Treatment

The treatment of cervical cancer depends on the size and location of the tumor, whether the cancer has spread, and the woman's overall health. In many cases, a team of doctors will work with the woman to determine the best treatment plan.

This section outlines treatments that are the standard of care (the best treatments available) for this specific type of cancer. Patients are also encouraged to consider clinical trials when making treatment plan decisions. A clinical trial is a research study to test a new treatment to prove it is safe, effective, and possibly better than standard treatment. Your doctor can help you review all treatment options. For more information, visit the Clinical Trials section

The most common treatments for cervical cancer are surgery, radiation therapy, and chemotherapy. The type of treatment used depends on the stage of the disease, the size of the tumor, the woman's age, her health, and her desire to have children. A woman who is pregnant should talk with her doctor about how treatments could affect both her and the unborn child, and whether treatment can be delayed until after the baby is born.

Radiation therapy alone or surgery is generally used for a small tumor. Chemoradiation (a combination of chemotherapy and radiation therapy) is generally used for women with invasive cervical cancer. Surgery and radiation therapy are both called local therapies because they affect only the area around the cancer site. Chemotherapy is a systemic therapy because it affects the entire body.

Surgery

In surgery, the doctor operates on the patient to remove the cancerous tissue. 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 (see
• Diagnosis) 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 desire fertility preservation (to have children in the future). 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 is the removal of the cervix, uterus, part of the vagina, and the nearby lymph nodes.
  
  
• Exenteration is 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.

If extensive surgical procedures have affected sexual function, other surgical procedures can construct an artificial vagina. Because these surgical procedures can affect a woman's sexual health, women should talk with their doctor about their symptoms in detail. The doctor may be able to help reduce the side effects of surgery.

Chemotherapy

Chemotherapy is the use of drugs to kill cancer cells. Systemic chemotherapy is delivered through the bloodstream, targeting cancer cells throughout the body. The goal of chemotherapy can be to destroy cancer remaining after surgery, slow the tumor's growth, or reduce side effects.

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, 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 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 potential longer-term side effects include the inability to become pregnant and premature menopause. Rarely, specific drugs may cause some hearing loss. Others may cause kidney damage. Patients may be given extra fluid intravenously for kidney protection.

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. Learn more about your prescriptions through Cancer.Net's Drug Information Resources, which provides links to searchable drug databases.

Radiation therapy

Radiation therapy is the use of high-energy x-rays or other particles to kill cancer cells. 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.

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.

For more information about radiation therapy, see the American Society for Therapeutic Radiology and Oncology’s pamphlet, Radiation Therapy for Gynecologic Cancers.

Advanced cervical cancer

Cancer that has spread beyond the cervix may be called advanced cervical cancer. Palliative treatment with radiation therapy may be given to relieve pain. 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. The doctor may also suggest entering a clinical trial, which is a research study to test a new treatment.

To learn more about the terms used in this section, read the Cancer.Net Feature: Cancer Terms to Know: During Treatment.