Cervical Cancer Treatment

To plan your treatment, your health care professional needs to know the stage of the disease. The following stages are used for cervical cancer:

• Stage 0 or carcinoma in situ. This is very early cancer. The abnormal cells are found only in the first layer of cells of the lining of the cervix and do not invade the deeper tissues of the cervix.

• Stage I cancer involves the cervix but has not spread.

• Stage IA indicates a very small amount of cancer that is only visible under a microscope and is found in the deeper tissues of the cervix.

• Stage IB indicates a larger amount of cancer is found in the tissues of the cervix that can usually be seen without a microscope.

• Stage II cancer has spread to nearby areas but is still inside the pelvic area.

• Stage IIA cancer has spread beyond the cervix to the upper two-thirds of the vagina.

• Stage IIB cancer has spread to the tissue around the cervix, called the parametrial tissue.

• Stage III cancer has spread throughout the pelvic area. Cancer cells may have spread to the lower part of the vagina. The cells also may have spread to block the tubes that connect the kidneys to the bladder (the ureters).

• Stage IV cancer has spread to other parts of the body.

• Stage IVA cancer has spread to the bladder or rectum (organs close to the cervix).

• Stage IVB cancer has spread to other organs such as the lungs.

The best treatment plans for cervical cancer take into account several factors: the location of abnormal cells, the results of colposcopy, your age and whether you want to have children in the future. Basically, treatment involves destroying or removing the abnormal cells. Three basic approaches are used alone or in various combinations:

Surgery is used to remove the cancer. Various surgical techniques may be used, including:

• Excision (cutting out the abnormal cells)

• Electrosurgery (electric current is passed through a metal rod that touches, vaporizes and destroys abnormal cells)

• Cryosurgery (abnormal cells are frozen with carbon dioxide or nitrous oxide)

• Laser vaporization (precise destruction of the small areas of abnormal cells)

• Conization (a biopsy used as a treatment)

• Simple hysterectomy (removal of the cervix and uterus)

• Radical hysterectomy (removal of cervix, upper vagina, uterus and ligaments that support them)

Radiation therapy (using high-dose x-rays or other high-energy rays to kill cancer cells) is used to treat both early and advanced-stage diseases. Sometimes your health care professional will use it alone or in combination with surgery. A common way to receive radiation is externally, just like an x-ray. Another procedure, called brachytherapy, involves having the radioactive source placed inside your body; it continues to emit energy for a specific period of time. In most stages of cervical cancer, radiation should be used with chemotherapy.

Chemotherapy is the use of drugs to kill cancer cells. Chemotherapy may be taken by pill or infused into the body with a needle inserted into a vein. Chemotherapy is called a systemic treatment because the drugs enter the bloodstream, travel through the body and can kill cancer cells outside the cervix. Combination chemotherapy is constantly evolving, with the goal of improving response to treatment. Chemotherapy with platinum can also make radiation more effective, depending on the stage of the cancer.

Based on the stage of your cancer, treatment regimens usually include the following:

• Stage 0 cervical cancer is sometimes called carcinoma in situ. Treatment may be one of the following: conization; laser surgery; loop electrocautery excision procedure (LEEP); cryosurgery; and surgery to remove the cancerous area, cervix, and uterus (total abdominal or vaginal hysterectomy) for women who cannot or do not want to have children. The precancerous changes or the stage 0 cancer can recur in the cervix or vagina, so close follow-up is very important.

• Stage I cervical cancer treatments depend on how deep the tumor cells have invaded into the normal tissue.

  • For stage IA cancer, surgery is used to remove the cancer, uterus, and cervix (total abdominal hysterectomy). The ovaries may also be taken out (bilateral salpingo-oophorectomy), but are usually not removed in younger women.

    For tumors with deeper invasion (3-5 millimeters), surgery can be performed to remove the cancer, the uterus and cervix and part of the vagina (radical hysterectomy) along with the lymph nodes in the pelvic area (lymph node dissection).

    Conization and internal radiation therapy also are sometimes used for stage IA.

  • For stage IB cancer, your health care professional may recommend internal and external radiation therapy with chemotherapy; radical hysterectomy and lymph node dissection; radical hysterectomy and lymph node dissection followed by radiation therapy plus chemotherapy.

• Stage IIA cervical cancer treatment may include internal and external radiation therapy with chemotherapy; radical hysterectomy and lymph node dissection; radical hysterectomy and lymph node dissection followed by radiation therapy plus chemotherapy; or just radiation therapy. However, as mentioned earlier, recent clinical trials show that the combination of radiation therapy and chemotherapy with cisplatin, possibly combined with other drugs, is more effective than radiation alone.

• For stage IIB cancer, treatment may include internal and external radiation therapy with chemotherapy.

• Stage III and IVA: Most health care professionals combine these two groups in terms of prognosis and treatment. The treatment for these two groups used to include internal and external radiation therapy with chemotherapy, but new studies show that the combination of radiation and chemotherapy with cisplatin and possibly other chemotherapy drugs is most effective.

• Stage IVB cancer treatments often include chemotherapy and/or radiation therapy. Cancer at this stage is not usually considered curable, so treatments are more to relieve symptoms caused by the cancer than treat the cancer itself.

• Recurrent cervical cancer may require radiation therapy combined with chemotherapy. If the cancer has come back outside of the pelvis, a patient may choose to go into a clinical trial of a new treatment and/or use chemotherapy or radiation therapy to ease symptoms. If the recurrence is limited to the pelvis, radical pelvic surgery may be recommended.

Last medical review: 6/06
Last date updated: 1/07

Copyright 2007 National Women's Health Resource Center Inc. (NWHRC)