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Cervical cancer - Treatment

Alternative Names

Cancer - cervix

Treatment:

Treatment of cervical cancer depends on:

  • The stage of the cancer
  • The size and shape of the tumor
  • The woman's age and general health
  • Her desire to have children in the future

Early cervical cancer can be cured by removing or destroying the precancerous or cancerous tissue. There are various surgical ways to do this without removing the uterus or damaging the cervix, so that a woman can still have children in the future.

Types of surgery for early cervical cancer include:

  • Loop electrosurgical excision procedure (LEEP) -- uses electricity to remove abnormal tissue
  • Cryotherapy -- freezes abnormal cells
  • Laser therapy -- uses light to burn abnormal tissue

A hysterectomy (removal of the uterus but not the ovaries) is not often performed for cervical cancer that has not spread. It may be done in women who have repeated LEEP procedures.

Treatment for more advanced cervical cancer may include:

  • Radical hysterectomy, which removes the uterus and much of the surrounding tissues, including lymph nodes and the upper part of the vagina.
  • Pelvic exenteration, an extreme type of surgery in which all of the organs of the pelvis, including the bladder and rectum, are removed.

Radiation may be used to treat cancer that has spread beyond the pelvis, or cancer that has returned. Radiation therapy is either external or internal.

  • Internal radiation therapy uses a device filled with radioactive material, which is placed inside the woman's vagina next to the cervical cancer. The device is removed when she goes home.
  • External radiation therapy beams radiation from a large machine onto the body where the cancer is located. It is similar to an x-ray.

Chemotherapy uses drugs to kill cancer. Some of the drugs used for cervical cancer chemotherapy include 5-FU, cisplatin, carboplatin, ifosfamide, paclitaxel, and cyclophosphamide. Sometimes radiation and chemotherapy are used before or after surgery.

Support Groups:

National Cervical Cancer Coalition - http://www.nccc-online.org/

Expectations (prognosis):

Many factors influence the outcome of cervical cancer. These include:

  • The type of cancer
  • The stage of the disease
  • The woman's age and general physical condition

Pre-cancerous conditions are completely curable when followed up and treated properly. The chance of being alive in 5 years (5-year survival rate) for cancer that has spread to the inside of the cervix walls but not outside the cervix area is 92%.

The 5-year survival rate falls steadily as the cancer spreads into other areas.

Complications:

  • Some types of cervical cancer do not respond well to treatment.
  • The cancer may come back (recur) after treatment.
  • Women who have treatment to save the uterus have a high risk of the cancer coming back (recurrence). 
  • Surgery and radiation can cause problems with sexual, bowel, and bladder function.

Calling your health care provider:

Call your health care provider if you:

  • Are a sexually active woman who has not had a Pap smear in the past year
  • Are at least 20 years old and have never had a pelvic examination and Pap smear
  • Think your mother may have taken DES when she was pregnant with you
  • Have not had regular Pap smears (ask your health care provider how often you should have one performed)
  • Reviewed last on: 12/28/2010
  • Yi-Bin Chen, MD, Leukemia/Bone Marrow Transplant Program, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

References

Kahn JA. HPV vaccination for the prevention of cervical intraepithelial neoplasia. N Engl J Med. 2009 Jul 16;361(3):271-8.

Noller KL. Intraepithelial neoplasia of the lower genital tract (cervix, vulva): Etiology, screening, diagnostic techniques, management. In: Katz VL, Lentz GM, Lobo RA, Gershenson DM, eds. Comprehensive Gynecology. 5th ed. Philadelphia, Pa: Mosby Elsevier; 2007:chap 28.

National Comprehensive Cancer Network. NCCN Practice Guidelines in Oncology: Cervical Cancer Screening. v.1.2011.

Smith RA, Cokkinides V, Brooks D, Saslow D, Brawley OW. Cancer screening in the United States, 2010: a review of current American Cancer Society guidelines and issues in cancer screening. CA Cancer J Clin. 2010;60:99-119.

NCCN Clinical Practical Guidelines in Oncology: Cervical cancer. V.1.2010. National Comprehensive Cancer Network, Inc. Available at www.nccn.org. Accessed December 28, 2009.

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