Cervical cancer treatments

At City of Hope, our cervical cancer program uses a variety of therapies to target the disease. A multidisciplinary team of gynecologic oncology experts recommends cervical cancer treatment options based on each patient’s unique diagnosis.

Along with the gynecologic oncologist, the cancer care team may include:

• A radiation oncologist to treat cancer with radiation
• A medical oncologist to treat cancer with chemotherapy and other drugs (a gynecologic oncologist may also prescribe cancer drugs)
• A surgeon to perform operations (a gynecologic oncologist may also perform surgeries)

Many other medical professionals may take part in treatment and care as well, including nurses, social workers, counselors, pharmacists, dietitians and research team members.

The cancer care team develops a recommended individualized treatment plan based on all the information that has been gathered about the patient’s cancer during any tests, scans or other procedures.

What influences treatment options for cervical cancer?

Factors that determine a treatment plan include:

• Stage of cervical cancer
• Available treatment options
• Age
• Medical history
• Personal preferences

Because some cervical cancer treatments may impact the patient’s sexual life or fertility, it’s important to understand the risks before making decisions. For women with early-stage cervical cancer, fertility-sparing surgery may be a treatment option. We consider fertility issues for younger women, and we provide support for all women who experience sexual side effects as a result of cervical cancer treatment, through our survivorship support program.

Primary treatments for cervical cancer

A gynecologic cancer patient exploring treatment options at City of Hope may expect to meet with a gynecologic oncologist on the first visit. A gynecologic oncologist will discuss the patient’s health and spend time addressing questions and concerns regarding cervical cancer treatment.

After reviewing medical records and health history, and performing a pelvic exam, the gynecologic oncologist may order appropriate diagnostic tests to determine a recommended course of treatment. These may include biopsies, imaging scans and blood tests. The patient and gynecologic oncologist will meet again, generally within a few days of the first visit, to discuss test results.

At that time, doctors will discuss the available cervical cancer treatment options, as well as the ways supportive care services may be incorporated into the treatment plan. Our gynecologic oncology team individualizes treatment using evidence-based medicine, tailoring the program to each patient. A treatment plan may include:

• Surgery
• Radiation therapy
• Chemotherapy
• Targeted therapy
• Immunotherapy

Different combinations of these therapies may be used to treat cervical cancer, but the general strategy is based on the cancer stage.

Along with these standard treatments, new treatments for cervical cancer are being studied in clinical trials. Patients should ask whether clinical trials are the right approach for them or check out clinical trials supported by the National Cancer Institute.

Surgery for cervical cancer

A majority of cervical cancer patients undergo surgery, and there are a few different types that may be used for treatment.

For precancers (in which abnormal cells have the potential of becoming cancer), a surgical procedure called conization may be used. A surgeon may remove abnormal cells or tissue with a scalpel or through other methods such as laser surgery or a procedure called loop electrosurgical excision procedure (LEEP). LEEP utilizes a loop of thin wire heated by electricity and laser surgery uses intense beams of light to remove a tumor or surface lesion.

Besides those used to treat precancers, the main types of surgery for cervical cancer are:

• Simple or radical hysterectomies
• Simple or radical trachelectomy 
• Pelvic exenteration

Hysterectomies

There are two kinds of hysterectomy that may be performed for cervical cancer.

• Simple hysterectomy: A hysterectomy is a surgery to remove the entire uterus (which includes the cervix). It may be recommended in the earliest stage of cervical cancer.
• Radical hysterectomy: A radical hysterectomy is a surgery to remove the entire uterus and cervix, the uppermost part of the vagina, and some of the tissue surrounding these organs. The ovaries, fallopian tubes and lymph nodes may also be removed at the same time.

Hysterectomies are performed in a hospital under general anesthesia. After the surgery, patients may need to remain in the hospital for one to five days, depending on the method used to perform the operation.

Sometimes, women who undergo radical hysterectomies may initially have trouble urinating after the surgery because nerves near the bladder were manipulated. This usually resolves on its own over time. Patients should ask their doctor about any other complications or side effects of the surgery.

Radical trachelectomy

A radical trachelectomy is a surgery that removes the cervix and some of the surrounding tissue, the upper part of the vagina and the lymph nodes.

A radical trachelectomy is done to preserve fertility because the upper part of the uterus is left intact. This procedure is only recommended for patients with early-stage cervical cancers who meet a pre-defined oncologic criteria and desire to retain the ability to have children.

Pregnant women who’ve had a trachelectomy in the past may need a cesarean section (C-section). After a trachelectomy, there may be an elevated chance of miscarriage or preterm delivery.

Pelvic exenteration

Pelvic exenteration is a surgery used to treat cervical cancer that has come back after it was treated the first time (recurrent cervical cancer). It's may be an option if the cancer returned in the pelvic area but hasn’t spread farther.

In general, there are three types of pelvic exenteration:

Total pelvic exenteration removes the rectum, bladder, uterus and cervix (if present), vagina, tubes and ovaries (if present) and the lower part of the colon. Dissection of nearby lymph nodes may be done to confirm lack of spread of the cancer prior to proceeding with the surgery.

Anterior pelvic exenteration removes bladder, uterus and cervix (if present), vagina, and tubes and ovaries (if present).

Posterior exenteration removes rectum, uterus and cervix (if present), vagina, and tubes and ovaries (if present).

After removal of the bladder, rectum and part of the colon, the essential functions of these organs need to be replaced. To store and excrete stool and urine without a rectum or bladder, the patient will have two small openings (stomas) put into the abdomen for the waste to exit into a small plastic bag.

Plastic surgery to replace the vagina using skin and tissue from elsewhere on the body may be an option after the initial operation.

Radiation therapy for cervical cancer

Our radiation oncologists use technology designed to deliver high radiation doses to cancerous cells in the cervix, while sparing healthy tissue. By focusing the radiation directly on the tumor, these therapies are designed to reduce the risk of common gastrointestinal and sexual function side effects associated with radiation therapy for cervical cancer.

The two types of radiation therapy are:

• External beam radiation therapy (EBRT), in which a machine outside the body emits high-energy X-rays and targets them at the cervix to kill off the cancerous cells.
• High-dose rate (HDR) brachytherapy (internal radiation), in which a radioactive source is inserted into the vagina and placed either near or inside the cancer.

Because radiation harms healthy cells in the same way it damages cancer cells, side effects are common. But they differ depending on how the radiation is delivered. Most side effects subside once treatment is over, but some may last.

Short-term side effects of external radiation may include:

• Fatigue
• Digestive problems
• Loose stools
• Nausea, vomiting
• Skin changes
• Bladder irritation
• Vaginal pain
• Menstrual changes
• Low blood cell counts

Internal radiation (brachytherapy) may also cause these side effects, but they are less common, as the treatment is concentrated in the area where the radioactive source is implanted. As a result, the most common side effect of internal radiation for cervical cancer is vaginal irritation.

Long-term radiation therapy effects may include:

• Dryness or narrowing of the vagina
• Rectal bleeding
• Bladder irritation
• Bone weakness
• Leg swelling

Chemotherapy for cervical cancer

Chemotherapy treats cancer with drugs that kill cancerous cells or prevent cancerous cells from spreading. It’s recommended for a significant percentage of cervical cancer patients. For women treated primarily with radiation therapy, chemotherapy may be added to the treatment regimen to help improve responses.

Chemotherapy regimens may consist of a single drug or a combination of drugs at set times over weeks or months. The cancer care team carefully calculates the types of drugs, dosages and times administered to the patient to maximize their effect on the cancer while limiting their harm to healthy cells.

Like radiation therapy, chemotherapy harms healthy cells in its quest to kill cancer, which causes side effects. Most go away after treatment.

Common side effects include:

• Fatigue
• Appetite loss
• Mouth sores
• Upset stomach
• Hair loss

During chemotherapy, the care team will provide supportive care services to help ease side effects. For example, our naturopathic clinicians may suggest supplements to reduce nausea.

Targeted therapy for cervical cancer

Targeted therapy is designed to identify and counteract unique qualities of specific cancer cells. Targeted therapy drugs work by attaching themselves to proteins or receptors on cancer cells, either killing the cells or helping other therapies, such as chemotherapy, work better. Among the drugs used in targeted therapy are so-called angiogenesis inhibitors, designed to prevent cancer cells from developing blood vessels that feed tumors.

Immunotherapy for cervical cancer

Immunotherapy helps fight cancer using substances made in the body or created in a lab to boost the body’s immune system or help it detect and attack cancer cells.

Designed to stimulate the immune system to target certain cancer cells, these drugs have been approved to treat melanoma, kidney and/or lung cancers—and trials on a variety of other cancers are in the works. Combining immunotherapies with other treatments may improve outcomes for some patients.

The more common side effects of immunotherapy include:

• Rashes
• Flu-like symptoms
• Diarrhea
• Thyroid changes
• Weight changes

Treating advanced cervical cancer

For women with cervical cancer that has spread (metastasized), treatment options may vary. These options may include:

• Combining radiation therapy with chemotherapy
• Combining immunotherapy drugs with other therapies
• Individualized surgical options
• Clinical trials, if available and appropriate for the patient’s cancer stage and other factors