Cervical Cancer - Treatment

The treatment of cervical cancer depends on the stage of the cancer and other prognostic factors. In many cases, physicians will also perform some type of treatment on patients with pre-cancerous conditions to prevent these conditions from developing into cervical cancer. For patients with invasive cervical cancer, the main types of treatment include surgery, radiation therapy, and/or chemotherapy. As with many other types of cancer, the earlier cervical cancer is detected, the greater the chances for successful treatment and survival.

Treatment Options:

• Cauterization
• Cryosurgery
• Laser Surgery
• Cone Biopsy
• Simple Hysterectomy
• Radical Hysterectomy
• Pelvic Exenteration
• Radiation Therapy
• Chemotherapy

Cauterization

Cauterization (also called diathermy) involves burning off abnormal cervical cells using heat, electricity, or chemicals. The procedure is most commonly used on patients with pre-cancerous cervical conditions. Cauterization can be performed in a physician’s office or outpatient section of a hospital with minimal discomfort. However, in some instances, cauterization may cause scarring that could interfere with future Pap smear interpretation.

Cryosurgery

Cryosurgery is performed by inserting a special metal probe called a cryoprobe through the vagina so that it directly touches the cervical lesion. Once the probe is properly positioned, liquid nitrogen is sent through the probe. The temperature of liquid nitrogen is approximately –256 degree Fahrenheit or –160 degrees Celsius, cold enough to freeze and destroy the desired cervical tissue. Cyrosurgery is commonly used to treat pre-cancerous cervical conditions (such as cervical neoplasia) before they have a chance to develop into cervical cancer. The procedure may also be used to treat early-stage cervical cancer.

Cryosurgery can be performed in a physician’s office (typically by a gynecologist). The most common side effect of cyrosurgery is mild cramping; severe discomfort does not usually occur. Women are typically able to resume normal activities immediately after the procedure, although they are usually advised to refrain from sexual intercourse and douching for several weeks after surgery. During the weeks following surgery, most women who undergo cryosurgery experience a watery discharge in which the dead cervical tissue is expelled.

Laser Surgery

Laser surgery involves using a focused laser beam to burn off abnormal cervical cells or to remove a sample of cervical tissue for examination in a pathology laboratory. Laser surgery is a quick procedure that does not usually damage the surrounding tissue. The procedure can be performed in a physician’s office or outpatient section of a hospital. Recovery time is usually very fast. Laser surgery is usually performed on patients with pre-cancerous or non-invasive forms of cervical cancer.

Cone Biopsy

A cone biopsy removes a piece of tissue which is cylindrical or cone shaped. The procedure is usually performed to diagnose cervical cancer but can also be used as a treatment if the cancer is small enough to be completely removed during biopsy. After the tissue is removed, it is analyzed in the pathology laboratory to determine whether cancer is present. There are two main methods used to perform cone biopsy. The LEEP (also called LLETZ) method, short for loop electrosurgical excision procedure, removes the tissue by using a wire that is heated by an electrical current. Patients are given local anesthesia and the procedure can be performed quickly in a physician's office. Another method of cone biopsy involves using a surgical scalpel or laser to remove the tissue. This procedure typically requires general anesthesia and may be performed in a hospital or outpatient facility. However, an overnight hospital stay is not usually required.

The most common side effects of cone biopsy include cramping/discomfort and moderate or mild bleeding for a few weeks after the procedure. Patients should avoid sexual intercourse, tampons, and douching until the incision is completely healed, which may take several weeks. Patients should also discuss other possible side effects of cone biopsy treatment prior to the procedure.

The advantages of cone biopsy are that it provides a large sample of tissue for analysis and it can sometimes completely remove the cancer so the patient does not need additional surgery. However, because complications from cone biopsy are possible, women should discuss all aspects of the procedure with their physician before undergoing biopsy. If a cone biopsy is recommended after abnormal Pap smear results, a patient may wish to ask if a colposcopy (looking at the cervix with magnification) or cervical biopsy would be an appropriate alternative (if they have not already been performed), based on her individual case.

Simple Hysterectomy

A simple hysterectomy involves surgically removing the uterus through an incision in the abdomen or vagina under general or epidural (regional) anesthesia. A simple hysterectomy does not usually involve removing any tissues near the uterus (such as the parametria and uterosacral ligaments), the vagina, the pelvic lymph nodes, the ovaries, or the fallopian tubes. The procedure is most commonly used to treat stage I cervical cancer. In some cases, simple hysterectomy may also be performed on patients with stage 0 (carcinoma in situ) cervical cancers if abnormal cells are found in the margins (edges) of a cone biopsy sample or on non-cancerous conditions, such as fibroids (small tumors).

A simply hysterectomy is typically performed in a hospital and involves a few days of recovering in the hospital (approximately three to five days for abdominal hysterectomy). Patients take approximately four to six weeks to heal from a simple hysterectomy. Possible complications of a simple hysterectomy include excessive bleeding, wound infection, or damage to the urinary or intestinal systems. A hysterectomy will result in permanent infertility.

Radical Hysterectomy

As with a simple hysterectomy, a radical hysterectomy involves surgically removing the uterus, usually through an incision in the abdomen. This procedure involves also removing the tissues near the uterus (parametria and uterosacral ligaments), the upper portion of the vagina, and the pelvic lymph nodes. The ovaries and fallopian tubes are usually left intact unless there is a specific reason why they should be removed. Recent technological advances now make it possible for the radical hysterectomy to be performed through the vagina when using laparoscopy. Laparoscopy allows surgeons to view the pelvis and abdomen through a tube inserted through a small surgical incision below the navel. Pelvic lymph nodes may be removed through the tube instead of a large incision in the abdomen.

A radical hysterectomy and removal of the pelvic lymph nodes is most commonly used to treat stage I or stage II cervical cancers. A radical hysterectomy is usually performed in a hospital and requires a five to seven day recovery in the hospital. As with a simply hysterectomy, the possible complications of a radical hysterectomy include excessive bleeding, wound infection, or damage to the urinary and intestinal systems. Hysterectomy causes permanent infertility. Although the vagina is shortened during hysterectomy, the procedure does not usually interfere with a woman’s sexual function. In fact, many women report an improved sexual life after hysterectomy because the procedure can alleviate symptoms that may make sexual intercourse uncomfortable (such as pain or bleeding during intercourse).

Pelvic Exenteration

Pelvic exenteration involves removing the bladder, vagina, rectum, and/or a portion of the colon in addition to performing a radical hysterectomy (see description above). The procedure is rarely performed and usually reserved for treating recurring invasive cervical cancer that has spread past the cervix. Pelvic exenteration may involve performing several additional procedures to ensure urine and feces can still be stored and eliminated. Plastic surgery can be performed to create an artificial vagina.

Radiation Therapy

Radiation therapy (or radiotherapy) uses high-energy rays to stop cancer cells from growing and dividing. There are two main types of radiation therapy: external beam and internal beam (also called brachytherapy). External beam radiation is delivered from a source outside the body on the specific area of the body that has been affected by the cancer. Experts compare the experience of external beam radiation to having a diagnostic x-ray, except that radiation is usually administered for a longer period of time and at a higher dose. Internal beam radiation involves either placing a capsule of radioactive material into the vagina near the tumor or placing small radioactive needles directly into the tumor.

For external beam radiation, the physician will measure the correct angles for aiming the radiation beam at the specific area of the body and make ink marks on the patient’s skin. The procedure itself is pain-free. While the radiation is being administered, the technologist will leave the room and monitor the patient on a closed-circuit television. However, patients should be able to communicate with the technologist at any time over an intercom system.

Side effects of radiation therapy vary among patients. The most common side effect is fatigue (extreme tiredness). Fatigue can be especially bothersome in the later weeks of treatment. Patients who experience fatigue after radiation sessions should get plenty of rest and try to maintain an active lifestyle. While many patients can still work and participate in normal activities during radiation therapy, some patients find it necessary to limit their work or activities until treatment has been completed. Another side effect that may occur from pelvic radiation is vaginal stenosis, a narrowing of the vagina caused by scar tissue. Vaginal stenosis may cause pain or discomfort during sexual intercourse.

Click here to learn more about radiation therapy.

Chemotherapy

Chemotherapy involves using anticancer drugs to help control or prevent the growth of cancerous tumors. Chemotherapy is often used as an adjuvant (supplemental) therapy in addition to other treatments, such as surgery or radiation therapy, which are designed to achieve local control of the cancer. Normally, chemotherapy is administered through a semipermanent catheter (a flexible tube) implanted into a large vein, or by a smaller, temporary, intravenous catheter placed into the smaller veins in the arm or hand. Some chemotherapy drugs are administered orally in form of pills or liquid. Chemotherapy may also be given intramuscularly (injected in the muscle), under the skin, topically (on the skin), or injected locally into the cancer area.

Chemotherapy may be used to:

• cure cancer
• stop cancer from spreading to other parts of the body
• slow cancer growth
• kill cancer cells
• relieve symptoms of cancer

Chemotherapy is a systemic form of treatment; that is, it is distributed throughout the bloodstream, affecting tissues and organs in the entire body. In this way, chemotherapy is different from local treatments such as surgery or radiation therapy, which only target specific parts of the body. Both local and systemic treatments are used to provide optimal cancer control, and the approach is tailored to the individual patient.

Cervical cancer patients who undergo chemotherapy may be given one drug or a combination of two or more drugs during treatment. Most physicians believe that combination chemotherapy (administering two or more drugs) is most effective for cervical cancer patients because combination therapy has been shown to provide better cancer cell control with lower doses of individual drugs. With combination chemotherapy, better results may be achieved while causing fewer of the side effects associated with higher doses of an individual drug. At this time, there are over 90 chemotherapy drugs used to treat different types of cancer.

Chemotherapy drugs most often used to treat cervical cancer include:

• cisplatin (brand name, Platinol)
• ifosfamide (brand name, Ifex)
• fluorouracil (brand names, Fluorouracil, 5-Fu, Adrucil)

The side effects a cancer patient experiences while undergoing chemotherapy vary significantly depending on several factors, including the types of drugs used, their dosages, and the duration of treatment. Some patients experience few to no negative effects from chemotherapy. In most cases, the benefits of treating cancer with chemotherapy far outweighs the risks or inconveniences of any side effects. The most common side effects of chemotherapy include nausea, hair loss, and fatigue.

Updated: June 3, 2008