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Cancer Medicine :: Cervical Cancer Treatment

Cervical Cancer

Treatment Options

This section outlines treatments that are the standard of care (the best proven treatments available) for this specific type of cancer. When making treatment plan decisions, patients are also encouraged to consider clinical trials as an option. A clinical trial is a research study to test a new treatment to evaluate whether it is safe, effective, and possibly better than standard treatment. Your doctor can help you review all treatment options. 

          

 

Treatment overview

In cancer care, different types of doctors often work together to create a patient’s overall treatment plan that combines different types of treatments. This is called a multidisciplinary team.

Descriptions of the most common treatment options for cervical cancer are listed below. The treatment of cervical cancer depends on several factors, including the type and stage of cancer, possible side effects, and the patient’s preferences and overall health. 

Women with cervical cancer may have concerns about if or how their treatment may affect their sexual function and fertility (ability to have children), and these topics should be discussed with the health care team before treatment begins. A woman who is pregnant should talk with her doctor about how treatments could affect both her and the unborn child. Treatment may be able to be delayed until after the baby is born.

Surgery

Surgery is the removal of the tumor and surrounding tissue during an operation. A surgical oncologist is a doctor who specializes in treating cancer using surgery. For cervical cancer that has not spread beyond the cervix, these procedures are often used:

Conization is the use of the same procedure as a cone biopsy  to remove all of the abnormal tissue. It can be used to remove microinvasive cervical cancer.

LEEP is the use of an electrical current passed through a thin wire hook. The hook removes the tissue. It can be used to remove microinvasive cervical cancer.

A hysterectomy is the removal of the uterus and cervix. Hysterectomy can be either a simple hysterectomy, which is the removal of the uterus and cervix, or a radical hysterectomy which is the removal of the uterus, cervix, upper vagina, and the tissue around the cervix. In addition, a radical hysterectomy includes an extensive pelvic lymph node dissection (removal of the lymph nodes).

If needed, a bilateral salpingo-oophorectomy (the removal of both fallopian tubes and both ovaries) is done at the same time as the hysterectomy.

Radical trachelectomy (surgery to remove the cervix that leaves the uterus intact) with pelvic lymph node dissection may be used for young patients who want to preserve their fertility. This procedure has gained acceptance as an alternative to a hysterectomy.

For cervical cancer that has spread beyond the cervix, one of these procedures may be used:

Radical hysterectomy

Exenteration: the removal of the uterus, vagina, lower colon, rectum, or bladder if cervical cancer has spread to these organs following radiation therapy.

Complications or side effects from surgery vary depending on the extent of the procedure. Occasionally, patients experience significant bleeding, infection, or damage to the urinary and intestinal systems. Talk with your doctor about what to expect about your specific surgery.

If extensive surgical procedures have affected sexual function, other surgical procedures can be used to make an artificial vagina. Because these surgical procedures affect a woman's sexual health, women should talk with their doctor about their symptoms and concerns in detail before the surgery. The doctor may be able to help reduce the side effects of surgery and provide support resources on coping with any changes. 

Radiation therapy

Radiation therapy is the use of high-energy x-rays or other particles to kill cancer cells. A doctor who specializes in giving radiation therapy to treat cancer is called a radiation oncologist. Radiation therapy may be given alone or before surgery to shrink the tumor. Some women may be treated with a combination of radiation therapy and chemotherapy.

The most common type of radiation treatment is called external-beam radiation therapy, which is radiation given from a machine outside the body. When radiation treatment is given using implants, it is called internal radiation therapy or brachytherapy. A radiation therapy regimen (schedule) usually consists of a specific number of treatments given over a set period of time.

Side effects from radiation therapy may include fatigue, mild skin reactions, upset stomach, and loose bowel movements. Side effects of internal radiation therapy may include abdominal pain and bowel obstruction. Most side effects usually go away soon after treatment is finished.

Sometimes, doctors advise their patients not to have sexual intercourse during radiation therapy. Women may resume normal sexual activity within a few weeks after treatment if they feel ready.

Chemotherapy

Chemotherapy is the use of drugs to kill cancer cells, usually by stopping the cancer cells’ ability to grow and divide. Systemic chemotherapy is delivered through the bloodstream to reach cancer cells throughout the body. Chemotherapy is given by a medical oncologist, a doctor who specializes in treating cancer with medication. A chemotherapy regimen (schedule) usually consists of a specific number of cycles given over a set period of time. A patient may receive one drug at a time or combinations of different drugs at the same time. The goal of chemotherapy can be to destroy cancer remaining after surgery (also called adjuvant therapy), slow the tumor's growth, reduce side effects, or treat recurrent cervical cancer (cancer that has come back after original treatment).

Although chemotherapy can be given orally (by mouth), most drugs used to treat cervical cancer are given intravenously (IV). IV chemotherapy is either injected directly into a vein or through a thin tube called a catheter, which is a tube temporarily put into a large vein to make injections easier.

The side effects of chemotherapy depend on the individual and the dose used, but they can include fatigue, risk of infection, nausea and vomiting, loss of appetite, and diarrhea. These side effects usually go away once treatment is finished.

Other possible long-term side effects include the inability to become pregnant and early menopause. Rarely, specific drugs may cause some hearing loss. Others may cause kidney damage. Patients may be given extra fluid intravenously for kidney protection. Talk with your doctor about the possible short-term and long-term side effects based on the drugs and dosages you’ll be receiving.

The medications used to treat cancer are continually being evaluated. Talking with your doctor is often the best way to learn about the medications prescribed for you, their purpose, and their potential side effects or interactions with other medications. 

Treatment options by stage

Radiation therapy alone or surgery is generally used for a small tumor. These treatments have been shown to be equally effective at treating early stage cervical cancer. Chemoradiation (a combination of chemotherapy and radiation therapy) is generally used for women with a larger tumor. Sometimes, radiation and chemotherapy are used after surgery when the patient is at a high risk for a recurrence or if the cancer has spread.

Palliative/supportive care

Cancer and its treatment often cause side effects. In addition to treatment to slow, stop, or eliminate the cancer, an important part of cancer care is relieving a person’s symptoms and side effects. This approach is called palliative or supportive care, and it includes supporting the patient with his or her physical, emotional, and social needs.

Palliative care can help a person at any stage of illness. People often receive treatment for the cancer and treatment to ease side effects at the same time. In fact, patients who receive both often have less severe symptoms, better quality of life, and report they are more satisfied with treatment.

Before treatment begins, talk with your health care team about the possible side effects of your specific treatment plan and supportive care options. And during and after treatment, be sure to tell your doctor or another health care team member if you are experiencing a problem, so it is addressed as quickly as possible. 

Recurrent cervical cancer

A remission is when cancer cannot be detected in the body and there are no symptoms. This may also be called “no evidence of disease” or NED. 

A remission can be temporary or permanent. This uncertainty leads to many survivors feeling worried or anxious that the cancer will come back. While many remissions are permanent, it’s important to talk with your doctor about the possibility of the cancer returning. Understanding the risk of recurrence and the treatment options may help you feel more prepared if the cancer does return. 

If the cancer does return after the original treatment, it is called recurrent cancer. Recurrent cancer may come back in the same place (called a local recurrence), nearby (regional recurrence), or in another place (distant recurrence).

When this occurs, a cycle of testing will begin again to learn as much as possible about the recurrence. After testing is done, you and your doctor will talk about your treatment options. Often the treatment plan will include the therapies described above (such as chemotherapy and radiation therapy) but may be used in a different combination or given at a different pace. Your doctor may also suggest clinical trials that are studying new ways to treat this type of recurrent cancer.

People with recurrent cancer often experience emotions such as disbelief or fear. Patients are encouraged to talk with their health care team about these feelings and ask about support services to help them cope. 

Metastatic cervical cancer

If cancer has spread to another location in the body, it is called metastatic cancer. Patients with this diagnosis are encouraged to talk with doctors who are experienced in treating this stage of cancer, because there can be different opinions about the best treatment plan. 

Your health care team may recommend a treatment plan that includes a combination of palliative treatment with radiation therapy to relieve pain and other symptoms. Chemotherapy and surgery may be used to treat or remove newly affected areas both within the pelvic area and in other parts of the body. Supportive care will also be important to help relieve symptoms and side effects.

For many patients, a diagnosis of metastatic cancer can be very stressful and, at times, difficult to bear. Patients and their families are encouraged to talk about the way they are feeling with doctors, nurses, social workers, or other members of the health care team. It may also be helpful to talk with other patients, including through a support group.

If treatment fails

Recovery from cancer is not always possible. If treatment is not successful, the disease may be called advanced or terminal cancer.

This diagnosis is stressful, and this is difficult to discuss for many people. However, it is important to have open and honest conversations with your doctor and health care team to express your feelings, preferences, and concerns. The health care team is there to help, and many team members have special skills, experience, and knowledge to support patients and their families. Making sure a person is physically comfortable and free from pain is extremely important.

Palliative care given toward the end of a person’s life is called hospice care. You and your family are encouraged to think about where you would be most comfortable: at home, in the hospital, or in a hospice environment. Nursing care and special equipment can make staying at home a workable alternative for many families.

Coping with Side Effects

Fear of treatment side effects is common after a diagnosis of cancer, but it may help to know that preventing and controlling side effects is a major focus of your health care team. This is called palliative or supportive care, and it is an important part of the overall treatment plan, regardless of the stage of disease.

Common side effects from each treatment option for cervical cancer are described in detail within the Treatment section. 

Before treatment begins, talk with your doctor about possible side effects of each type of treatment you will be receiving. Ask which side effects are most likely to happen, when they are likely to occur, and what can be done to prevent or relieve them. And, ask about the level of caregiving you may need during treatment and recovery, as family members and friends often play an important role in the care of a person with cervical cancer. 

In addition to physical side effects, there may be psychosocial (emotional and social) effects as well. Patients and their families are encouraged to share their feelings with a member of their health care team who can help with coping strategies. 

During and after treatment, be sure to tell the health care team about the side effects you experience, even if you feel they are not serious. Sometimes, side effects can last beyond the treatment period, called a long-term side effect. A side effect that occurs months or years after treatment is called a late effect. Treatment of both types of effects is an important part of survivorship care. 

After Treatment

After treatment for cervical cancer ends, talk with your doctor about developing a follow-up care plan. This plan may include regular physical examinations and/or medical tests, such as pelvic examinations and Pap tests , to monitor your recovery in the coming months and years. Women treated for cervical cancer need regular follow-up appointments to make sure that the tumor is not recurring, but the risk of recurrence declines over time.

Women recovering from cervical cancer are encouraged to follow established guidelines for good health, such as maintaining a healthy weight, not smoking, eating a balanced diet, and having recommended cancer screening tests. Talk with your doctor to develop a plan that is best for your needs. For women who smoke, quitting smoking can help recovery and reduce the risk of cancer recurrence. Moderate physical activity can help rebuild your strength and energy level. Your doctor can help you create an appropriate exercise plan based upon your needs, physical abilities, and fitness level. 

Latest Research

Doctors are working to learn more about cervical cancer, ways to prevent it, how to best treat it, and how to provide the best care to people diagnosed with this disease. The following areas of research may include new options for patients through clinical trials. Always talk with your doctor about the diagnostic and treatment options best for you.

Improved detection and screening methods. Because cervical cancer is highly treatable when detected early, researchers are developing better ways to detect cervical cancer. For example, fluorescent spectroscopy is the use of fluorescent light to detect changes in precancerous cervix cells.

HPV prevention. As discussed in the Prevention section, the HPV vaccines help prevent infection from the HPV strains that cause most cervical cancers. Gardasil is also approved by the FDA for boys and men ages 9 through 26 to prevent genital warts. Researchers are looking at the impact of the HPV vaccine on boys to reduce the risk of HPV transmission.

Immunotherapy. Immunotherapy (also called biologic therapy) is designed to boost the body’s natural defenses to fight the cancer. It uses materials either made by the body or in a laboratory to bolster, target, or restore immune system function. For women who already have cervical cancer, a therapeutic vaccine is being developed. These vaccines help "train" the immune system to recognize cervical cancer cells and destroy them. 

Fertility-preserving surgery. There is continued interest in improving surgical techniques and finding out which patients with cervical cancer can be treated successfully without loss of fertility. 

Targeted therapy. Targeted therapy is a treatment that targets the cancer’s specific genes, proteins, or the tissue environment that contributes to cancer growth and survival. Drugs called anti-angiogenesis inhibitors that block the action of a protein called vascular endothelial growth factor (VEGF) are being tested for women with cervical cancer. VEGF promotes angiogenesis (the formation of new blood vessels), which is necessary for tumor growth and metastasis. 

Combination therapy. Some clinical trials are exploring various combinations of immunotherapy, radiation therapy, and chemotherapy.

Supportive care. Clinical trials are underway to find better ways of reducing symptoms and side effects of current cervical cancer treatments in order to improve patients’ comfort and quality of life.

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