Cervical Cancer

Treatment

Treatment for cervical cancer depends on tumor size and location, disease stage and the patient's age and overall health. Cervix cancer most often treated with one or a combination of treatments: surgery, radiation, and/or chemotherapy. Cervical cancer is curable by removing or destroying the pre-cancerous tissue. If the cervix cancer in its early stages, a simple hysterectomy or a radical hysterectomy can be performed. But in the most advanced cases, the pelvic extenteration is used. 

Surgery
Surgery is the primary treatment for cancer of the cervix in its early stages. The type of surgery required depends on the stage and site of the cancer. Some common surgical procedures used as part of treatment for cervical cancer are:

Hysterectomy- A surgical procedure to remove the cervix and uterus. If the uterus and cervix are taken out through the vagina, the operation is called a vaginal hysterectomy. If the uterus and cervix are taken out through a large incision (cut) in the abdomen, the operation is called a total abdominal hysterectomy. If the uterus and cervix are taken out through a small incision in the abdomen using laparascopic technology, the operation is called a total laparoscopic hysterectomy. The common side effects are lower abdominal pain and difficulty with urination after the operation. After a hysterectomy, women no longer menstruate and can no longer have children.

Bilateral salpingo-oophorectomy- A surgical procedure to remove the ovaries and fallopian tubes

Radical hysterectomy- A surgical procedure to remove the uterus, cervix, and part of the vagina. During a radical hysterectomy, the lymph nodes in the pelvic area are usually removed as well. This is called lymph node dissection. (Lymph nodes are small bean-shaped structures that are found throughout the body. In this procedure it is not  necessary to remove the ovaries in a radical hysterectomy, which helps keep the woman's ovaries working.

Pelvic exenteration- A surgical procedure to remove the lower colon, rectum, and bladder. In women, the cervix, vagina, ovaries, and nearby lymph nodes are also removed. Artificial openings (stoma) are made for urine and stool to flow from the body to a collection bag. Plastic surgery may be needed to make an artificial vagina after this operation.

Cryosurgery - This surgery technique uses an instrument to freeze and destroy abnormal tissue, such as carcinoma in situ. This type of treatment is also called cryotherapy. The technique is used to treat pre-invasive cancer of the cervix.

Laser surgery-  A surgical procedure that uses a laser beam (a narrow beam of intense light) as a knife to make bloodless cuts in tissue or to remove a small piece of tissue. 

Loop electrosurgical excision procedure (LEEP)- A treatment that uses electrical current passed through a thin wire loop as a knife to cutting out the abnormal cells.

Radiation therapy
If the tumor has spread more than a small amount beyond the cervix, and it is unlikely that surgery alone can treat it, radiotherapy is the usual treatment. Radiation therapy uses x-rays or other high-energy particles to kill cancer cells. Radiotherapy may also be used after surgery to prevent recurrence.

Treatment is concentrated on a specific area. Radiation may be used alone or after surgery. Patient may receive both internal and external radiation.

The most common type of radiation is called external-beam radiation, which is radiation given from a machine outside the body. Treatment is usually given five days a week for about six weeks.

Radiation therapy has been used with great success in early-stage cervix cancer. Five-year cure rates for women with stage IB or IIA with radiation therapy are 85- 90%. Stages IIB, III, and IVA are best treated with radiation therapy combined with chemotherapy. The 5-year survival rate for stage IIB is 60- 65%. The 5-year survival rates for stage III ranges from 25- 40%. For stage IV, 5-year survival rates are in the 15- 20% range.

In other cases a device that gives off radiation is inserted into the vagina, so the radiation is closer to the area requiring treatment. Side effects depend on the treatment dosage, area, and type of radiation. Common side effects may include hair loss, nausea, tiredness, diarrhoea, and dysuria.

Chemotherapy
Chemotherapy, the use of drugs to kill cancer cells. The chemotherapy can be to destroy cancer remaining after surgery, slow the tumor's growth, or reduce symptoms. This is sometimes used before radiotherapy or surgery and may be used after surgery to ensure no cancer cells are let, and can control symptoms if cancer comes back after an initial treatment.

It is usually given as a series of injections into a vein. Since chemotherapy drugs affect normal cells as well as cancer cells, many people experience side effects from treatment. Side effects depend on the drug used and the dosage amount. Some general  side effects include nausea and vomiting, loss of appetite, diarrhea, fatigue, low blood count, bleeding, headaches, hair loss,  a burning sensation on passing urine, and early menopause. Side effects usually go away when treatment is complete.

Treatment by Stage

For Stage 0 (carcinoma in situ)

Treatment of  Stage 0 cervical cancer given below. The probability of cure is 100% 

• Treatment options cryosurgery

• Laser surgery

• Loop electro surgical excision procedure, and cold knife conization

• A simple hysterectomy may be done if the cancer returns and also for those women who cannot or no longer want to have children.

For stage I

Treatment of stage I cancer given below. The probability of cure is 85-90% 

For stage IA 

1. Surgery 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.

2. Conization.

3. For tumors with deeper invasion (3-5 millimeters): Surgery 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).

4. Internal radiation therapy.

For stage IB 

1. Internal and external radiation therapy.

2. Radical hysterectomy and lymph node dissection.

3. Radical hysterectomy and lymph node dissection followed by radiation therapy plus chemotherapy.

4. Radiation therapy plus chemotherapy.

Stage II

Treatment of Stage  II cancer given below. The probability of cure is  75-80% 

For stage IIA

1. Internal and external radiation therapy.

2. Radical hysterectomy and lymph node dissection.

3. Radical hysterectomy and lymph node dissection followed by radiation therapy plus chemotherapy.

4. Radiation therapy plus chemotherapy.

For stage IIB 

1. Internal and external radiation therapy plus chemotherapy.

Stage III

Treatment of Stage III cancer given below. The probability of cure is  50%

1. Internal and external radiation therapy combined with chemotherapy.

Stage IV

Treatment of Stage IV cancer given below. The probability of cure is 30% 

For stage IVA 

1. Internal and external radiation therapy combined with chemotherapy.

For stage IVB 

1. Radiation therapy to relieve symptoms caused by the cancer.

2. Chemotherapy.  

Recurrent

If the cancer has come back (recurred) in the pelvis, treatment may be one of the following:

1. Radiation therapy combined with chemotherapy.

2. Chemotherapy to relieve symptoms caused by the cancer.

If the cancer has come back outside of the pelvis, a patient may choose to go into a clinical trial of systemic chemotherapy.

Ways to Reduce Cervical Cancer

The best ways reduce the risk of cervical cancer:

• Delay first intercourse. Girls less than 16 years of age should avoid sexual activity or always use condoms. Condoms may help prevent the transmission of HPV.

• Have fewer sexual partners. Practice safe sex with only your partner and make sure your partner is having sex only with you.

• Use condoms

• Annual pelvic examinations, including a pap smear, should begin when a woman becomes sexually active, or by the age of 20 in a non-sexually active woman. Have routine Pap tests. Women who do not regularly have a Pap test are at increased risk of cervical cancer.