Treatments for cervical cancer
The following is adapted from Surgery, a publication of the American Cancer Society.
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
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.
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.
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.
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.
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
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
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.
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
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…
How can I avoid or prevent cervical
Diagnostic tests for women with abnormal cervical
Treating cervical cancer
Human papilloma virus (HPV)