Treating Cervical Cancer

Updated on 10/13/09

Once a diagnosis of cervical cancer is made, your doctor will explain your prognosis and treatment options. Your prognosis is what the doctor thinks will happen with your cancer—your chance of recovery, the expected course of the cancer, or the length of time you will be sick.

Your prognosis will depend on the following:

• The stage of the cancer (The stage tells whether the tumor has spread to nearby tissues and other parts of the body.)
• The type of cervical cancer (squamous cell or adenocarcinomas) Read more about cervical cancer types in the About section.
• The size of the tumor
• Lymph node involvement

Treatment options will depend on the following:

• The stage of the cancer
• The size of the tumor
• The patient's desire to have children
• The patient's age and overall health

Treatment of cervical cancer during pregnancy depends on the stage of the cancer and the stage of the pregnancy. If cervical cancer is detected before it has spread or found in the last trimester of pregnancy, treatment may be delayed until after the baby is born.

This section includes more information on:

• Staging
• Treatment for precancerous lesions
• Surgery for small cancers and precancerous lesions
• Surgery for larger cancers
• Radiation therapy
• Chemotherapy
• Recurrent Cervical Cancer

Staging

If the biopsy shows that you have cancer, your doctor will do a pelvic exam and may biopsy additional tissue to learn the stage of your disease. Staging may also include other tests, such as a chest X-ray and cystoscopy or proctoscopy (but not exploratory surgery). The stage tells whether the tumor has spread to nearby tissues and other parts of the body.

Stages of Cervical Cancer:

Stage 0: The cancer is found only in the top layer of cells lining the cervix and has not invaded deeper tissues of the cervix. Stage 0 is also called carcinoma in situ.

Stage I: The cancer has invaded the cervix beneath the top layer of cells. It is found only in the cervix.

Stage II: The cancer has spread beyond the cervix but not to the pelvic wall (the tissues that line the part of the body between the hips) or to the lower third of the vagina.

Stage III: The cancer has spread to the lower part of the vagina and may have spread to the pelvic wall and nearby lymph nodes. The cancer may also be pressing on the ureter, the tube that carries urine from the kidney to the bladder.

Stage IV: The cancer has spread to the bladder, rectum, or other parts of the body.

Recurrent cervical cancer is cancer that comes back after it has been treated. The cancer may appear again in the cervix or in other parts of the body. The cancer's stage never changes even if your cancer recurs.

Treatment for Precancerous Lesions

Treatment for a precancerous lesion of the cervix depends on whether the lesion is low or high grade, whether the woman wants to have children in the future, and the woman's age and general health. A woman with a low-grade lesion may not need further treatment, especially if the abnormal area was completely removed during biopsy. When a precancerous lesion requires treatment, the doctor may use cryosurgery (freezing) or laser surgery to destroy the abnormal area without harming nearby healthy tissue. More often, the doctor will remove the abnormal tissue by LEEP or conization. In some precancerous cases, a woman may have a hysterectomy (removal of the uterus, including the cervix), particularly if abnormal cells are found inside the opening of the cervix.

Precancerous lesions are usually curable if caught early. However, a woman should continue with regular Pap tests and pelvic exams, especially if she has HPV.

Read more about LEEP, conization, and other procedures used for precancerous lesions and small cancers below.

Surgery for Small Cancers and Precancerous Lesions

The following surgical procedures may be used for precancerous lesions or for cancerous tissue that has not spread beyond the cervix.

Cryosurgery (cryotherapy): This surgical procedure uses an instrument to freeze and destroy precancerous tissue. This is not used on invasive cancer. The advantage to this procedure is that it can be performed in the doctor's office and women typically do not experience any bleeding after the exam. One disadvantage to this therapy is that no tissue is removed, which means there is nothing to be evaluated under a microscope. This type of procedure also has the potential for missing a cancer or causing a change in the cervical mucus.

LEEP (loop electrosurgical excision procedure): This procedure uses electrical current passed through a thin wire hook. The hook removes the tissue. This is primarily used on precancerous lesions under local anesthesia. The advantage of this procedure is that more of the tissue can be removed for evaluation and the chances of cure are greater. There is some bleeding after the procedure.

Cone: A gynecologist uses the same procedure as a cone biopsy to remove all of the cancerous tissue. This procedure can be used in a woman who has a very small cervical cancer and who wishes to preserve the ability to have children. It is performed in the operating room, and more of the tissue can be removed for evaluation. There is some bleeding after the procedure.

Hysterectomy: This operation removes the uterus and the cervix. If a woman has a hysterectomy, she will no longer be able to have children. This kind of hysterectomy is performed only on women with very small cervical cancers, less than 3 millimeters in depth.

Bilateral salpingo-oophorectomy: In this procedure, the fallopian tubes and ovaries are removed at the same time as the hysterectomy. If a woman is close to the age of menopause, her doctor may discuss removing her ovaries and fallopian tubes to reduce the chance that the cancer will recur in one of those organs.

Side effects from surgery vary depending on the procedure. Some women have excessive bleeding, infection, or damage to the urinary and intestinal systems. Most of the risks are very small and temporary.

Surgery for Larger Cancers

The following surgical procedures may be used for larger cervical cancer lesions (usually up to 4 to 5 centimeters in width), but only if the cancer is all within the cervical tissue. If the cancer has spread beyond the cervix, doctors will usually recommend chemotherapy in combination with radiation therapy.

Trachealectomy: This procedure removes the cervix and surrounding tissue but not the uterus. It is used in special circumstances for women who have a larger cancer but wish to preserve the ability to have children. A woman who undergoes a trachealectomy will have to have stitches placed in the cervix (a procedure called cerclage) in order to carry a future pregnancy. Trachealectomies are only done at specialized hospitals. The procedure may include removal of lymph nodes.

In some cases, these procedures can be done without open surgery, with the help of a small telescope called a laparoscope. The laparoscope is inserted through small incisions in the abdomen so the surgeon can see the area around the uterus. At the same time, surgical instruments can be inserted through another incision. Laparoscopy allows the surgeon to inspect the abdominal cavity for spread of cervical cancer and scar tissue without making a large incision.Laparoscopy may allow a woman to avoid more invasive open surgery that uses larger incisions. Compared with open surgery, it leaves smaller scars, is often less risky, and usually requires a shorter recovery period.

Radical hysterectomy: The surgeon removes the cervix, uterus, part of the vagina, and the tissues surrounding the cervix called the parametria. At the same time, the surgeon also removes nearby lymph nodes. Hospital stay is usually from 1 to 2 days for postsurgery care. Some women may stay in the hospital up to 4 days.

More and more radical hysterectomies are being done laparoscopically or with help from robots by gynecologic oncologist(s). When robotics are used, it is called robotic-assisted surgery. By using robotics, surgeons are able to perform surgeries in a precise and controlled manner using clear 3-D views of the abdominal cavity. First, the surgeon inserts the surgical instruments and 3-D cameras into the body through incisions that are 1 to 2 centimeters long. The surgeon sits at a special console that enlarges the 3-D views of the surgery site. While sitting at the console, the surgeon moves the instruments precisely to direct the robotic arms and perform the surgery in “real time.” Robotic-assisted surgery cannot be programmed, and it requires that every surgical movement be performed with direct input from the surgeon. You should discuss your surgical options with your doctor.

Side effects from surgery vary depending on the procedure. Some women have excessive bleeding, infection, or damage to the urinary and intestinal systems. Most of the risks are very small and temporary. Complete recovery usually takes four to eight weeks. Activity after surgery can be gradually increased, but you should avoid heavy lifting for the first two weeks. After a few weeks, you may begin to do light chores and some driving, and return to work if your job is not too physically demanding. By the sixth week you should be able to take tub baths and resume sexual activities.

Radiation Therapy

Radiation therapy is used for cancers that have spread beyond the cervix (II, III, or IV) or very large lesions (larger than 5 centimeters).

Radiation therapy uses high-energy X-rays or other types of radiation to kill cancer cells or shrink the tumor. Radiation therapy is used instead of surgery in most cases. However, it is sometimes necessary after surgery if it is discovered that the cancer has spread outside the cervix, or to reduce the risk that a cancer will come back after surgery.

There are two types of radiation therapy: external and internal. External radiation therapy uses a machine outside the body to send radiation toward the cervical cancer. Internal radiation therapy uses a small amount of radioactive material that is delivered directly to the tumor using implants. The type of radiation used depends on the stage of the cervical cancer. A radiation oncologist, a doctor who specializes in radiation therapy, will give you your radiation treatments. The length of your radiation treatment will be determined by your radiation oncologist.

For internal radiation therapy, implants are inserted through the vagina into the cervix, where they are placed next to the tumor while the patient is under anesthesia. The implants stay in place for a few days. During that time, you will stay in the hospital, with limited visits, to protect others from the radiation. Internal radiation therapy may also be done on an outpatient basis, using something called high-dose-rate radiation. Outpatient radiation treatment is done under sedation, in several three-hour visits. Whether your radiation is received inpatient or outpatient, once the implants are removed, no radioactivity is left in your body.

When external radiation is prescribed, patients will be given an appointment for pretreatment simulation. Simulation involves taking X-rays of your pelvis and marking the skin on your hips and lower back with a colored marking pen to show the radiation therapist where to aim the radiation. The simulation is painless; however, you will have to lie face down on a special table for at least an hour. You will need to keep the colored lines marked on your skin, so you should not take tub baths during the course of radiation treatment, and sponge baths are better than showers.

On the days of your actual treatment with external radiation, you will lie on a treatment table, and the radiation therapist will position you so the radiation will reach the right part of your body. Once you are positioned, you cannot move until the treatment is finished. External radiation typically requires 25 outpatient visits lasting about 30 minutes each. Your position on the table will be the same for each treatment. Your doctor will tell you when you can wash off your colored markings, after the course of treatment is over.

During treatment, sexual intercourse is not recommended. Even after treatment is completed, the side effects of radiation therapy may make sexual intercourse uncomfortable or painful for a period of time. Other side effects of radiation therapy include:

• Fatigue
• Dryness, itching, tightening, and burning in the vagina
• Red, dry, tender, itchy skin
• Moist, weepy skin (later in treatment)
• Hair loss in the treated area
• Loss of appetite
• Diarrhea
• Frequent and uncomfortable urination
• Reduced white blood cell count
• Premature menopause

In most cases, chemotherapy will be given with the radiation to help the radiation work better, as a radiation sensitizer.

Chemotherapy

Chemotherapy uses drugs to stop the growth of cancer cells either by killing the cells or by stopping them from dividing. Chemotherapy can be given by mouth or injected into a vein or muscle. In most cases, it is given to a patient through a vein during an outpatient visit. The drugs enter the bloodstream and can reach cancer cells throughout the body. This is called systemic chemotherapy.

When chemotherapy is placed directly into an organ or a body cavity, such as the abdomen, the drugs mainly affect cancer cells in that area. This is called regional chemotherapy.

How chemotherapy is given depends on the stage of the cervical cancer. Almost all cervical cancer patients in good medical condition and receiving radiation for stage IIA or higher will be offered chemotherapy in addition to radiation therapy. The kind of chemotherapy you receive and the course (length) of your chemotherapy treatment will be determined by your doctor. In most cases, it includes a drug called cisplatin, which contains platinum and can cause kidney problems and hearing loss.

Chemotherapy affects normal cells as well as cancer cells. You may experience side effects from chemotherapy treatment such as nausea and vomiting, loss of appetite, diarrhea, fatigue, low blood count, bleeding or bruising after minor cuts or injuries, numbness and tingling in the hands or feet, headaches, hair loss, and darkening of the skin and fingernails.

Recurrent Cervical Cancer

If cervical cancer recurs, the treatment depends on where the cancer is located and how it was treated before. If radiation has not already been given, it may be the treatment of choice for the recurrence. If radiation has already been given and the cervical cancer has spread to the lower colon, rectum, and bladder, a surgeon may be able to remove these organs, but this surgery is not always possible. If the cancer has spread to multiple areas, chemotherapy is usually the treatment of choice.