Cervical Cancer Treatment

  • Treatment

    If you experience abnormal vaginal bleeding or discharge, see your clinician.

    Your doctor is the best source of information on the drug treatment choices available to you.

    Often, mild abnormal changes in the cells on the surface of the cervix (dysplasia) do not require treatment and may disappear over a period of careful “watchful waiting”.

    If you do not wish to or cannot undergo surgery, or if your cancer is more advanced, your clinician may recommend radiation therapy.

    Radiation therapy uses high-energy rays to kill cancer cells and shrink tumors. Radiation can be delivered from an outside source or from radiation-producing materials placed directly in or around a tumor.

    The side effects of radiation may include fatigue, skin changes, loss of appetite, nausea, and diarrhea. These side effects are usually temporary. Sometimes, radiation in the pelvic region results in scar tissue that narrows the vagina, which could make sex uncomfortable or painful. Early menopause and urination problems can occur as well.

    If cancer has penetrated deeply into your cervix or beyond, your clinician may recommend chemotherapy as part of your treatment regimen.

    Chemotherapy is given to women with bulky tumors in the cervix or in the cervix and upper part of the vagina. The combination of chemotherapy and radiation therapy is more effective than radiation alone. The same holds true for women whose cancer has spread throughout the pelvic area or to organs close to the cervix such as the bladder and rectum.

    The chemotherapy that is given along with radiation is called low-dose chemotherapy and is used to make radiation therapy more effective. Because the doses are low and the rate of administration is slow, the side effects are minimal and considerably less severe than one would expect with conventional (full-dose) chemotherapy.

    Full-dose chemotherapy is given to patients with cancer that has spread beyond the pelvis to other areas of the body, such as the lungs or lymph nodes in the neck.

    Chemotherapy drugs (typically given by mouth or through a vein) kill cancer cells, but they kill healthy cells as well. Full-dose chemotherapy can lead to side effects such as hair loss, nausea, vomiting, and diarrhea. The effects are temporary and generally resolve once chemotherapy is stopped.

    During full-dose chemotherapy, some of the unpleasant side effects can be minimized with other medications. Chemotherapy also weakens the immune system. People undergoing chemotherapy are more vulnerable to infection. The likelihood of bleeding and bruising after minor injuries is also increased during chemotherapy.

    Most mild dysplasias do not require treatment and often disappear over a period of careful “watchful waiting”. Those that persist may require surgical treatment.

    If you have more severe dysplasia, a variety of minor surgical procedures can be used to remove it.

    Dysplasias and carcinoma in situ (certain types of cervical intraepithelial neoplasia, or CIN) can be treated on an outpatient basis using any one of a number of techniques. These treatments generally require only local anesthesia. Abnormal cervical tissue can be destroyed via freezing (cryotherapy), light (laser surgery), or heat (electrosurgery).

    Most severe CIN lesions are treated with a loop electrosurgical excision procedure (LEEP), a highly effective minor operation. During a LEEP, abnormal tissue is cut out with a thin wire loop that has an electrical current passing through it. This can be performed in a clinician's office with local anesthesia in most cases. Another way to remove large pieces of tissue is conization, in which a wedge-shaped piece of the cervix is taken out. A conization can also be performed using a LEEP.

    Treatment of invasive cervical cancer consists of surgery, radiation, and chemotherapy. Your treatment options depend on your age, overall health, whether you want to have children, and the stage of your cancer Table 02.

    If you are young and healthy and are in the earliest stages of the disease, one option would be to have the cancer removed surgically. If you do not plan to have children, you might opt to have your uterus removed (hysterectomy) Table 02.

    Table 2.   Treatment Options for Invasive Cervical Cancer By Stage

    Stage 1
    Conization
    Hysterectomy with or without lymph node removal
    Hysterectomy plus lymph node removal with or without radiation
    Radiation with or without chemotherapy
    Stage 2
    Radiation with or without chemotherapy
    Hysterectomy plus lymph node removal with or without radiation and chemotherapy
    Stage 3
    Radiation and chemotherapy
    Stage 4
    Radiation
    Chemotherapy
    Radiation and chemotherapy

    If your cancer is more advanced or if you are an older woman in poor health, radiation might be your primary treatment choice. If your cancer has spread, adding chemotherapy to surgery and/or radiation therapy might be recommended.

    If you do not wish to have children or if you have more extensive cervical cancer, removal of the entire uterus and cervix (hysterectomy) is an option.

    If you decide to have a hysterectomy, your entire uterus and cervix will be removed; not just the cancerous parts. The uterus may be removed through the vagina (vaginal hysterectomy) or through an incision in the abdomen (abdominal hysterectomy), depending on your circumstances. In some cases, the ovaries and fallopian tubes are taken out as well.

    In most cases of extensive cervical cancer, a modified radical or radical abdominal hysterectomy is performed. With a radical hysterectomy, all of your cervix, part of your vagina, your uterus, and nearby lymph nodes are removed.

    If you are pregnant and develop cervical cancer, your options depend on the stage of your cancer.

    If your cancer is in its early stages, it may be safe to wait until after you have given birth to undergo treatment. If your cancer is in a later stage, you and your clinician need to discuss whether you should continue the pregnancy. If you decide to carry it to term, the baby will be delivered via cesarean section as soon as it can survive outside the womb. If you have very advanced cancer, immediate treatment is your safest choice.

    Your long-term outlook depends on which stage your cancer was in when it was discovered and how well you responded to your treatments.

    If your cancer was caught early, your chance of a cure is high. In general, nearly every case of early cervical cancer can be treated and cured. The cure rate drops sharply when the cancer is advanced and has spread to distant parts of the body.

    Because cancer can come back, you will need to see your clinician regularly.

    Your clinician may wish to see you as frequently as every 3 months for exams and Pap test during the first year after your cancer diagnosis. If everything looks good, your clinician may decrease the frequency of exams and tests to every 6 months.

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