Paliatívna medicína a liečba bolesti 1/2008

COMPLEX PALLIATIVE CARE OF PATIENTS WITH ADVANCED CERVIX CANCER

Palliative care in advanced cervical cancer focuses on treatment or alleviation of distressing symptoms of disease progression. Severe pain and other embarassing symptoms (lymphoedema, rectovaginal and vesicovaginal fistulas, incontinence, smelling discharge, stomas) interfere with normal functioning and lead to depression, suffering, hopelessness and social isolation of these patients. Pain management includes non opioids (mainly non steroidal antiinflamatory drugs) and opioids (morhin, oxycodon, fentanyl, buprenorphin). As neuropathic pain is less responsive to opioids, adjuvant drugs (anticonvulsants, antidepressants, ketamine, benzodiazepins, corticosteroids) are needed. Radiotherapy should be considered. Sometimes invasive approaches (spinal analgaesia, nerve blocks) are necessary. Acute renal failure due to ureteric obstruction is treated by percutaneous placement of nephrostomy, indwelling ureteric stent can be considered later. Palliative options of lymphoedema treatment include skin care, massage, compression bandaging, excercise. Drug treatment except corticosteroids is of limited value. Small vesicovaginal urinary fistula can heal spontanneously, urinary diversion can be achieved by surgery (ileal conduit), in extensive pelvic disease leading to urinary obstruction placement of unilateral or bilateral nephrostomy will releave symptoms. The only treatment option of rectovaginal fistula is surgery – colostomy. Relief of symptoms of malignant bowel obstruction can be achieved by combination of morphin, haloperidol and hyoscin.

Keywords: palliative care, cervical cancer, pain, lymfoedema.