Cancer

Treatments for cervical cancer

The stage of a cancer refers to its size, depth of invasion, and how far it has spread. Having said that, the treatment options for cervical cancer depend on the stage of the disease as well as on the age and health of the patient and her individual circumstances and preferences. It's important to carefully consider the treatment options presented to you and to ask questions if there is anything you do not understand. Be sure you understand all the risks, side effects, and long-term implications of each treatment before making a decision.

You may want to seek a second opinion, particularly from a doctor experienced in the treatment of cervical cancer. A second opinion will help you gather more information and may also help you feel more confident about the treatment option being considered. Some insurance companies require—and nearly all will pay for—a second opinion.

Treatment of cervical cancer typically involves a combination of two of the following: surgery, radiation therapy, and chemotherapy. Recovery from cervical cancer is the goal of treatment. However, where a cure is not possible, the goal is to remove or destroy as much of the cancer as possible to keep it from growing, spreading or recurring. Palliative treatment is designed to help alleviate symptoms.

Surgery

Cryosurgery

Performed as an outpatient procedure in a doctor's office or clinic, cryosurgery is used to treat preinvasive cancer. A metal probe cooled with liquid nitrogen is used to kill abnormal cells by freezing them. This treatment is not used in the treatment of invasive cancers. After cryosurgery, you may experience a watery, brown discharge for a few weeks.

Laser surgery

Also done as an outpatient procedure, laser surgery uses a focused beam of high-energy light to vaporize (burn off) abnormal cells or to remove a small sample for study. As with cryosurgery, you may experience a watery, brown discharge for a period of a few weeks. You should know that laser surgery is used in the treatment of preinvasive cervical cancer, but it is not used to treat invasive cancer.

Conization

This procedure involves the removal of a small, cone-shaped piece of tissue from the cervix. The base of the cone is formed by the ectocervix, while the apex (point) of the cone comes from the endocervical canal. The transformation zone—that area between the ectocervix and the endocervix—is contained within the cone. It is within the transformation zone that precancers and cancers are most likely to develop. Also a treatment, a cone biopsy can be used to completely remove many precancers and early cancers.

Cone biopsies may be performed using one of two methods: the loop electrosurgical excision procedure (LEEP) and the cold knife cone biopsy. (See Diagnostic tests for women with abnormal cervical cytology results for more information on LEEP and cold knife cone biopsies.)

Rarely used as the sole treatment, except in women with early cancer who may wish to have children, conization is used to establish the diagnosis of cancer before treatment with additional surgery or radiation.

Total hysterectomy

A surgical procedure to remove the uterus and cervix, a total hysterectomy leaves the parametria and uterosacral ligaments intact. Because these latter structures—and the vagina and pelvic lymph nodes—are left intact, the procedure is called a simple hysterectomy. The ovaries and fallopian tubes are normally preserved unless they are affected by some other gynecologic disease or if the patient is over the age of 45. (See Hysterectomy for more information on the types of hysterectomy.)

Performed under general or epidural anesthetic to treat stage IA (early) cervical cancers and some stage 0 cancers (see How Is Cervical Cancer Staged? for more information), a simple hysterectomy involves the removal of the uterus through a surgical incision in the lower abdomen (abdominal hysterectomy) or through the vagina (vaginal hysterectomy). Following hysterectomy, a woman is no longer able to bear children.

Radical trachelectomy

Used in women with early stage cancer who may want to have children, a radical trachelectomy involves surgical removal of the cervix and perhaps only the lower part of the uterus. The lymph nodes are also removed, but the upper two thirds of the uterus remain intact.

Radical hysterectomy and pelvic lymph node dissection

As in a simple hysterectomy, a radical hysterectomy and pelvic lymph node dissection involve the surgical removal of the entire uterus. This procedure differs from a simple hysterectomy, however, in that in a radical hysterectomy and pelvic lymph node dissection, the upper part of the vagina (1 inch; 2 1/2 centimetres) next to the cervix, the pelvic lymph nodes, the parametria, and the uterosacral ligaments are also removed. Unless there is a medical reason to remove them also, the ovaries and fallopian tubes remain intact.

Radical hysterectomy and pelvic lymph node dissection is used to treat stages IA2, IB, and IIA cervical cancers and requires a hospital stay of 5 to 7 days.

Laparoscopic hysterectomy

Although normally performed through an incision in the lower abdomen, a hysterectomy may also be performed vaginally, in combination with a laparascopic pelvic node dissection. Using a laparascope, a camera attached to a telescope, the doctor is able to view the uterus, fallopian tubes, and ovaries. The laparascope allows the doctor to surgically remove the uterus from inside the body through an incision in the vagina. One advantage of this type of procedure is that the incisions are smaller (1/2 inch; 12 millimetres) and less uncomfortable than that of an abdominal hysterectomy.

Because small instruments can be controlled through the tube, laparoscopy can also be used to view the inside of the abdomen and pelvis. If necessary, lymph nodes, ovaries, and fallopian tubes can be removed through an incision in the vagina and without the need for a large surgical incision in the abdomen.

Although the recovery period is shorter for laparascopic surgery than for an abdominal hysterectomy, laparoscopy is more difficult and requires a high level of skill and experience because of the risk of damage to internal organs.

You may worry that a simple or total hysterectomy may impact your relationship. Radical hysterectomy may change a woman's ability to feel sexual pleasure because certain nerves that allow her to feel sexual arousal may be damaged. If a radical hysterectomy has been recommended for you, be sure to discuss these implications with your doctor since a procedure to spare these nerves has been developed. If the nerves can be spared, sexual pleasure should remain. You should note that women do not need a uterus or cervix to reach orgasm. (To learn more, read Hysterectomy and Relationships.)

Pelvic exenteration

Used to treat recurrent cervical cancers, a pelvic exenteration removes all of the organs and tissues as in a radical hysterectomy and pelvic lymph node dissection and may also perhaps remove the bladder, vagina, rectum, and part of the colon.

If the bladder is removed, a new way to store and eliminate urine is needed. This usually involves using a short segment of intestine to function as a new bladder. Urine may be drained periodically either through a catheter placed through a small opening called a urostomy, or it may drain continuously into a small plastic bag attached to the front of the abdomen.

If the rectum and part of the colon are removed, a new way to eliminate feces must be created. This is done by attaching the remaining intestine to the abdominal wall so that fecal matter can pass through a colostomy into a small plastic bag worn on the front of the abdomen. It may be possible to remove the involved colon and to reconnect it so that no external appliances are needed.

If the vagina is removed, a new one may be created out of skin, intestinal tissue, or muscle and skin grafts.

Recovery from pelvic exenteration takes several months, with many women beginning to feel like their old selves again only after 6 months or more. Some women claim it takes a year or two to adjust completely. Nevertheless, with determination and practice, these women can not only lead normal and productive lives, but they can also experience sexual desire, pleasure, and orgasm.

Also be sure to read…

Cervical cancer
How can I avoid or prevent cervical cancer?
Diagnostic tests for women with abnormal cervical cytology results
Treating cervical cancer
Pap test
Chlamydia
Human papilloma virus (HPV)