If diagnosed early, cervical cancer is very treatable, and survival rates are high. When a Pap smear catches precancerous changes before they become cancer, death is extremely rare.
The outlook for cervical cancer depends on when it is diagnosed. The five-year survival rates for cancers caught 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.
The type of treatment used for cervical cancer also depends on the stage at diagnosis. More advanced cancers require more aggressive treatment. Standard treatment includes:
- radiation therapy
Surgery for cervical cancer aims to remove as much cancer as possible. Surgery is performed on cervical tumors. It can also remove cancer in lymph nodes and metastases.
The choice of surgery depends on several factors including how advanced your cancer is and whether you want to have children.
Cryotherapy involves destruction of abnormal cervical tissue by freezing. Cryotherapy is a less invasive method for destroying cancerous tissue than other types of surgery.
A surgical laser may be used to destroy abnormal cells.
Cone biopsy removes a cone-shaped section of the cervix. It is 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.
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, further treatment may not be necessary.
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. It removes the uterus through several small incisions
A radical hysterectomy is sometimes needed. It is 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.
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 is 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.
This surgery is only used if cancer has spread. It is a treatment of last resort. Exenteration may remove the:
- pelvic lymph nodes
- part of the colon
The extent of the surgery depends on where the cancer has spread.
Radiation uses high-energy beams to destroy cancer cells. Radiation can be delivered by an external beam that is aimed at the site. This type of therapy takes up to two months to complete.
Radiation can also be delivered internally. This may require only a single treatment. A technique called brachytherapy is used.
During brachytherapy, a metal tube containing radioactive material is placed in the uterus or vagina. The tube is left in place. 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 can be permanent. Damage to the ovaries can also be long lasting.
In 2014, the 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:
- 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
Other drugs approved by the FDA for treating cervical cancer are:
- blenoxane (Bleomycin)
- hycamtin (Topotecan Hydrochloride)
- platinol (Cisplatin)
- platinol-AQ (Cisplatin)
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 cancerous cells. Studies have also demonstrated that chemotherapy helps radiation to work more effectively than when it is used alone.
High doses of chemotherapy can also be used to treat inoperable cancers.
Chemotherapy can cause significant side effects. These usually go away once treatment is over.
Survival is not the only concern when choosing a cancer treatment. Many women wish to preserve their fertility. This requires functioning ovaries and a viable uterus.
Researchers are developing new options to improve fertility and sexual functioning. One option for preserving fertility is called a cortical strip. In this technique, a portion of the ovary is transplanted into the forearm. It continues to function in the new location. However, the tissue is less at risk for damage as a result of radiation treatment.
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.
If a woman has a partner, they can use in vitro fertilization. Then the embryos can be frozen and used for pregnancy after the treatment is over.