Treatment of cervical cancer will depend on a number of factors, including:
- The stage of the cancer
- The size of the tumor
- The patient's desire to have children
- The patient's age and overall health
Treating cervical cancer when a woman is pregnant depends on two factors: the stage of pregnancy and the stage of cervical cancer. Treatment may be delayed until the baby is born if a woman is in her third trimester of pregnancy. Treatment may also be delayed in pregnant women if cervical cancer is detected before it has spread.
Small Precancerous Lesions
The following surgical procedures may be used for precancerous lesions or for cancerous tissue that has not spread beyond the cervix.
Cryosurgery (cryotherapy): This surgical procedure uses an instrument to freeze and destroy precancerous tissue.
Laser surgery: This surgical procedure uses a narrow laser beam to destroy precancer cells. This is not used on invasive cancer. A benefit of laser treatment is its precision; it destroys only diseased tissue inside in the cervix.
LEEP (loop electrosurgical excision procedure): This procedure uses electrical current passed through a thin wire hook. This is primarily used on precancerous lesions under local anesthesia. The advantage of this procedure is that more of the tissue can be removed for evaluation.
Cone: A gynecologist uses the same procedure as a cone biopsy to remove all of the cancerous tissue. This procedure can be used in a woman who has a very small cancerous area and who wishes to preserve the ability to have children.
Hysterectomy: This operation removes the uterus and the cervix. This kind of hysterectomy is performed only on women with cervical cancer less than three millimeters in depth.
Bilateral salpingo-oophorectomy: In this procedure, the fallopian tubes and ovaries are removed at the same time as the hysterectomy. If a woman is close to the age of menopause, her doctor may discuss removing her ovaries and fallopian tubes to reduce the chance that the cancer will recur in one of those organs.
Large Cervical Cancer Lesions
The following surgical procedures may be used for larger cervical cancerlesions (usually up to four to five centimeters in width), but only if the cancer is all within the cervical tissue. If the cancer has spread beyond the cervix, doctors will usually recommend chemotherapy in combination with radiation therapy.
Trachealectomy: This procedure removes the cervix and surrounding tissue but not the uterus. It is used for women who have a larger cancerous area but wish to preserve the ability to have children. The procedure may include removal of lymph nodes. Typically patients considered for this procedure have to have tumors less than two centimeters in size.
Radical hysterectomy: The surgeon removes the cervix, uterus, part of the vagina and the tissues surrounding the cervix called the parametria. At the same time, the surgeon also removes nearby lymph nodes. Depending on a woman's age and the size of the tumor, she may also have a bilateral salpingo-oophorectomy (removal of the ovaries and fallopian tubes).
Radiation therapy is used for cancers that have spread beyond the cervix (II, III or IV) or very large lesions (larger than four centimeters).
Radiation therapy uses high-energy X-rays or other types of radiation to kill cancer cells or shrink the tumor. Radiation therapy is used instead of surgery in most cases. However, it is sometimes necessary after surgery if it is discovered that the cancer has spread outside the cervix, or to reduce the risk that a cancer will come back after surgery.
There are two types of radiation therapy:
External radiation therapy uses a machine outside the body to send radiation toward the cervical cancer. Internal radiation therapy uses a small amount of radioactive material that is delivered directly to the tumor using implants.
Internal radiation therapy implants are inserted through the vagina into the cervix, where they are placed next to the tumor while the patient is under anesthesia. The implants stay in place for a few days.
Types of radiation therapy are used with this disease:
Virtual CT simulation
Intensity modulated radiation therapy (IMRT)
Volumetric Modulated Arc Therapy (VMAT)
- Gynecologic brachytherapy consists of implanting a device in the cavity of the vagina or neck of the womb through which radiation is delivered by means of a radioactive source of Ir-192. The technique has the advantage that a low-volume, high-intensity dose of radiation can be delivered whilst protecting the surrounding healthy tissue from the Iridium source.
High-dose brachytherapy (HDR) has the advantage that it is safer for those handling the radiation and for the patient, as there is no need for the patient to be isolated or admitted to hospital being an ambulatory treatment.
Types of brachytherapy administered (combined or not with external radiation treatment).
- Endocavitary brachytherapy is used as an adjuvant therapy in surgery on endometrial tumors, where we treat the vaginal vault in uterine tumors, cervical tumors, primary vaginal tumors or relapse of other vaginal tumors.
- Interstitial brachytherapy: requires sedation. Locally advanced cervical tumors.
Intraoperative radiation therapy
- We apply this technique when treating patients with a relapsed tumorpreviously treated with radiation. Radiation therapy is applied during surgery when the surgeon has just resected the tumor, but where the margins are suspected of not being negative. Radiation is delivered during surgery by means of a source of Iridium 192.
Chemotherapy uses drugs to stop the growth of cancer cells either by killing the cells or by stopping them from dividing. Chemotherapy can be given by mouth or injected into a vein or muscle. In most cases, it is given to a patient through a vein during an outpatient visit using systemic chemotherapy. The drugs enter the bloodstream and can reach cancer cells throughout the body.
Regional chemotherapy is chemotherapy which is placed directly into an organ or a body cavity, such as the abdomen. Almost all cervical cancerpatients in good medical condition who are receiving radiation for stage IIA or higher, will be offered chemotherapy in addition to radiation therapy.