Our Treatment Approach to Cervical Cancer
City of Hope uses a multidisciplinary approach to combat cervical cancer. Our surgeons, medical and radiation oncologists and researchers collaborate closely throughout treatment to ensure cervical cancer patients receive the best care possible.

Surgery remains the preferred method for treatment of cervical cancer. Because most cervical cancers are found early, surgical removal offers an excellent chance at curing the patient.

Many patients with cervical cancer, even in early stages, will choose to have a total hysterectomy (removal of the cervix and uterus). However, for very early (Stage 0) cervical cancer, a hysterectomy may not be needed. Other ways to remove the cancerous tissue include conization, cryosurgery, laser surgery, or a loop electrosurgical excision procedure.
 
Some women need a radical hysterectomy. A radical hysterectomy is surgery to remove the uterus, cervix and part of the vagina. With either type of hysterectomy, a physician may also perform a bilateral salpingo-oophorectomy which entails removal of the fallopian tubes and ovaries. The surgeon may also remove the lymph nodes near the tumor to see if they contain cancer. If cancer cells have reached the lymph nodes, it means the disease may have spread to other parts of the body.

The predominant technique utilized is the abdominal hysterectomy. As the name implies, the incision and access to the uterus is via an abdominal incision. This allows for a better view and easier dissection of the necessary areas. As an alternative, hysterectomy can also be performed via a vaginal incision, and a laparoscopic approach is also possible. Laparoscopic surgeries allow for smaller incisions, less bleeding and less postoperative pain.

City of Hope is one of a few institutions to operate four da Vinci S HD Surgical Systems – the most advanced robotic technology available. Our team possesses a thorough knowledge of robotics, due in part to our large volume of patients and expertise across a variety of procedures.

The robotic surgical approach means smaller incisions, reducing trauma to the patient and resulting in quicker healing. This means that women may feel better and return to their normal lives sooner. Robotic systems use highly advanced imaging navigation, high-definition monitors and fine optics so surgeons can operate with more precision than ever before.

In radiation therapy, high-energy rays are used to kill cancer cells. Like surgery, radiation therapy is a local therapy. It affects cancer cells only in the treated area.

Women may have radiation therapy alone, with chemotherapy, or with chemotherapy and surgery. The doctor may suggest radiation therapy instead of surgery for the small number of women who cannot have surgery for medical reasons. Most women with cancer that extends beyond the cervix have radiation therapy and chemotherapy. For cancer that has spread to distant organs, radiation therapy alone may be used.

Doctors use two types of radiation therapy to treat cervical cancer:
 
  • External radiation: In external radiation therapy, a large machine outside the body is used to aim radiation at the tumor area. The woman is usually an outpatient in a hospital or clinic and receives external radiation five days a week for several weeks. This schedule helps protect healthy cells and tissue by spreading out the total dose of radiation. No radioactive materials are put into the body for external radiation therapy.
 
  • Intensity-Modulated Radiotherapy (IMRT) has evolved as a technique that can treat certain areas such as the tumor or areas at risk of recurrence while sparing adjacent normal tissues from high-dose irradiation. IMRT is an advanced form of radiotherapy that produces high-dose volume of radiation, which may have an irregular shape that better conforms to the clinical target volume. By having a better conformation of the target volume, normal pelvic tissues (e.g., small bowel, bladder, rectum) are relatively spared. The potential advantage of IMRT in these treatments, in the post-operative setting, is the ability to shape a dose distribution that delivers a lower dose to abdominal cavity contents (e.g., small and large bowel), which in turn will make it possible to reduce side effects from treatment.
 
  • Internal radiation: In internal radiation therapy, tiny tubes containing a radioactive substance are inserted through the vagina and left in place for a few days. The woman stays in the hospital during this treatment. To protect others from radiation exposure, the patient may not be able to have visitors or may have visitors only for a short period of time while the implant is in place. Once the implant is removed, the woman has no radioactivity in her body.
     
Some patients need both external and internal radiation therapies.

Chemotherapy
In advanced cervical cancer, chemotherapy may be indicated. Combinations of the following have been used clinically:
 
  • ifosfamide
  • 5-FU
  • irinotecan
  • paclitaxel
  • docetaxel
  • gemcitabine
 
In 2006, the Food and Drug Administration approved the combination of topotecan (Hycamtin) and cisplatin for late-stage cervical cancer.