Women’s Cancers: Pathways to Healing J. Richard Smith Women’s Cancers: Pathways to Healing A Patient’s Guide to Dealing with Cancer and Abnormal Smears Co-author: Giuseppe Del Priore Illustrated by Dee MacLean Authors J. Richard Smith, MD, FRCOG West London Gynaecological Cancer Centre Imperial College at Hammersmith & Queen Charlotte’s Hospitals London, UK Adjunct Associate Professor New York University School of Medicine NY, USA Giuseppe Del Priore, MD, MPH Vice President Research NY Downtown Hospital Associate Professor Weil Medical College Cornell University New York, NY, USA ISBN 978-1-84628-437-3 e-ISBN 978-1-84628-438-0 DOI 10.1007/978-1-84628-438-0 British Library Cataloguing in Publication Data A catalogue record for this book is available from the British Library Library of Congress Control Number: 2008934039 © Springer-Verlag London Limited 2009 Apart from any fair dealing for the purposes of research or private study, or criticism or review, as permitted under the Copyright, Designs and Patents Act 1988, this publication may only be reproduced, stored, or transmitted, in any form or by any means, with the prior permission in writing of the publishers, or in the case of reprographic reproduction in accordance with the terms of licenses issued by the Copyright Licensing Agency. Enquiries concerning reproduction outside those terms should be sent to the publishers. The use of registered names, trademarks, etc. in this publication does not imply, even in the absence of a specific statement that such names are exempt from the relevant laws and regulations and therefore free for general use. Product liability: The publisher can give no guarantee for information about drug dosage and application thereof contained in this book. In every individual case the respective user must check its accuracy by consulting other pharmaceutical literature. Cover illustration: Vladimirka Road, painted by Levitan in 1892. Reproduced with kind permission of the Tretyakov Gallery, Moscow. Printed on acid-free paper Springer Science + Business Media springer.com This book is dedicated to all those women we have had the privilege to look after and who have encouraged the use of the 4-cusp approach and thus this project. Preface This book is designed, as the title “Pathways to healing” suggests, to allow you and your family ready access to all the information you require about your can- cer to allow you to understand the different directions your disease may take. It should allow you to realize the breadth of possible outcome from where you stand at the particular point in time when you buy the book, or as your disease progresses or not. This book has been written for you wherever you are in the disease, ranging from cured, to those that spend many years living with their cancer, to those who sadly die of their cancer. One of the greatest privileges working in the field of cancer care is meeting many wonderful people, some of who have very kindly written sections of this book. We do hope that by reading this book things may be a little clearer for you and at least some worries made lighter. J. Richard Smith Giuseppe Del Priore “Above all, what matters is not to lose the joy of living for the fear of dying.” Maggie Keswick Jencks, Co-founder of Maggie’s Cancer Caring Centres By kind permission of Laura Lee CEO Maggie’s Acknowledgments I would like to thank my wife, Deborah, for all her help and support through a long germination process. Thanks also to the late Roger Houghton, Nina Mar- tin-Brown, and the late Ann Martin, literary agents without whose teaching, guidance, and encouragement this book would never have been produced. My sister Alison Reid was highly instrumental in allowing me the time to write this book. My thanks also go to Mr. Sam Abdalla, Mr. Shaun Hammond, Ms. Suzanne Thomas, Dr. Charles Innes, and the Rev. Gary Bradley, all of whom, over time, have shaped much of the thinking in this book. I met three people while on holiday who have been very helpful with this project and they are Father Vito Borgia and Joe and Carol Puttock. I would also like to thank Ms. Rodena Kelman, Mrs. Liz Lainis, and Ms. Vicky Lynch for all their secretarial support without which there would be no book. My thanks also go to Mrs. Pietraszewska, Sr. Catherine Gillespie, Mrs. Jo Abrams, and Dr. Mark Bower for reading the text and making many helpful suggestions. Mr. Tom Lewis and Dr. Bruce Barron have my gratitude for their friendship, support, and introduction to Dr. Del Priore. Many of the pictures appeared in two-tone form originally in the “Patient Pictures” series published by Health Press and my thanks go to the publisher Sarah Redstone for allowing their reproduction again. Thanks also to Mr. Andy Nordin editor of Patient Pictures Gynaecological Oncology. My thanks also go to Laura Lee and the Board of Maggie’s Centres for allow- ing the use of the quote in the front fly leaf. Finally, and last but certainly not least, I would very much like to acknowl- edge Dr. Giuseppe Del Priore, for his help, wise advice, and editorial skills; any mistakes and idiosyncrasies are mine. About the Author My name is Richard Smith and I am a Consultant Gynaecological Surgeon who specializes in treating women with cancer. I was born and educated in Scotland, graduating from Glasgow University (MB, ChB). I subsequently underwent postgraduate training in the West of Scotland and London. In the late 1980s, I worked at St. Mary’s Hospital in London and did my thesis on the interaction of infections with cervical cancer (MD, Glasgow). I have worked for many years the Chelsea and Westminster Hospital and have recently joined the new West London Gynaecological Centre at the Ham- mersmith Hospital in West London. In terms of Teaching, I am a Senior Lec- turer at Imperial College School of Medicine, London, UK, and Adjunct Associ- ate Professor at New York University School of Medicine. I have had a long running interest in doctor–patient communication and have edited two series of books (The “Guide to …” series and another series, “Patient Pictures”), which were designed to help doctors and nurses explain surgical operations to their patients. These books have sold well (approximately 240,000 copies), suggesting that colleagues, both nursing and medical, are very much interested in this area, not what you would think from looking in the press! I have always been keen on the synthesis of “standard” or orthodox medi- cine with “complementary” medicine. This started with being taught hypno- sis, practicing it, and has subsequently widened out to include referring my patients for hypnotherapy, homeopathy, acupuncture, counseling, and psycho- therapy. Over the last decade I have also become convinced that although I believe that people with some form of religious belief do not survive longer, I am sure they cope better with their cancer. For those with no religious senti- ment there are other ways of helping them to find the inner self. The synthesis of these factors allows for a truly holistic approach. My co-author, Giuseppe Del Priore is also a gynecologist specializing in cancer treatment. He works at New York Downtown Hospital, Weill-Cornell School of Medicine in New York City and has a long-standing interest in doctor–patient communication. He has been a pioneer in the field of fertility- sparing surgery. The artist for the book is Ms. Dee MacLean, who is one of the foremost medical artists in the world today. She has an outstanding ability to make com- plex anatomy look comprehensible to both doctors and patients and has a long running interest in illustrating medical problems for patients. The Rev. Gary Bradley is the Vicar of the Churches of Little Venice, London, and Founder and Chairman of the Westminster Bereavement Council. Mrs. Mira Dharamshi, Mrs. Patricia Walker, Mrs. Gallina Dean, and her hus- band John kindly wrote pieces as to their feelings about living with their cancer, or in John’s case, his wife’s cancer. Contents Preface ................................................................................................. vii Acknowledgments .............................................................................. xi About the Author................................................................................ xiii General Information 1. General Introduction ................................................................ 3 2. Anatomy Overview .................................................................... 7 3. The 4-cusp Approach to Cancer Care...................................... 11 4. General Concepts of Surgical Management ........................... 33 5. Sex, Cancer, and Surgery .......................................................... 35 Specific Cancers 6. Cervical Cancer and Precancer (Cervical Intraepithelial Neoplasia) ........................................ 39 7. Ovarian Cancer (Including Cancer of the Fallopian Tube) ......................................................................... 55 8. Endometrial Cancer .................................................................. 65 9. Vulval Cancer ............................................................................. 77 10. Breast Cancer ............................................................................. 85 11. Choriocarcinoma: Gestational Trophoblastic Neoplasia ................................................................................... 97 General Treatments and Care 12. General Concepts of Chemotherapy and Radiotherapy ........ 103 13. Pain Management ...................................................................... 107 14. Complementary Therapies ....................................................... 113 xvi Contents 15. Bereavement/Grief .................................................................... 123 16. Spiritual Approaches to Living with Cancer ........................... 125 17. Conclusion ................................................................................. 129 Suggested Further Reading ............................................................... 131 Glossary ............................................................................................... 133 Index .................................................................................................... 135