rate of new cases of cancer of the cervix is the highest in the Caribbean and nearly twice as high as the global average, experts say a one-two punch is proving most effective in treating the disease.
At almost one new case per week being diagnosed, doctors at Cleveland Clinic Florida are working closely with the Bahamian medical community to find the best route to alleviate what they call "the immeasurable physical and mental suffering and the socio-economic impacts" that accompany the disease, especially for women with children or hoping to have children.
The one-two punch, as they term it, begins with surgery that may cure the cancer without further treatment if the condition is caught early enough.
Surgery is the mainstay for treating endometrial and cervical cancer, most medical professionals agree. However, women diagnosed with more advanced stages of these diseases may require more than an operation. That's when treatment with radiation (including brachytherapy and external-beam radiotherapy), and in some cases chemotherapy, become necessary. When these situations arise, specialists at cancer treatment centres like Cleveland Clinic's Maroone Cancer Centre in Weston, Florida collaborate on a combination treatment plan that produces the best results.
"The combination of Intensity-modulated radiation therapy (IMRT) with brachytherapy is a technique that allows us to be more precise in targeting the cancer, and helps to minimise secondary effects," said Dr Eva Suarez, radiation oncologist for Cleveland Clinic Florida.
"Oftentimes, doing both of these procedures would require a patient to visit two different facilities, Cleveland Clinic can offer our patients these options at the same facility and are performed as an outpatient procedure, which facilitates recovery times."
For cervical cancer
The team approach to treating gynaecological cancer at the Maroone Cancer Centre is probably most evident to patients with cervical cancer. Sometimes cervical tumours are too large or have already spread beyond the cervix at the time of diagnosis, so surgery isn't an option initially. Instead, external radiation and chemotherapy may be administered over the course of about five to six weeks to shrink the tumour.
Then gynaecological surgical oncologist Dr Thomas Morrissey and Dr Suarez work together in the operating room to place a brachytherapy device that allows for precise delivery of tiny radioactive sources that target the tumours while minimising the radiation's adverse effects on benign tissues and organs nearby.
Research suggests that this treatment approach, particularly when completed within eight weeks, has been shown to improve outcomes among cervical cancer patients, said Dr Suarez.
"It offers more controlled, targeted radiation therapy and in some cases increases survival rates. Updated treatment planning has also allowed for more flexibility with radiation treatment design. This allows patients to receive the benefit of the treatment while experiencing less side effects.
"We really work together in the operating room and afterward to make sure we're optimising the treatment," said Dr Morrissey. "For cervical cancer patients it's really the best way to cure that disease, with the gynaecological oncologist, radiation oncologist and medical oncologist all working together to get these treatments done optimally."