Cervical Cancer Treatment

A diagnosis of cervical cancer used to be a death sentence. Once upon a time, cervical cancer was the leading cause of death among American women. However, since 1955, the number of deaths from this disease has decreased dramatically, thanks to the routine use of the Pap test (also called a pap smear) in early cervical cancer detection.

The earlier that you're diagnosed with cervical cancer, the better your prognosis and the higher your survival rate. Routine pap smears can detect the early signs of cervical cancer, even before you notice any symptoms. The pap test can also detect abnormal cervical cells that might turn into cancerous cells. It's recommended that you have a pap test every two years after you turn 21.

Treating cervical cancer depends on the stage of disease -which describes the size of the cancer, the depth of invasion (how deep the cancer has grown into the cervix), and how far the cancer has spread in your body. The three primary methods of treating cervical cancer include surgery, radiation therapy, and chemotherapy.

Table: Cervical cancer staging, 5 year survival rate and definition of stage.

In the early stages of cervical cancer, surgery is the most common treatment option for this disease. Patients in the earliest stages of cervical cancer (such as stage 1A) can be treated with a total hysterectomy or a procedure called conization.

• Total hysterectomy - A surgery that is commonly used to treat stage 1A1 cervical cancer. During a total hysterectomy, also called a simple hysterectomy, the uterus and cervix is removed, but the vagina and parametrium (the tissue that surrounds the uterus) are left alone. The lymph nodes in the pelvis are also left intact.
  
  If the patient is of childbearing age, her ovaries are usually left alone with a total hysterectomy. If the event that her ovaries are removed, she will go into premature menopause.


• Conization - Used to treat pre-cancerous cells as well as stage 1A1 cervical cancer, conization is a surgical procedure that removes a cone-shaped piece of tissue from the cervix. This procedure uses either a surgical or laser knife, or a thin heated wire. Conization is often used in women with stage1A1 cervical cancer who wish to preserve their fertility.

Once the cervical cancer progresses to stage 1A2, stage 1B1 and 1B2, and stage 2A, your treatment options change. Treating cervical cancer at these stages include a total radical hysterectomy or a complex surgical procedure called a radical trachelectomy.

• Total Radical Hysterectomy - This is a primary treatment for stage 1A2, stage 1B, and stage 2A of cervical cancer. During a total radical hysterectomy, your entire uterus (including cervix) and all of its support structures (the parametrium) are removed. The upper part of the vagina and some or all the pelvic lymph nodes are also surgically removed. The ovaries and fallopian tubes are not removed, unless there's a medical reason for it.
  
  If cancerous cells are found at the edges of the removed tissue or lymph nodes, or if the tumor has other features that increase the risk of the cervical cancer returning, you will undergo further treatment, such as chemotherapy or radiation therapy.


• Radical Trachelectomy - For women in stage 1A2 or stage 1B1 cervical cancer who want to preserve their fertility, they may be candidates for this surgical procedure. During a radical trachelectomy, your cervix and parametrium are removed. Depending on the size and depth of your cervical cancer, the upper part of your vagina might be partially or completely removed. The surgeon will place a permanent purse-string stitch to the lower end of the uterus, or remaining cervix.
  
  The radical trachelectomy is still a relatively new procedure and has only been around since the mid-90s. While you may be able to become pregnant after this surgical procedure, you are at high risk for miscarriage. About half the women who undergo radical trachelectomy can go on to have full-term pregnancies with a cesarean delivery.

Surgery is not the only option for treating cervical cancer. Radiation therapy and chemotherapy are used commonly for the more advanced stages of cervical cancer. They are often used together to treat cervical cancer.

• Radiation Therapy - Commonly used to treat both early and late stages of cervical cancer, radiation therapy is often used in conjunction with chemotherapy. Radiation therapy alone treats stage 1A2 to stage 1B1 cervical cancer. When given with chemotherapy, radiation therapy can treat stages 1B2 to stage 4A cervical cancer.
  
  When you undergo radiation therapy, high energy x-rays are used to kill and stop the growth of cancer cells. Radiation can be given externally or internally. External beam radiation therapy is less invasive than internal radiation therapy.
  
  With external beam radiation, your body is placed underneath an x-ray machine and exposed to radiation for a few seconds every day, five days a week for five or six weeks.
  
  With external beam radiation, your body is placed underneath an x-ray machine and exposed to radiation for a few seconds every day, five days a week for five or six weeks.
  
  Radiation therapy that's given internally is called brachytherapy. During brachytherapy, a device is inserted into your vagina, which delivers high doses of radiation to the tumor area.
  
  There are two types of brachytherapy: low dose rate brachytherapy (the device delivers radiation through the vagina for 24 hours a day, for two or three days. You have to stay in the hospital during this therapy) and high dose rate brachytherapy (the device is placed in the vagina for a few minutes at a time once per day, and treatment is repeated several more times.)
  
  Side effects of radiation therapy may include fatigue, the frequent need to empty your bladder, discomfort when you urinate, loose stools or the feeling that you have to have a bowel movement frequently, and your public hair falling out. These side effects often disappear after your treatment is complete.
  
  Long-term side effects from radiation therapy include vaginal dryness, urine leakage, pain or bleeding with bowel movements, and narrowing or vaginal scarring (which can lead to pain during sexual intercourse).
  
  The radiation itself can sometimes increase the risk of future cancer in the area surrounding the treated tissue. The risk of secondary cancer with radiation therapy is definitely something that may concern younger patients.

• Chemotherapy - This treatment method is used to treat stages 1B1 to stage 4B cervical cancer. In the most advanced stage of cervical cancer (4B), chemotherapy is used to relieve the symptoms of the disease. It is commonly used along with radiation therapy (the combination is called "chemoradiotherapy"). Chemotherapy is thought to help increase the effectiveness of radiation therapy.
  
  During chemotherapy, you are typically given anti-cancer drugs intravenously (in your vein) at a hospital or a doctor's office. These drugs are cell-killing drugs that destroy widespread cancer cells that can't be treated with surgery or radiation therapy alone. Chemotherapy kills all fast growing cells in your body, including healthy ones, and this may lead to some side effects.
  
  Side effects from chemotherapy include nausea and vomiting, loss of appetite, hair loss, and mouth sores. Because chemotherapy can also damage the blood-producing cells of your bone narrow, this can lead to low blood cell counts.

For more information on treating cervical cancer and the disease, go to: