Cervical Cancer: Treatment Options

How is it treated?

Like most cancers, the treatment options for Cervical Cancer vary with the stage of development that the disease is in. Some form of surgery is often part of the procedure. This can be as simple as the removal of a small lesion on the cervix or as extensive as the removal of the entire uterus and some surrounding organs. Early detection is the most important factor that determines how invasive the treatment will be. Having a yearly Pap test and pelvic exam can prevent the need for major surgery. Treatment options are different for each individual case, but some common procedures are listed below. The information presented is intended to provide patients and their families with information that they can use in discussing treatment options with their physician.

Treatment for Pre-Cancerous Conditions

Treatment of the pre-cancerous stage of Cervical Cancer, or SIL, is often approached differently than treatment of fully developed Cervical Cancer. SIL's only affect the surface layer of cells and therefore normally only require minor procedures. Some of the factors that determine which type of treatment is used are:

• The severity of the SIL (high-grade or low-grade lesion)
  
• The location of the lesions on the cervix
  
• The woman's overall health and age
  
• The woman's desire to have children in the future
  

A woman and her doctor must decide which treatment is right for her. Some common procedures used to remove lesions that are determined to be harmful are listed below. Local or general anesthesia is used for all of the following procedures.

• Cryosurgery - The pre-cancerous lesions are rapidly frozen (usually with liquid nitrogen). As the area thaws, the unhealthy cells form something like a scab, and then fall off by themselves.
  
• Diathermy - Heat is carefully used to destroy and remove the unhealthy cells
  
• Laser Surgery - Guided laser instruments are used to remove the lesions
  
• Loop Epithelial Excision Procedure (LEEP) - An electrical wire loop is used to slice of a thin round area of tissue
  
• Conization - A cone shaped sample of tissue is removed from the affected area of the cervix
  
• Hysterectomy - This involves the removal of the entire uterus, including the cervix. This surgery is normally only for women whose lesions are found deeper into the cervix and who do not want to have children in the future.
  

Possible Side Effects of Treatments for Pre-Cancerous Conditions

Each patient's response to treatment will be different but there are some common temporary side effects. Some of the side effects women have experienced after treatment include:

• Cramping
  
• Abdominal pain
  
• Bleeding
  
• Vaginal discharge
  

Treatments for Cervical Cancer

Once a pre-cancerous lesion has fully developed into Cervical Cancer, the treatment approach becomes more complex. Management of Cervical Cancer often involves a combination of surgical and non-surgical treatments. If the cancer has spread to other organs, then treatment of these areas must be considered as well.

Surgical Treatments

If the cancer has not spread beyond the cervix, then the procedures listed above in "Treatments for pre-cancerous conditions" are often used. However, when used for Cervical Cancer, a larger amount of tissue often needs to be removed.

If the cancer has spread beyond the cervix, more invasive surgery is often involved. The surgery required depends on the extent to which the cancer has spread. These surgeries are often combined with radiation therapy or chemotherapy.

• Simple hysterectomy: The entire uterus is removed, but the surrounding tissue remains intact.
  
  
• Radical hysterectomy and pelvic lymph node dissection: The entire uterus, the tissues next to the uterus, the upper part of the vagina, and the lymph nodes from the pelvis are removed.
  
  
• Pelvic Exenteration: A radical hysterectomy and pelvic lymph node dissection is accompanied by a removal of the bladder, vagina, rectum, and part of the colon. This operation is only used in advanced stages when the cancer has come back after earlier treatment.
  

Other Treatments

There are several other treatments for Cervical Cancer that are not surgical. These treatments are often combined with surgery and sometimes used instead of surgery. Radiation therapy, chemotherapy, and biological therapy are all administered on an outpatient basis.

• Radiation Therapy - In some cases X-rays can be used to kill or shrink cancer cells at the site of the tumor. The radiation may be administered by a machine, such as a linear accelerator or cobalt apparatus, or from a radioactive source implanted within the diseased area. External beam radiation therapy uses radiation from outside the body to focus on the cancer and is, therefore, not the primary treatment for cancer that may have spread beyond the pelvis.
  
  
• Chemotherapy - Drugs are administered by mouth or injection to kill the cancer cells. The drugs enter the blood stream and can, therefore, reach areas of the body where the cancer may have spread.
  
  
• Biological Therapy - Substances that improve the way the body's immune system fights disease are used to treat cancer that has spread from the cervix to other parts of the body. Interferon is a type of biological therapy commonly used to fight this type of cancer. Interferon therapy is often combined with chemotherapy.
  
  
• Clinical Trials - There are always new experimental treatments being tested that often have promising results. The effectiveness and side effects of clinical trials are not always known, but they can sometimes offer hope of survival especially for end stage cancer patients. Consult your physician or the Rhode Island Cancer Council to find out what clinical trials are going on near you and if you are eligible.
  

Side Effects of Treatments for Cervical Cancer

Surgical Treatments

• Hysterectomy - Any surgery that removes the uterus stops the menstrual cycle and prevents the woman from ever becoming pregnant. If the ovaries are removed as well, then the woman will enter menopause. This surgery involves an abdominal incision and requires a hospital stay of 2 days and about 4-8 weeks total recovery time.
  
  
• Pelvic Exenteration - Removal of the bladder and rectum requires the surgeon to create alternate methods to urinate and remove waste from the body. If this type of surgery is necessary, ask your doctor to explain the possible surgical procedures that can be performed.
  

Other Treatments

*Most side effects are temporary and can often be relieved with medication.

• Radiation Therapy
  
  • Nausea, vomiting, diarrhea
    
  • Sexual dysfunction
    
  • Irritation to the skin near the radiation site
    
  • Narrowing of the vagina (can make intercourse painful)
    
  • Urinary complications
    
  • Early Menopause
    
  • Infertility
    
• Chemotherapy
  
  • Nausea and vomiting - Loss of appetite
    
  • Loss of hair
    
  • Mouth or vaginal sores
    
  • Increased susceptibility to infection
    
  • Premature menopause (permanent)
    
  • Infertility (permanent)
    

If you found this information helpful, please consider making a donation to the Rhode Island Cancer Council so we may continue adding content to our website and providing valuable services to Rhode Island residents. Please click the Donate icon to the left to make a donation via credit card or your PayPal account.

See also: