Cervical cancer is survivable for about 75 percent of those who have it, although the prognosis varies widely depending primarily on the size and extent of the tumor. As with all cancers, cervical cancer can metastasize (spread) to the lymph nodes and then to other organs in the body. The more advanced the cancer, the more aggressive the treatment. Standard treatments for cervical cancer include surgery, radiation therapy, chemotherapy, or a combination of these treatments.
Surgery is intended to remove as much cancer as possible at the site of origin, in regional lymph nodes, and sites to which the cancer has spread, if any.
Cryotherapy is a less invasive method for destroying cancerous tissue. With this procedure, abnormal tissue is destroyed by freezing.
A surgical laser may be used to ablate—that is, destroy or vaporize—abnormal cells.
Cone biopsy, also called cone excision or cervical conization, is a procedure performed to remove a V-shaped section of the cervix containing dysplastic or cancerous cells. Excision is accomplished using a cold knife or a loop electrosurgical excision (LEEP) procedure. The abnormal cells are then analyzed by a pathologist and staged to determine appropriate treatment. The conization procedure is often considered to be both a diagnostic technique and a treatment. A recent study, however, found that abnormal cells are left behind at the surgical margins (edges of the incision) in about one-fourth of patients who have a LEEP or cold-knife procedure, depending on the surgeon's skill and several other factors. Further study is needed to determine the likelihood of cervical cancer development among this subset of patients.
In some cases, a hysterectomy may be required. A hysterectomy is a surgery to remove the uterus (including the cervix). The uterus can be removed via a surgical incision in the front of the abdomen (abdominal hysterectomy), through the vagina (vaginal hysterectomy), or using laparoscopy (laparoscopic hysterectomy).
A radical hysterectomy is also sometimes needed. In this surgery, more than just the uterus is removed. Also removed are:
- Tissue nearby the uterus (parametrea and uterosacral ligaments)
- The upper part of the vagina (about one inch)
In some cases, the pelvic lymph nodes are also removed. This is called a pelvic lymph node dissection.
Any woman who undergoes any type of hysterectomy will, unfortunately, be unable to have children in the future. Hysterectomy, even a radical hysterectomy, won’t change a woman’s ability to feel sexual pleasure. The shortening of the vagina and the removal of the uterus and cervix in no way affect a woman’s ability to reach orgasm.
Some women may be able to have a trachelectomy instead of a hysterectomy. In a trachelectomy, the cervix and upper part of the vagina are removed, and a “purse-string” stitch is used to create an artificial opening to the uterine cavity. Trachelectomies allow women to be treated without losing the ability to have children.
If, even after extensive treatment, cervical cancer continues to recur, a woman may need to go through pelvic exenteration. This is a more serious surgery where the uterus, nearby tissue, upper part of the vagina, and pelvic lymph nodes are all removed along with the bladder, vagina, rectum, and/or part of the colon—depending on where the cancer has spread.
Radiation can be delivered by an external beam aimed at the site, or it can be delivered internally, sometimes in a single dose, using a technique called brachytherapy (the prefix brachy- means brief). In this procedure, radiation-containing seeds are implanted through the cervix or injected directly into the tumor. Brachytherapy is useful for specific patients, such as those in whom the tumor has invaded the colon, making the cancer inoperable because surgery would cause a systemic infection almost certain to be swiftly fatal.
Studies have demonstrated that women with invasive cervical cancer who undergo chemotherapy with concomitant (meaning "at the same time") radiation therapy have a significantly better chance of survival than those who receive chemotherapy alone. The chemotherapeutic agents (drugs) given for treatment of cervical cancer include cisplatin (Platinol), often combined with fluorouracil (Adrucil, Carc, Efudex, Flouroplex) or hydroxyurea (Hydrea, Droxia). Other agents have been tested in clinical trials and in practice, but none has proved more effective than weekly administration of cisplatin, either alone or in combination with another chemotherapy agent. The drawback of chemotherapy treatment is that it damages healthy cells as well as cancerous ones and can cause numerous side effects such as hair loss, nausea, and vomiting.
Related Treatment Advances
Survivability is not the only consideration in selecting a course of treatment for cervical cancer. Many women wish to preserve their fertility, which requires functioning ovaries and, ideally, a viable uterus. Researchers are developing astonishing new options to give women and couples more control over treatment and subsequent fertility and sexual functioning. One fascinating technique being developed experimentally is the transfer of a portion of a patient's ovarian tissue from the pelvis to the forearm. Once this tissue, called a cortical strip, has been transplanted, it resumes normal functioning in its new location, producing hormones and even ovulating. Researchers are trying to develop reliable techniques for harvesting oocytes (immature ova, or eggs) from the strip and implanting them into the uterus of the patient or a surrogate.
Another investigational method of retaining fertility is to cryopreserve (preserve by freezing) oocytes harvested from the ovaries before radiation therapy or chemotherapy begins or before the ovaries are surgically removed. This technique is not the same as embryo preservation, in which a fertilized ovum or ova are retrieved. Cryopreservation harvests only immature oocytes that could later be brought to maturity and fertilized. The procedure still has a high failure rate, but further research could eventually make it a realistic option for some patients.