Treatment
Treatment options for cervical cancer depend on the size of the tumor, the depth of invasion, and the extent of cancer spread. The primary treatments for cervical cancer are surgery, radiation therapy, and chemotherapy, depending on the stage. Here are some of the procedures your doctor may recommend to treat cervical cancer:
Surgery
Surgery is usually the main treatment for cervical cancers that are confined within the cervix. Your doctor may be able to perform the following outpatient procedures to remove small cancerous or precancerous lesions:
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Laser surgery
Your doctor will use a precise laser beam to destroy abnormal cells in the cervix, without harming surrounding tissue. Laser surgery is only performed in order to treat precancerous changes, not invasive cancer.
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Cryosurgery
Your doctor places a metal probe directly on the abnormal part of the cervix, and shoots cold gases through the probe to freeze and destroy the tumor. Cryosurgery is only used to treat precancerous changes, not invasive cancer.
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Conization
Your doctor will remove a cone-shaped area of tissue from the “transformation zone”. Your doctor may perform a LEEP (loop electrosurgical procedure), and use a wire heated by electricity to remove the tissue sample. Your doctor may also use a regular scalpel or a carbon dioxide laser. This procedure may be used to diagnose cervical cancer or treat small tumors in women who want to have children.
Your doctor may recommend more extensive surgery to treat larger tumors that have invaded deeper layers of tissue or spread beyond the cervix:
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Hysterectomy
A hysterectomy is surgery to remove the uterus and cervix, but not any surrounding tissues or lymph nodes. This procedure may be performed with a surgical incision in the abdomen, through the vagina, or laparoscopically/robotically.
Radical Hysterectomy/Lymph Node Assessment
In this procedure, the surgeon removes the cervix, uterus, surrounding tissues (parametria), and the upper part of the vagina. Lymph node assessment will be performed utilizing either lymphadenectomy or sentinel lymph node mapping. During a lymphadenectomy, the doctor will remove multiple lymph nodes in your pelvic region to determine if the cancer has spread. Sentinel lymph node mapping is the use of a special dye to identify and remove only the primary draining lymph nodes to assess for cancer spread.
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Radical Trachelectomy
Your surgeon removes a portion of the cervix, surrounding tissues, the upper part of the vagina, and some nearby pelvic lymph nodes, but not the uterus. A stitch is placed to support the remaining cervical tissue in the case of future pregnancy. A radical trachelectomy is used for younger women who want to have children in the future.
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Bilateral salpingo-oophorectomy
In this procedure, your surgeon removes your ovaries and fallopian tubes as well as your uterus and cervix during a hysterectomy. Doctors usually recommend this procedure for older, post-menopausal women to reduce the risk of the cancer coming back in these organs.
Pelvic Exenteration
Your doctor may recommend a pelvic exenteration to treat recurrent cervical cancer. Your surgeon performs a radical hysterectomy (if a previous hysterectomy has not been performed), and also removes the bladder, vagina, rectum, and a portion of the colon. If your bladder is removed, your surgeon may form a new bladder out of intestine and drain your urine out of an opening in your abdomen (urostomy). If your rectum or colon is removed, your doctor may attach your intestine to an opening in your abdomen (colostomy) to allow feces to pass out of your body. If your vagina is removed, your surgeon may be able to construct a new one.
Radiation Therapy
Radiation therapy uses waves of high-energy rays to kill cancer cells. Doctors commonly use radiation therapy to treat larger cervical tumors or cervical cancer that has spread beyond the cervix. Radiation therapy may be given in early stage cervical cancer sometimes after surgery to reduce the risk of recurrence. You may receive any of the following types of radiation therapy for cervical cancer:
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Brachytherapy
In brachytherapy, also known as internal radiation therapy, the doctor places the source of radiation inside the body near the tumor. For cervical cancer, your doctor will place implants through your vagina directly next to the tumor in your cervix. In low-dose rate brachytherapy, your doctor may leave the implants in your cervix for a few days while you remain in the hospital. In high-dose rate brachytherapy, the implant delivers a much higher dose of radiation in a shorter time, allowing you to leave the same day.
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Three-dimensional conformal radiation therapy (3D-CRT)
Your doctor will use a CT or MRI scan to find the exact location of your tumor. Your doctor will then administer radiation to the tumor from many different positions. This technique allows your doctor to deliver the maximum amount of radiation to the tumor without harming normal tissue.
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Intensity-modulated radiotherapy (IMRT)
IMRT changes the shape of the radiation beam to match the shape of the tumor. Your doctor can adjust the strength of the beam to limit the amount of radiation to healthy tissue. This allows your doctor to target the tumor more precisely and administer higher amounts of radiation with fewer side effects.
Additional Treatments
The doctor may also recommend any of the following treatments:
Chemotherapy
Chemotherapy is the use of drugs to target rapidly growing cells in an effort to eliminate cancer cells. Doctors often combine chemotherapy with internal and external radiation therapy to make both more effective.
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Targeted Therapy
Targeted therapy is a type of medication that blocks the growth of cancer cells by interfering with specific molecules needed to turn normal cells into cancer cells and make them grow. An example of this is the antiangiogenic drug bevacizumab. Cervical tumors create their own network of blood vessels to support their continued growth. Targeted therapy attacks this process, called angiogenesis, and prevents the growth of new blood vessels. This therapy may shrink the tumor or slow its growth, but can't cure the disease by itself.
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Chemoradiation
Chemoradiation is a combination of chemotherapy and radiation therapy. Combining these two treatments makes both more effective. Chemoradiation is the main treatment for some more advanced stages of cervical cancer.
Immunotherapy
This is a novel therapy that stimulates the natural immune system to fight the cancer.
Clinical Trials
Clinical trials allow patients to try a new treatment before it is available to the general public. In some cases, this may be a new surgical technique, a new drug that has not been used in humans before, or a drug or drug combination that is not currently used for that specific type of cancer. Early phase clinical trials are often used to test side effects of a drug or drug combination, while later phase clinical trials are used to see how effective a new treatment might be for a certain type of cancer. Clinical trials allow doctors and researchers to improve the treatment of cancers with possibly more effective therapies. A clinical trial may be a new, groundbreaking drug or it may have no effect. It is important to talk with your doctor about the pros and cons of clinical trials for your particular situation.
