Cervical Cancer Treatments

Surgery

Surgery for cervical cancer is done to remove the tumor and not leave any cancer cells behind. A gynecologic oncologist can determine if a tumor can be safely removed with surgery.

The type used depends on the extent (stage) of the cancer, as well as your desire to have children. The most common types of surgery for invasive cervical cancer include:

• Conization or LEEP. This is a type of biopsy. Your doctor may use this procedure instead of a hysterectomy to treat a stage IA1 cancer if you want to get pregnant in the future. He or she can do this procedure in the office under local anesthetic. The doctor uses a laser knife or an electric wire to remove a cone-shaped piece of tissue from the outer part of the cervix. A pathologist examines the cells under a microscope to make sure no cancer cells are found around the edges of the cone. In many cases, women are cured after one procedure. However, when using this treatment there is a small chance that the cancer will come back. So make sure to keep all follow-up appointments with your doctor.
• Hysterectomy. This is the standard treatment for stage IA1 invasive cancer in women who don’t want to get pregnant in the future. A doctor removes your whole uterus and cervix through your abdomen or vagina. This surgery requires regional or general anesthesia. You are sedated or asleep. You stay at least one night in the hospital. Women often recover faster when the hysterectomy is done through the vagina. Laparoscopic or robot-assisted surgery also usually leads to faster recovery. The ovaries and fallopian tubes don’t need to be removed to cure cervical cancer. Talk about the removal of your ovaries and tubes with your surgeon before the surgery. Removing ovaries causes menopause and long-term side effects.
• Radical abdominal hysterectomy. This type of surgery can be used to treat stage IA2, IB1, IB2 and IIA cancer. A doctor removes your uterus, cervix, the upper part of your vagina and the tissue that holds your uterus in place. The surgeon removes the lymph nodes in the pelvic area to test them for disease spread. The doctor can remove all the tissues through an incision in your abdomen. He or she may be able to use minimally invasive techniques, like laparoscopic surgery. This is a surgery where these tools are used through smaller cuts. This surgery is done with general anesthesia. You are asleep during the procedure. You may spend several days in the hospital. It’s not needed to remove your ovaries in a radical hysterectomy. This is important for younger women. Removing ovaries causes menopause and long-term side effects.
• Radical trachelectomy. This procedure is less often used. It is an option that may be used to preserve fertility in young women. The doctor removes your cervix, pelvic lymph nodes, upper part of your vagina and surrounding tissue. The uterus is then reattached to the remaining vagina. For certain people, this procedure is as likely as a radical hysterectomy to cure cervical cancer. The procedure is complex. It should only be done by a gynecologic oncologist who has experience with this method. After this surgery, there is an increased risk of infertility and pregnancy-related complications. For a future pregnancy, you may need fertility treatments and high-risk pregnancy care.

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• Division of Gynecological Oncology Surgery

Radiation Therapy

Radiation therapy uses high-energy X-rays or other forms of radiation to kill cancer cells. It may be delivered externally using focused beams of energy, or internally, placing an energy emitting substance in or near the tumor site.

Your doctor may advise radiation therapy in these cases:

• You have cervical cancer that has spread beyond the cervix.
• You have a large cancer that is found only in the pelvis. When cancer is large, radiation therapy is the preferred treatment.
• You need treatment after surgery to make sure that all the cancer cells are gone.
• You have early-stage cervical cancer, so you can have radiation instead of surgery. Radiation therapy works as well as radical hysterectomy for treating small cervical cancer.
• You can’t have surgery because you have other medical problems.
• You need treatment to shrink a tumor before surgery.

Women with cervical cancer who are treated with radiation usually receive low-dose chemotherapy at the same time. This makes the radiation work more effectively. For smaller cancer or one that has not spread, radiation works as well as surgery. Doctors also use radiation for larger cancer or one that has spread in combination with other therapies or to help control symptoms.

City of Hope is a leader in image-driven radiation planning, using computed tomography and magnetic resonance imaging scans to determine tumor size and location. This ensures radiation is accurately delivered to the tumor site, while minimizing exposure to nearby normal tissues.

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• Radiation Therapy and Gynecologic Cancers

Drug Therapy

Drug therapy may be given to patients to fight cervical cancer cells throughout the body by killing the cancer cells or stopping their growth and spread. These drugs include:

• Chemotherapy, which targets rapidly dividing cells, including cervical cancer cells
• Targeted therapy, which selectively attacks cancer cells based on specific characteristics

The drug or drug combination used depends on the type and stage of cervical cancer, previous treatments used, the patient’s health and overall treatment goals. This personalized medicine approach may be further enhanced by molecular or genetic testing of your cancer, which can help identify treatments that are more effective and with fewer side effects.

In addition to standard drug treatments, patients may also be eligible for new, promising drugs through our clinical trials program.