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Cervical Cancer Treatments

Cervical cancer

Cervical cancer treatment is very successful if you’re diagnosed in the early stages. Survival rates are very high. Pap smears have led to increased detection and treatment of precancerous cellular changes. This has reduced the incidence of cervical cancer in the western world.

The type of treatment used for cervical cancer depends on the stage at diagnosis. More advanced cancers usually require a combination of treatments. Standard treatment includes:

  • surgery
  • radiation therapy
  • chemotherapy

Treatment for precancerous cervical lesions

There are several ways to treat precancerous cells found in your cervix:

Cryotherapy

Cryotherapy involves the destruction of abnormal cervical tissue through freezing. Cryotherapy is less invasive than surgery. It’s usually used to treat precancerous lesions on the cervix to prevent them from developing into cancer. Local anesthesia will likely be administered during the procedure.

Laser ablation

Lasers may also be used to destroy abnormal or precancerous cells. Laser therapy uses heat to destroy the cells. Usually a local anesthesia will be needed and this can be done in the doctor’s office.

Surgery for cervical cancer

Surgery for cervical cancer aims to remove all of the visible cancer. Sometimes nearby lymph nodes or other tissues are also removed, where the cancer has spread from the cervix.  

Your doctor may recommend surgery based on several factors. This includes how advanced your cancer is, whether you want to have children, and your overall health.

Cone biopsy

Cone biopsy removes a cone-shaped section of the cervix. It’s also called cone excision or cervical conization. It can be used to remove precancerous or cancerous cells. The cone shape maximizes the amount of tissue removed at the surface. Less tissue is removed below the surface.

Conization is performed using a cold knife or a loop electrosurgical excision (LEEP) procedure. LEEP uses electrical current to cut through and cauterize cervical tissue.

After conization, the abnormal cells are sent to a specialist for analysis. The procedure can be both a diagnostic technique and a treatment. When there is no cancer at the edge of the cone-shaped section that was removed, further treatment may not be necessary.

Hysterectomy

Hysterectomy is the surgical removal of the uterus and cervix. It greatly reduces the risk of recurrence when compared to more localized surgery. However, a woman cannot have children after a hysterectomy.

There are three ways to perform a hysterectomy:

  • abdominal hysterectomy removes the uterus through an abdominal incision
  • vaginal hysterectomy removes the uterus through the vagina
  • laparoscopic hysterectomy uses miniaturized instruments to remove the uterus through several small incisions 

A radical hysterectomy is sometimes needed. It’s more extensive than a standard hysterectomy. It removes the upper part of the vagina. It also removes other tissues near the uterus.

In some cases, the pelvic lymph nodes are also removed. This is called a pelvic lymph node dissection.

Trachelectomy

This surgery is an alternative to a hysterectomy. The cervix and upper part of the vagina are removed. The uterus is left in place. It’s connected to the vagina with an artificial opening. Trachelectomies allow women to maintain the ability to have children. However, there is a high rate of miscarriage.

Pelvic exenteration

This surgery is only used if cancer has spread. This treatment is usually reserved for more advanced cases. Exenteration may remove the:

  • uterus
  • pelvic lymph nodes
  • bladder
  • vagina
  • rectum
  • part of the colon

The extent of the surgery depends on where the cancer has spread.

Radiation treatment for cervical cancer

Radiation uses high-energy beams to destroy cancer cells. Traditional radiation treatment employs a machine outside the body to deliver an external beam that is aimed at the cancerous site.

Radiation can also be delivered internally. This may require only a single treatment. The technique is called brachytherapy.

During the procedure a metal tube containing radioactive material is placed in the uterus or vagina. The tube is left in place for 24 hours and then removed. It provides an ongoing dose of radiation.

Radiation can have significant side effects. Most of these go away once treatment is completed. However, vaginal narrowing and damage to the ovaries can be permanent.

Medications for cervical cancer

In 2014, the Federal Drug Administration (FDA) approved the use of a drug called bevacizumab (Avastin) in people with aggressive and late-stage cervical cancer. According to the FDA, this is the first drug to be approved for use in people with late-stage cervical cancer since 2006.

Avastin works by interfering with blood vessels that help to develop cancerous cells. Some of its most common side effects include:

  • fatigue
  • decreased appetite
  • high blood pressure (hypertension)
  • increased glucose in the blood (hyperglycemia)
  • decreased magnesium in the blood (hypomagnesemia)
  • urinary tract infection
  • headache and decreased weight

Chemotherapy treatment for cervical cancer

Chemotherapy uses drugs to kill cancer cells. Drugs may be administered before surgery to shrink tumors. They can also be used afterwards to get rid of remaining microscopic cancerous cells. Studies have also demonstrated that chemotherapy combined with radiation is more effectively than when radiation is used alone.

Chemotherapy combined with radiation can also be used to treat inoperable cancers. The drugs can cause significant side effects, but these usually go away once treatment is over. Chemotherapy drugs approved by the FDA for treating cervical cancer include:

  • blenoxane (Bleomycin)
  • hycamtin (Topotecan Hydrochloride)
  • platinol (Cisplatin)
  • platinol-AQ (Cisplatin)

Preserving fertility in women with cervical cancer

Many cervical cancer treatments can make it difficult or impossible for a woman to get pregnant after treatment is over. Researchers are developing new options for women who’ve had treatment for cervical cancer to preserve fertility and sexual functioning.

One option currently being studied is a procedure called a cortical strip. In this technique, a portion of the ovary is transplanted into the forearm. It continues to produce hormones in the new location. This is a very new technique. In some cases women continued to ovulate using this procedure.

Oocytes are at risk of damage from radiation therapy or chemotherapy. However, they can be harvested and frozen before treatment. This allows a woman to get pregnant after treatment using her own eggs.

In vitro fertilization is also an option. The women’s eggs are harvested and fertilized with sperm before treatment begins and then the embryos can be frozen and used for pregnancy after the treatment is over. 

Talk to your doctor

The outlook for cervical cancer depends on the stage at the time it’s diagnosed. The five-year survival rates for cancers diagnosed early are excellent. According to the American Cancer Society, more than 90 percent of women with localized cancers survive at least five years. However, when cancer has reached stage 2A, five-year survival drops to 63 percent. At stage 4A, it drops to 16 percent.

Talk to your doctor about the treatment plan that is right for you. Your treatment options will depend on:

  • the stage of your cancer
  • your medical history
  • if you want to get pregnant after treatment

Your doctor will help you determine which combination of surgery, medication, radiation, or chemotherapy is best for you.

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