Cervical Cancer

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Treating Cervical Cancer TOPICS

Treatment options for cervical cancer, by stage

The stage of a cervical cancer is the most important factor in choosing treatment. But other factors can also affect your treatment options, including the exact location of the cancer within the cervix, the type of cancer (squamous cell or adenocarcinoma), your age and overall health, and whether you want to have children.

Stage 0 (carcinoma in situ)

Although the AJCC staging system classifies carcinoma in situ (CIS) as the earliest form of cervical cancer, doctors often think of it as a pre-cancer. That is because the cancer cells in CIS are only in the surface layer of the cervix; they have not grown into deeper layers of cells.

All cases of CIS can be cured with the right treatment. However, pre-cancerous changes can sometimes recur (come back) in the cervix or vagina, so it’s very important for your doctor to watch you closely after treatment. This includes follow-up with regular Pap tests and in some instances with colposcopy.

For information about work-up and treatment of abnormal Pap test results and cervical pre-cancers other than CIS, see Cervical Cancer Prevention and Early Detection.

Treatment options for squamous cell carcinoma in situ include:

  • Cryosurgery
  • Laser surgery
  • Loop electrosurgical excision procedure (LEEP/LEETZ)
  • Cold knife conization
  • Simple hysterectomy (as the first treatment or if the cancer returns after other treatments)

Treatment options for adenocarcinoma in situ include:

  • Hysterectomy
  • Cone biopsy (a possible option for women who wish to have children). The cone specimen must have no cancer cells at the edges, and the woman must be closely watched after treatment. Once the woman has finished having children, a hysterectomy is recommended.

Stage IA1

Treatment for this stage depends on whether or not you want to continue to be able to have children (maintain fertility) and whether or not the cancer has grown into blood or lymph vessels (called lymphovascular invasion).

Treatment options for women who want to maintain fertility:

A cone biopsy is the preferred procedure for women who want to have children after the cancer is treated.

  • If the edges of the cone don’t contain cancer cells (called negative margins), the woman can be watched closely without further treatment as long as the cancer doesn’t come back.
  • If the edges of the cone biopsy have cancer cells (called positive margins), then cancer may have been left behind. This can be treated with a repeat cone biopsy or a radical trachelectomy (removal of the cervix and upper vagina). A radical trachelectomy is preferred if the cancer has grown into blood or lymph vessels.

Treatment options for women who don’t want to maintain fertility:

  • A simple (total) hysterectomy may be an option if the cancer shows no lymphovascular invasion.
  • If the cancer has grown into blood or lymph vessels, you might need a radical hysterectomy along with removal of the pelvic lymph nodes.

Stage IA2

Treatment for this stage depends in part on whether or not you want to continue to be able to have children (maintain fertility).

Treatment options for women who want to maintain fertility:

  • Cone biopsy with removal of pelvic lymph nodes (pelvic lymph node dissection)
  • Radical trachelectomy with pelvic lymph node dissection

Treatment options for women who don’t want to maintain fertility:

  • External beam radiation therapy (EBRT) to the pelvis plus brachytherapy
  • Radical hysterectomy with removal of pelvic lymph nodes and sampling of the para-aortic lymph nodes
  • If none of the lymph nodes are found to have cancer, radiation may still be discussed as an option if the tumor is large, if the tumor has grown into blood or lymph vessels, or if the tumor is invading the surrounding connective tissue that supports organs such as the uterus, bladder, vagina (the stroma).
  • If the cancer has spread to the tissues next to the uterus (called the parametria) or to any lymph nodes, or if the tissue removed has positive margins, radiation (EBRT) with chemotherapy is usually recommended. The doctor may also advise brachytherapy after the combined chemo and radiation are done.

Stages IB and IIA

The main treatment options are surgery, radiation, or radiation given with chemo (concurrent chemoradiation).

Stages IB1 and IIA1

Treatment options for women who want to maintain fertility:

  • trachelectomy with pelvic lymph node dissection

Treatment options for women who don’t want to maintain fertility:

  • hysterectomy with removal of lymph nodes in the pelvis and some lymph nodes from the para-aortic area
  • If none of the lymph nodes are found to have cancer, radiation may still be discussed as an option if the tumor is large, if the tumor has grown into blood or lymph vessels, or if the tumor is invading the surrounding connective tissue that supports organs such as the uterus, bladder, vagina (the stroma).
  • If the cancer has spread to the tissues next to the uterus (called the parametria) or to any lymph nodes, or if the tissue removed has positive margins, radiation (EBRT) with chemotherapy is usually recommended. The doctor may also advise brachytherapy after the combined chemo and radiation are done.
  • using both brachytherapy and external beam radiation therapy may be an option if a woman is not healthy enough for surgery or if she decides they do not want surgery
  • (chemo) may be given with the radiation (concurrent chemoradiation).

Stages IB2 and IIA2

Treatment options:

  • This is usually the standard treatment. The chemo may be cisplatin or cisplatin plus fluorouracil. The radiation therapy includes both external beam radiation and brachytherapy.
  • hysterectomy with pelvic lymph node dissection and para-aortic lymph node sampling: If cancer cells are found in the removed lymph nodes, or in the edges of the tissue removed (positive margins), surgery may be followed by radiation therapy, which is often given with chemo (concurrent chemoradiation).

Some doctors recommend radiation given with chemotherapy first followed by a hysterectomy.

Stages IIB, III and IVA

Treatment options:

  • The chemo may be cisplatin or cisplatin plus fluorouracil. The radiation therapy includes both external beam radiation and brachytherapy.

Stage IVB

At this stage, the cancer has spread out of the pelvis to other areas of the body. Stage IVB cervical cancer is not usually considered curable. Treatment options include radiation therapy and/or chemo to try to slow the growth of the cancer or help relieve symptoms . Most standard chemo regimens include a platinum drug (cisplatin or carboplatin) along with another drug such as paclitaxel (Taxol), gemcitabine (Gemzar), or topotecan. The targeted drug bevacizumab (Avastin) may be added to chemo.

Clinical trials are testing other combinations of chemo drugs, as well as some other experimental treatments.

Recurrent cervical cancer

Cancer that comes backs after treatment is called recurrent cancer. Cancer can come back locally (in or near where it first started, such as the cervix, uterus or nearby the pelvic organs), or it can come back in distant areas (such as the lungs or bone).

If the cancer has recurred in the pelvis only, extensive surgery (pelvic exenteration) may be an option for some patients. Sometimes radiation or chemo may be used to slow the growth of the cancer or help relieve symptoms, but they aren’t expected to cure the cancer.

If chemo is used, you should understand the goals and limitations of this therapy. Sometimes chemo can improve your quality of life, and other times it might diminish it. You need to discuss this with your doctor.

New treatments that may benefit patients with distant recurrence of cervical cancer are being evaluated in clinical trials. Clinical Trials may help if you are thinking about participating in a clinical trial.

Cervical cancer during pregnancy

A small number of cervical cancers are found in pregnant women. Most of these (70%) are stage I cancers.

The treatment plan during pregnancy is determined by:

  • size
  • nearby lymph nodes have cancer
  • far along the pregnancy is
  • specific type of cervical cancer

If the cancer is at a very early stage, such as carcinoma in situ (Stage 0) or stage IA, most doctors believe it is safe to continue the pregnancy to term and have treatment several weeks after birth. Surgery options after birth for early-stage cancers include a hysterectomy, radical trachelectomy, or a cone biopsy.

If the cancer is stage IB or higher, then you and your doctor must decide whether to continue the pregnancy. If not, treatment would be radical hysterectomy and/or radiation. Sometimes chemotherapy can be given during the pregnancy (in the second or third trimester) to shrink the tumor.

If you decide to continue the pregnancy, the baby should be delivered by cesarean section as soon as it is able to survive outside the womb. More advanced cancers typically need be treated immediately.

The treatment information given here is not official policy of the American Cancer Society and is not intended as medical advice to replace the expertise and judgment of your cancer care team. It is intended to help you and your family make informed decisions, together with your doctor. Your doctor may have reasons for suggesting a treatment plan different from these general treatment options. Don't hesitate to ask him or her questions about your treatment options.

Last Medical Review: 11/16/2016
Last Revised: 12/05/2016