Cervical Cancer - Treatment Overview

Treatment Overview

Cervical cancer detected in its early stages can be cured with treatment and close follow-up. Treatment choices for cervical cancer may include one or more of the following therapies:

• Surgery to remove the cancer
• Radiation therapy to treat the cancer itself or other organs affected by the cancer
• Chemotherapy to help make the cancer more sensitive to radiation therapy and to treat cancer that has spread (metastasized)

Your quality of life becomes a critical issue when considering treatment options. Be sure to discuss your personal preferences with your oncologist when he or she recommends treatment.

Initial treatment

The choice of treatment and the long-term outcome (prognosis) of cervical cancer depends on the type and stage of cancer. Your age, overall health, quality of life, and desire to be able to have children must also be considered. Treatment choices for cervical cancer may be a single therapy or a combination of therapies, such as:

• Cone biopsy to remove the cancer.
• Simple hysterectomy to remove the uterus and cervix.
• Modified radical hysterectomy and lymph node dissection to remove the cancer.
• Radiation therapy, which uses high-dose X-rays or implants in the vaginal cavity to kill cancer cells.
• Chemotherapy, which uses medicines to kill cancer cells.
• Radical trachelectomy to remove the cervix and the pelvic lymph nodes (lymph node dissection). But the uterus is left in place. This treatment is done less often.

Chemotherapy may be given at the same time as radiation therapy (chemoradiation). Studies show that chemotherapy given at the same time as radiation treatment (chemoradiation) improves survival rates in stages IIB, IIIA, IIIB and IVA cervical cancer without significantly increasing the side effects of either treatment. Chemoradiation may also improve survival rates in stages IB and IIA for women with large tumors.^{5, 6, 1} Compared with radiation alone, chemoradiation improves survival.⁷ It is usually used as the primary therapy or after a hysterectomy.

Microinvasive squamous cell carcinoma (stage IA1) with minimal invasion into deeper cell layers is the most treatable stage with the highest survival rates. This stage is treated with a cone biopsy or loop electrosurgical excision procedure (LEEP) or simple hysterectomy; 5-year survival rates are close to 100%.⁸

Most treatments for cervical cancer cause side effects. Side effects may differ, depending on the type of treatment used and your age and overall health. Your doctor can talk to you about your treatment choices and the side effects associated with each treatment.

• Side effects of chemotherapy may include loss of appetite, nausea, vomiting, diarrhea, mouth sores, or hair loss.
• Side effects of radiation therapy may include fatigue, skin irritation, or changes in your bowel or urinary habits.
• Side effects of surgery depend on the surgery used to treat the stage of your cancer.

Home treatment measures may help relieve some common side effects of cancer treatment. For more information, see the Home Treatment section of this topic.

If you have recently been diagnosed with cervical cancer, you may experience a wide variety of emotions in reaction to your diagnosis. Most women will feel some denial, anger, and grief. There is no "normal" or "right" way to react to a diagnosis of cancer. You can take steps, though, to manage your emotional reactions to learning that you have cervical cancer. Some women find that talking with family and friends is comforting, while others may need to spend time alone to understand their feelings about their disease.

If your emotions are interfering with your ability to make decisions about your health and to move forward with your life, it is important to talk with your doctor. Your cancer treatment center may offer counseling services. You may also contact your local chapter of the American Cancer Society to help you find a support group. Talking with other women who have had similar feelings after a diagnosis such as yours can help you accept and deal with your disease.

Treatment for pregnant women

Recommended treatments are the same for pregnant women as for nonpregnant women. Treatment for early stage IA cervical cancer may be delayed until after delivery if the pregnancy is in the third trimester. A vaginal delivery may be possible. ⁹

For all stages of cervical cancer, treatment will be managed by a team of doctors specializing in cancer and high-risk pregnancies. The baby does not appear to be affected by cervical cancer, but treatment for the cancer may cause problems such as an early delivery or even the loss of the baby.¹⁰ Treatment will consider the recommendations for the specific stage of cancer, the development of the baby, and the mother's preferences.⁹

What to think about during initial treatment

Depending on the extent (stage) of your cancer, surgery may be combined with radiation therapy and chemotherapy. Radiation or chemotherapy given after a surgery is called adjuvant therapy.

Some women with cervical cancer may be interested in participating in research studies called clinical trials. Clinical trials are designed to find better ways to treat cancer patients and are based on the most up-to-date information. Women who do not want standard treatments or are not cured using standard treatments may want to participate in clinical trials. These are ongoing in most parts of the United States and in some other countries for all stages of cervical cancer.

Cervical cancer progresses more rapidly, has higher recurrence rates, and has a poorer prognosis in women with human immunodeficiency virus (HIV).

For more information about specific cervical cancer treatments, see the topics:

• Cervical Cancer—Health Professional Information [NCI PDQ].
• Cervical Cancer—Patient Information [NCI PDQ].

Ongoing treatment

After initial treatment for cervical cancer, it is important to receive follow-up care. Your emotional reactions may continue throughout the course of your treatment depending on your prognosis, the treatment methods used, and your quality-of-life decisions.

Your oncologist or gynecological oncologist will schedule regular checkups that will include:

• A pelvic exam and Pap test every 3 months for the first 2 or 3 years.
• After the first 2 or 3 years, a pelvic exam and Pap test every 6 months until 5 years after treatment.

Follow-up tests that may be recommended by your oncologist include an abdominal and pelvic computed tomography (CT) scan to monitor whether cancer has spread to other organs in the abdomen or pelvis.

If respiratory symptoms are present, a chest X-ray may be done to determine whether cancer has spread to the lungs.

Treatment if the condition gets worse

Cervical cancer can return after treatment. About 35% of women with cervical cancer will have persistent or recurrent disease.¹¹ The chance that your cancer will return depends on the stage of the initial cancer: cancer found early is less likely to come back than cancer found at a later stage. If cancer returns after treatment, it is usually within 2 years of the first diagnosis.⁸ Your long-term outcome (prognosis) for recurrent cervical cancer depends greatly on how much the cancer has spread when the recurrence is diagnosed.^{8, 5}

• Overall, fewer than 5% of women with recurrent cancer survive 5 more years even with additional treatment.
• Women who have had a radical hysterectomy and develop a recurrence that has not spread outside the pelvis have a 5-year survival rate of 30% to 40% when treated with radiation therapy. Chemotherapy may also be recommended.
• Women who develop a local recurrence that has not spread outside the pelvis may be treated with an extensive surgery called pelvic exenteration, which removes all the pelvic organs and surrounding tissue to eliminate the risk of additional recurrences.

The goal of treatment of advanced-stage cervical cancer that has spread outside the pelvis is to control symptoms, reduce complications, and increase comfort (palliative care). It is not intended to cure the disease. Palliative care may include:

• Radiation therapy.
• Chemotherapy medicines.
• Medicines for symptoms such as nausea or pain.

Complementary therapies

In addition to conventional medical treatment, you may wish to try complementary therapies, such as:

• Acupuncture.
• Herbs.
• Biofeedback.
• Meditation.
• Yoga.
• Visualization.
• Vitamins and nutritional supplements.

Complementary therapies are not a substitute for the standard treatment recommended for cervical cancer. Before you try any of these therapies, discuss their possible benefits and side effects with your doctor. Let him or her know if you are already using any such therapies. For more information, see the topic Complementary Medicine.

End-of-life issues

Some women with advanced-stage disease that is not curable may choose not to have cancer treatment because the time, costs, and side effects of treatment may be greater than the benefits. Making the decision about when to stop cancer treatment aimed at prolonging life and shift the focus to best supportive care can be difficult. For more information, see the topics:

• Care at the End of Life.
• Hospice Care.