Cervical Cancer
Treatment Options
Cervical cancer treatment options are based on the stage of the cancer, as well as a person’s age, overall health and personal preferences. You may need more than one kind of treatment. Depending on your needs, you may work with many types of doctors:
- Gynecologists treat diseases of the female reproductive system.
- Gynecologic oncologists specialize in treating cancers of the female reproductive system with surgery, chemotherapy and radiation therapy.
- Medical oncologists use medicine (including chemotherapy) to treat cancer.
- Radiation oncologists use radiation therapy to treat cancer.
It is important for everyone with cancer to feel comfortable with their doctors, and that can be especially true for women with gynecologic cancers. You should feel free to seek a second opinion by asking another doctor to confirm your diagnosis and recommend treatment options.
Surgery, radiation and chemotherapy, either alone or in combination, are most often used to treat cervical cancer. Surgery or radiation alone can both be effective in treating early stages of the disease, while a combination of chemotherapy and radiation (known as concurrent chemoradiation) can be used after surgery for later stages. Targeted therapy may also be an option to treat cervical cancer.
Surgery
Surgery options differ by stage. Cone biopsy (conization) may be an option for women with early-stage disease who wish to preserve their fertility. It involves removing a cone-shaped piece of tissue using either a surgical or laser knife (cold knife cone biopsy), or a thin wire heated by electricity (loop electrosurgical excision procedure [LEEP]). A hysterectomy is surgery to remove the uterus (including the cervix). In a simple hysterectomy, the vagina and pelvic lymph nodes are not removed. The ovaries and fallopian tubes are usually not removed in younger patients.
In a radical hysterectomy, the uterus, tissues next to the uterus and the upper part of the vagina (about one inch, next to the cervix) are removed. The ovaries and fallopian tubes are usually left. Some lymph nodes may be removed, too. A radical hysterectomy is a common treatment for Stage IA2 and Stage IB cancer and may sometimes be used for Stage IIA cancer.
A radical trachelectomy treats cervical cancer while potentially preserving the ability to have children. For a radical trachelectomy, the cervix and upper part of the vagina are removed, but the body of the uterus stays. The surgeon places a stitch to act as an opening of the cervix into the uterus. Nearby lymph nodes are also removed. After trachelectomy, some women can carry a pregnancy to term and deliver by cesarean section (C-section).
Pelvic exenteration is the most extensive procedure used to treat cervical cancer, and it is reserved for recurrent cancers. This operation removes all of the same organs and tissues as a radical hysterectomy does, along with lymph nodes and possibly the vagina, urinary bladder, rectum and part of the large intestine, depending on where the cancer has spread.
Radiation therapy
Radiation therapy uses high-energy X-rays or particles to destroy cancer cells. It can be administered from outside or inside the body.
External-beam radiation therapy (EBRT) delivers radiation from outside the body. EBRT is often combined with chemotherapy but can also be used by itself.
Brachytherapy is another type of radiation therapy. Also called internal radiation therapy, it involves placing a source of radiation in or near the cancer. In brachytherapy for cervical cancer, the radioactive material is placed in a device that goes in the vagina. Brachytherapy can be administered at a low-dose rate or a high-dose rate. To receive low-dose rate brachytherapy, the patient stays in bed in the hospital for a few days, with instruments holding the radiation source in place. High-dose rate brachytherapy is done as an outpatient procedure over several treatments. For each high-dose treatment, the radiation source is inserted for a few minutes and then removed. This can be more convenient for patients because they do not have to stay in the hospital.
Chemotherapy
Chemotherapy uses drugs that fight cancer. They can be administered in multiple ways, most commonly intravenously, as an injection or orally. Chemotherapy is often used in combination with radiation therapy and is typically given in cycles. Chemotherapy is also an option for recurrent or metastatic cervical cancer.
Targeted therapy
Targeted therapy is aimed directly at genes, proteins or other contributors to the growth of cancer cells. Tumors have to form new blood vessels to grow. The process of forming new blood vessels is called angiogenesis. Some targeted therapy drugs prevent tumors from growing new blood vessels. These drugs are called angiogenesis inhibitors.
Clinical trials
Clinical trials are research studies that determine whether new treatments are effective. Ask your doctor about any clinical trials for which you might qualify. Participating in these studies may give you access to treatments that aren’t yet available. For more about clinical trials, see Clinical Trials.