Cervical Cancer Treatment, Surgery, Radiation and Chemotherapy

The focus on treatment of cervical cancer is to prevent precancerous lesions progressing to invasive cancer. Following an abnormal Pap smear and if the biopsy shows normal cells even in the deeper layers, no further treatment is advised except regular Pap tests and close monitoring.

Pre-cancerous lesions seen in the deeper layer, beyond the biopsy area, are usually treated with cold knife conization, LEEP, laser conization, laser vaporization, or cryotherapy. Hysterectomy may be an option for women who have completed their family.

Read more on Pap smear and biopsy of the cervix in cervical cancer diagnosis.

The standard treatment options available for patients with cervical cancer are surgery, radiation therapy, chemotherapy, or a combination therapy. Early stage cervical cancers are usually treated with surgery, while high-risk early stages and the more advanced stages may be treated with radiotherapy, chemotherapy, or combination therapy.

The treatment undertaken will depend upon factors such as :

• Age of the patient
• General health of the patient
• Tumor size
• Tumor spread (stage of cervical cancer) – whether the cancer is limited to the cervix or has spread beyond it
• Type of cervical cancer
• Desire for future pregnancy
• Consideration of the various side effects of treatment

Cervical Cancer Surgery

Surgery is usually recommended for tumors that are confined to the cervix (stage 0 and 1) and early stage 2 cervical cancers where the spread is limited to upper two thirds of the vagina.

The various types of surgery that may be performed are :

• Radical trachelectomy where the cervix, a portion of the vagina, and the pelvic lymph nodes are removed. It is usually recommended for women with small tumors who wish to fall pregnant in the future.
• Total hysterectomy is the removal of the uterus and cervix. A woman will not have her periods after a hysterectomy, and neither will she be able to fall pregnant.
• Radical hysterectomy is the removal of the cervix and some tissue around it, uterus, and a portion of the vagina.
• Bilateral salpingo-oophorectomy is the removal of the fallopian tubes and ovaries on both sides may accompany a total or radical hysterectomy. Premature menopause will occur with the removal of the ovaries.
• Lymphadenectomy is the removal of the lymph nodes near the tumor. Detection of cancer cells in the lymph nodes usually indicates that the cancer has spread to other sites.
• Pelvic exenteration, along with radical hysterectomy, is when most of the other tissues and organs in the pelvis, including the bladder and rectum, are removed. Recurrent cervical cancer that is confined to the pelvis may be treated by this extreme form of surgery.

Cervical Cancer Radiation Therapy

Radiation therapy may be given at any stage of cervical cancer, either alone or in combination with surgery or chemotherapy. In selected early stage cervical cancer, radiotherapy may first be attempted instead of surgery. Usually, late stage 2 cervical cancer (where the cancer has spread to tissues around the cervix) and stage 3 and 4 (where the cancer spread is more widespread) are treated with radiation therapy. It is also used as a palliative therapy for giving relief from symptoms where a cure is not possible. Recurrent cervical cancer may also be treated with radiation therapy.

High-energy rays are used to destroy or restrict growth and multiplication of the cancer cells. The two types of radiation therapy, used either alone or together, are :

• External beam radiation therapy where the radiation is given by a machine from the outside.
• Internal radiation therapy (brachytherapy) where small devices containing radioactive material are placed near the tumor through the vagina. It is removed after a set number of days.

Chemotherapy

Chemotherapy may be used alone or in combination with surgery or radiation therapy. Anti-cancer drugs, such as 5-FU, cisplatin, carboplatin, paclitaxel, and cyclophosphamide are used to destroy or stop multiplication of cancer cells. A single drug or a combination of drugs may be used. The drugs may administered orally or intravenously.

Chemotherapy is most often used in late stages of the disease, when the cancer has spread to other tissues and organs. It may be used as a palliative therapy to provide relief from symptoms in case of extensive spread of the disease or in case of recurrent cervical cancer.