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. However, other factors that affect this decision include the exact location of the cancer within the cervix, the type of cancer (squamous cell or adenocarcinoma), your age, your overall physical condition, 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 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.

Treatment options for squamous cell carcinoma in situ include cryosurgery, laser surgery, loop electrosurgical excision procedure (LEEP/LEETZ), and cold knife conization.

For adenocarcinoma in situ, hysterectomy is usually recommended. For women who wish to have children, treatment with a cone biopsy may be an option. The cone specimen must have no cancer cells at the edges, and the patient must be closely watched. After the woman has finished having children, a hysterectomy is recommended.

A simple hysterectomy is also an option for treatment of squamous cell carcinoma in situ, and might be done if it returns after other treatments. All cases of CIS can be cured with appropriate treatment. However, pre-cancerous changes can recur (come back) in the cervix or vagina, so it is very important for your doctor to watch you closely. 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 our document Cervical Cancer Prevention and Early Detection.

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).

Women who want to maintain fertility are often treated first with a cone biopsy to remove the cancer. If the edges of the cone don’t contain cancer cells (called negative margins), they 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 shows lymphovascular invasion.

Women who don’t want to maintain fertility can be treated with a hysterectomy. If the cancer has invaded the blood vessels or lymph vessels (lymphovascular invasion), 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).

For women who want to maintain fertility, the main treatment is radical trachelectomy with removal of pelvic lymph nodes (pelvic lymph node dissection). Another option is cone biopsy and pelvic lymph node dissection, followed by observation.

Women who don’t want to maintain fertility have 2 main options:

  • Radical hysterectomy along with removal of lymph nodes in the pelvis (pelvic lymph node dissection)
  • External beam radiation therapy to the pelvis plus brachytherapy

If cancer is found in any pelvic lymph nodes during surgery, some of the lymph nodes that lie along the aorta (the large artery in the abdomen) may be removed as well. Any tissue removed at surgery will be examined in the laboratory to see if the cancer has spread further than expected. If the cancer has spread to the tissues next to the uterus (called the parametria) or to any lymph nodes, radiation therapy is usually recommended. Often chemotherapy will be given with radiation therapy. If the pathology report says that the tissue removed has positive margins, this means that cancer cells are present in the edges of the tissue, and so some cancer might have been left behind. This is also treated with pelvic radiation (given with cisplatin chemotherapy). The doctor may advise brachytherapy, as well.

Stages IB and IIA

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

Stage IB1 and IIA1

The standard treatment is a radical hysterectomy with removal of lymph nodes in the pelvis (pelvic lymph node dissection). Some lymph nodes from higher up in the abdomen (called para-aortic lymph nodes) may also be removed to see if the cancer has spread there. Radical trachelectomy may be recommended instead of a radical hysterectomy if the patient still wants to be able to have children.

Another option is to treat with radiation using both brachytherapy and external beam radiation therapy. Chemotherapy (chemo) may be given with the radiation (concurrent chemoradiation).Stage IB2 and IIA2

The standard treatment is chemo given with radiation therapy. The chemo may be cisplatin or cisplatin plus fluorouracil. The radiation therapy includes both external beam radiation and brachytherapy.

Another choice is radical hysterectomy with removal of pelvic lymph nodes (pelvic lymph node dissection). 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 option) followed by a hysterectomy.

Stage IIB, III and IVA

Radiation therapy given with chemo (concurrent chemoradiation) is the recommended treatment. The chemo is either cisplatin or cisplatin plus fluorouracil (5-FU). The radiation includes both external beam radiation and brachytherapy.

If cancer has spread to the lymph nodes (especially those in the upper part of the abdomen) it can be a sign that the cancer has spread to other areas in the body. Some experts recommend checking the lymph nodes for cancer before giving radiation. One way to do this is by surgery. Another way is to do an imaging study (like MRI or PET/CT) to look at the lymph nodes. Lymph nodes that are bigger than usual and/or light up on PET are more likely to have cancer. Those lymph nodes can be biopsied to see if they contain cancer. If lymph nodes in the upper part of the abdomen (the para-aortic lymph nodes) are cancerous, doctors might want to do other tests to see if the cancer has spread to other parts of the body.

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 to relieve the symptoms of cancer that has spread to the areas near the cervix or to distant sites (such as the lungs or bone). Chemo is often recommended. Most standard regimens use a platinum compound (such as 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 cervix, uterus or nearby the pelvic organs) or come back in distant areas (spread through the lymphatic system and/or the bloodstream to organs such as the lungs or bone).

If the cancer has recurred in the pelvis only, extensive surgery (by pelvic exenteration) may be an option for some patients. This operation may successfully treat 40% to 50% of patients. (See the discussion in the section about surgery) Sometimes radiation or chemo may be used to 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 can diminish it. You need to discuss this with your doctors.

New treatments that may benefit patients with distant recurrence of cervical cancer are being evaluated in clinical trials. You may want to think about participating in a clinical trial.

Cervical cancer in pregnancy

A small number of cervical cancers are found in pregnant women. If your cancer is at a very early stage, such as IA, then most doctors believe that it is safe to continue the pregnancy to term. Several weeks after delivery, a hysterectomy or a cone biopsy is recommended (the cone biopsy is suggested only for substage IA1).

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. 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, should be treated immediately.

Last Medical Review: 09/19/2014
Last Revised: 01/29/2016