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Cervical Cancer

How is Cervical Cancer Treated?

Last modified: 
20/03/2012 - 18:13

Contributing Author: Guy Slowik FRCS

The main types of cervical cancer treatment are:

Also used in cervical cancer treatment are biological therapy and other therapies such as clinical trials.

The type of treatment that is most appropriate for each case depends primarily on how early the cervical cancer is diagnosed. Other factors that affect treatment options are:

  • Location of the tumor within the cervix
  • Tumor type
  • The woman's age
  • Her general health
  • Her childbearing plans
  • Whether or not the woman is pregnant

All treatments for invasive cervical cancer are associated with potentially serious side effects. In addition, women of childbearing age who have invasive cervical cancer must cope with the emotional consequences of premature menopause and infertility. Many people find strength in the support of counselors, clergy, medical personnel, and other women who share their fight and their fears.

In addition to standard treatments, women with cancer that has spread to distant organs/sites may decide to participate in clinical trials (experimental studies) that offer new medications or other therapies.

Surgery

Both surgery and radiation therapy are equally effective strategies for women who have early cervical cancer. Each form of treatment has a survival rate of 85% to 90%. The factors that influence the choice between radiation therapy and surgery include the woman's age, health, and the extent of the disease.

The surgical procedures used to treat early cervical cancer include:

  • Laser surgery. This outpatient treatment for cancer that has not spread uses a laser (a focused, high-energy light beam) to vaporize abnormal cells. Laser surgery can also be used to remove small pieces of tissue for laboratory analysis. It is not used to treat invasive cervical cancer.
  • Cryosurgery. Cryosurgery kills abnormal cervical cells by freezing them with a metal probe cooled with liquid nitrogen. This procedure, which can be performed in a physician's office, is used to treat cancer that has not penetrated deep layers of cervical tissue or spread beyond the cervix.
  • Conization (cone biopsy). This procedure, which can be used for diagnosis as well as treatment, uses a surgical scalpel, laser knife (cold cone knife), or LEEP (LEETZ) procedure to remove a small amount of cone-shaped tissue from the cervix. Physicians usually use this procedure to establish a diagnosis of cervical cancer before performing surgery or initiating radiation therapy.

    Conization rarely is used as the sole treatment for this disease unless a woman wants to preserve her ability to have children and the microscopic amount of cancer present hasn't spread beyond her cervix.

  • LEEP (LEETZ). This procedure removes abnormal tissue with a thin wire heated by electricity. It is used to treat cancer that has not spread beyond the area where it originated.

Laser surgery, cryosurgery, LEEP, and conization almost always remove or destroy all precancerous tissue and prevent abnormal cells from becoming malignant (cancerous). These procedures may cause cramping and a watery brown discharge that lasts for several weeks. Regular post-operative examinations are necessary to make sure the condition does not recur and require additional treatment.

Some individuals who undergo surgery may require additional radiation therapy or chemotherapy afterward. Women with very advanced cancers often require combinations of surgery, radiation, and chemotherapy.

Hysterectomy

Although women with later-stage cervical cancers usually receive radiation therapy, some individuals select hysterectomy (surgical removal of the uterus) as a primary treatment. Hysterectomy may:

  • Preserve the ovaries and vagina
  • Reduce treatment time
  • Allow for a more thorough examination of cancerous lesions

Women who have had a hysterectomy cannot become pregnant.

There are several types of hysterectomy:

  1. Simple (total) hysterectomy
  2. Radical hysterectomy
  3. Pelvic exenteration
  1. Simple (total) hysterectomy is used to treat microscopic cancer that hasn't spread beyond the uterus, and also some cases ofcarcinoma in situ. In simple hysterectomy:
    • The uterus (including the cervix) is removed.
    • The vagina remains intact.
    • The ovaries (the two reproductive glands in which the eggs and the female sex hormones are made) and the fallopian tubes (which carry the eggs into the uterus) are also left intact. They are removed only if they are affected by some other disease.
    • Pelvic lymph nodes, the parametrium (tissue surrounding the uterus), and the ligaments in the pelvis are not removed.

    A simple hysterectomy can be performed in two ways:

    • A vaginal hysterectomy involves removing the organs through the vagina.
    • An abdominal hysterectomy involves removing the organs through an incision in the abdomen.

    Although this operation usually doesn't affect sexual desire or the ability to have intercourse, a woman who has had a total hysterectomy no longer menstruates (has periods) and can't become pregnant. Yet, because the ovaries remain, she will not experience early menopause, which is the end of menstruation.

  2. Radical hysterectomy is performed once cancer has spread beyond the cervix. It involves the removal of the:
    • Uterus
    • Cervix
    • Parametrium (tissue surrounding the uterus)
    • Ovaries
    • Fallopian tubes
    • Upper vagina
    • Some or all of the local lymph nodes

    How-To Information:

    What to expect with hysterectomy

    • A woman who has had an abdominal hysterectomy can expect to spend three to five days in the hospital and should recover completely within four to six weeks.
    • A woman who has had a vaginal hysterectomy can expect to spend one or two days in the hospital and make a complete recovery in two or three weeks.
    • A woman who has had radical hysterectomy should expect to spend five to seven days in the hospital. She may experience difficulties controlling her bladder or moving her bowels normally. Medication or a catheter will help these problems. She can expect to resume normal activities - including sex - within four to eight weeks.
    • Surgical complications are rare but can include excessive bleeding, infection at the site of the incision, and damage to the woman's urinary or intestinal system.

    Nice To Know:

    After a woman's uterus is removed, she no longer menstruates. If her ovaries are also removed, she'll begin experiencing the symptoms of menopause. These symptoms are likely to be more intense than those experienced during the natural course of menopause.

    Hormone replacement therapy, which involves taking the hormones estrogen and/or progesterone, can relieve these symptoms.

  3. Pelvic exenteration. This rare and extreme procedure is used to treat recurrent cervical cancer that has spread to surrounding organs. Pelvic exenteration removes the same organs and tissues as radical hysterectomy. In addition, though, pelvic exenteration may remove the bladder, rectum, part of the colon, and/or vagina.

    If the bladder needs to be removed:

    • Surgeons who must remove the bladder may connect a short segment of the intestine to the abdominal wall. This allows urine to periodically drain into a catheter (small tube) that is placed within a small opening in the abdomen. Or,
    • The surgeon may attach a small plastic bag to the front of the abdomen to collect a continuous flow of urine.

    If the rectum (end of the large intestine) needs to be removed, surgeons must create a new way for the woman to eliminate solid waste. This can be done by:

    • Attaching the remaining intestine to the abdominal wall. This procedure, known as a colostomy, allows solid waste to pass through the opening in the abdomen into a small plastic bag at the front of the abdomen.
    • Reconnecting the healthy sections of the colon. A woman who undergoes this procedure doesn't have to wear a bag or other external appliance to collect waste.

    If the vagina has to be removed, plastic surgery must be performed to create an artificial vagina. Surgeons will use skin, muscle and/or intestinal tissue grafts to accomplish this. Such vaginal reconstruction is a very rare procedure.

Radiation Therapy (Radiotherapy)

Radiation therapy uses high-energy x-rays to destroy cancer cells. Cancers that extend beyond the cervix into the pelvis, lower vagina, and urinary tract typically receive radiation.

  • Radiation therapy can be combined with surgery or chemotherapy to treat early cervical cancers and more invasive stages of the disease.
  • Radiation also can be used to relieve symptoms caused by advanced cancer.

Physicians treat cervical cancer with external beam radiation, radioactive implants, or a combination of these therapies.

External beam radiation is administered the same way as a diagnostic x-ray. External beam radiation is usually given five times a week for five or six weeks, with an extra boost of radiation at the end of that time.

Women are encouraged to remain as active as possible during the course of this therapy, but they may experience side effects in the target area such as hair loss, dry or irritated skin, or permanent darkening of the skin. Therefore, women who undergo radiation therapy should: practice good personal hygiene, use lotions or creams only with a physician's approval, wear loose clothing, and expose the target area to air whenever possible.

Implant radiation (brachytherapy) puts cancer-killing radiation as close to the tumor as possible, but spares the healthy tissue nearby. The radioactive material is either placed in a capsule and inserted into the cervix, or placed in thin needles that are inserted directly into the tumor.

The woman stays in the hospital for one to three days while the implants remain in place. Repeated several times over a period of one to two weeks, brachytherapy can cause the treated area to look and feel sunburned. Treated tissues regain their normal appearance within 6 to 12 months.

A woman should not have sex until a few weeks after completing radiation therapy. These treatments can cause numerous side effects that can be severe but usually disappear after treatment is completed. Side effects include:

  • Fatigue
  • Diarrhea
  • Frequent or uncomfortable urination
  • Vaginal dryness
  • Itching
  • Burning

Other complications of external beam radiation and brachytherapy include:

  • Proctitis (inflammation of the rectum)
  • Cystitis (inflammation of the bladder)
  • Vaginal scarring
  • Anemia and/or bruising
  • Increased risk of infection
  • Sexual difficulties
  • Premature menopause
  • Vesicovaginal fistula (development of an abnormal tunnel between the vagina and the bladder or rectum)

Medications and special techniques can help a woman successfully manage the side effects and complications of radiation therapy. Regular medical monitoring can help to prevent cancer recurrence.

For further information about radiation therapy, go to Radiation Therapy.

Chemotherapy

Chemotherapy is the treatment of choice for cervical cancer that has:

  • Spread too far from its origin to be treated by surgery or radiation
  • Recurred (come back) after surgery or radiation therapy

Chemotherapy also may be used to:

  • Relieve pain associated with advanced cervical cancer
  • Shrink cancer to an operable size before surgery is performed. This is called neoadjuvant chemotherapy. It can help prevent cervical cancer from spreading.

The Drugs Most Often Used

The cytotoxic (cancer-killing) drugs most often used to treat advanced or recurrent cervical cancer are cisplatin (Cisplatinum®, Platinol®), ifosfamide (Ifex®), and 5-fluorouracil (5-FU). Taken by mouth or injected into a vein, these drugs enter the bloodstream and destroy cancer cells that have spread from the cervix to distant parts of the body.

Other drugs that have been used to treat cervical cancer includecarboplatin (Paraplatin®), methotrexate, bleomycin, mitomycin C (Mutamycin®), and vincristine (Oncovin®).

Paclitaxel (Taxol®), a drug used in breast cancer, is also being tested in clinical studies of cervical cancer.

Chemotherapy usually is administered at an outpatient facility, physician's office, or in the patient's home; but a woman who is in poor health may be hospitalized for treatment. Chemotherapy treatments alternate with recovery periods that allow a woman to rest and regain her strength before the next round of therapy begins.

Combination chemotherapy (a combination of two or more chemotherapy drugs) may be more effective than any single drug. When used in association with surgery or radiation, chemotherapy can help to prevent the spread or recurrence of cervical cancer. Recent clinical trials have shown that cisplatin combined with radiation therapy improves survival rates for women with advanced cervical cancer.

A woman undergoing chemotherapy may experience side effects such as:

  • Nausea and vomiting
  • Appetite changes
  • Mouth sores
  • Vaginal sores
  • Hair loss (temporary)
  • Fatigue
  • Bruising and bleeding
  • Susceptibility to infection
  • Anemia
  • Menstrual cycle changes
  • Early menopause
  • Infertility

Side effects generally subside after treatment is completed. Most women who undergo chemotherapy for cervical cancer are already infertile as a result of surgery or radiation therapy. Physicians may prescribe hormones to help with symptoms of premature menopause.

Biological Therapy

Biological therapy can be used to treat cancer that has spread from the cervix to other parts of the body. Interferon - a cell protein that provides immunity to viral infections - is the type of biological therapy most often used. Biological therapy is usually administered on an outpatient basis and is sometimes combined with chemotherapy.

"Flu-like" side effects, among other complaints, have been reported by women who undergo biological therapy. These include:

  • Fever and/or chills
  • Muscle aches
  • Weakness
  • Diarrhea
  • Rash
  • Appetite loss
  • Nausea or vomiting
  • Easy bleeding or bruising

Side effects can be severe, but they generally subside after treatment is completed.

Other Therapies

A woman whose cancer is advanced and whose chance of survival is poor may choose to:

  • Combine standard therapies with experimental treatment
  • Enroll in a clinical trial designed to measure the effectiveness of new treatments for cervical cancer
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Cervical Cancer

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From Andrew Maynard - Chair of the University of Michigan Department of Environmental Health Sciences, with help from David Faulkner - 2013 Master of Public Health graduate.