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)

Treatment options are the same as for pre-cancerous changes (dysplasia or cervical intraepithelial neoplasia [CIN]). Options include cryosurgery, laser surgery, loop electrosurgical excision procedure (LEEP/LEETZ), and cold knife conization.

A simple hysterectomy is also an option for treatment, and may be done if the cancer returns. All of these cancers can be cured with appropriate treatment. However, pre-cancerous changes or stage 0 cancer can recur (come back) in the cervix or vagina, so it is very important for your doctor to watch you closely.

Stage I

Stage IA is divided into stage IA1 and stage IA2

Stage IA1: For this stage you have 3 options

• If you still want to be able to have children, first the cancer is removed with a cone biopsy, and then you are watched closely to see if the cancer comes back.

• If the cone biopsy doesn't remove all of the cancer (or if you are done having children), the uterus will be removed (simple hysterectomy).

• If the cancer has invaded the blood vessels or lymph vessels, you will need a radical hysterectomy along with removal of the pelvic lymph nodes.

• radical hysterectomy along with removal of lymph nodes in the pelvis.

• external beam radiation therapy plus brachytherapy.

• radical trachelectomy with removal of pelvic lymph nodes can be done if the patient still wants to be able to have children.

If you have surgery, the tissue removed is 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 the radiation therapy. If the pathology report says that the tumor had positive margins, this means that some cancer may have been left behind. This is also treated with pelvic radiation (given with cisplatin chemotherapy). The doctor may advise brachytherapy, as well.

Stage IB is divided into stage IB1 and stage IB2

Stage IB1: Either of 3 treatments may be used if you have stage IB1 cervical cancer.

• The first option is a radical hysterectomy with removal of lymph nodes in the pelvis. Some lymph nodes from higher up in the abdomen (called para-aortic lymph nodes) are also removed to see if the cancer has spread there. If cancer cells are found in the edges of the organs removed (positive margins) or if cancer cells are found in lymph nodes during this operation, radiation therapy may be given, possibly with chemotherapy, after surgery.

• The second treatment option is high-dose internal and external radiation therapy.

• Radical trachelectomy with removal of pelvic (and some para-aortic) lymph nodes is an option if the patient still wants to be able to have children.

Stage IB2

• The standard treatment is the combination of chemotherapy with cisplatin and radiation therapy to the pelvis plus brachytherapy.

• Another choice is radical hysterectomy with removal of pelvic (and some para-aortic) lymph nodes. If cancer cells are found in the lymph nodes removed, or in the margins, radiation therapy may be given, possibly with chemotherapy, after surgery.

• Some doctors advise radiation given with chemotherapy (first option) followed by a hysterectomy.

Stage II

Stage IIA: Treatment for this stage depends on the size of the tumor..

• One choice for treatment is brachytherapy and external radiation therapy. This is most often recommended if the tumor is larger than 4 cm (about 1½ inches). Chemotherapy with cisplatin will be given along with the radiation.

• Some experts recommend removing the uterus after the radiation therapy is done.

• If the cancer is not larger than 4 cm, then the treatment may be radical hysterectomy and removal of lymph nodes in the pelvis (and some in the para-aortic area). If the tissue removed at surgery shows cancer cells in the margins or cancer in the lymph nodes, treatment will include radiation treatments given with chemotherapy. Brachytherapy may be given as well.

Stage IIB: Combined internal and external radiation therapy is the usual treatment. The radiation is given with the chemotherapy drug cisplatin. Sometimes other chemo drugs may be given along with cisplatin.

Stage III and IVA

Combined internal and external radiation therapy given with cisplatin is the recommended treatment.

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 a CT or MRI scan to see how big the lymph nodes are. Lymph nodes that are bigger than usual 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 may 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 locally (near the cervix) or distant metastases. Chemotherapy is often recommended. Most standard regimens use a platinum compound, either cisplatin or carboplatin along with another drug such as paclitaxel, gemcitabine, topotecan, or vinorelbine. Clinical trials are testing other combinations of chemotherapy drugs, as well as some other experimental treatments.

Recurrent cervical cancer

Cancer is called recurrent when it come backs after treatment. Cancer can come back locally (in the pelvic organs near the cervix) 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 "Surgery" section.) Sometimes radiation or chemotherapy may be used for palliative treatment (treatment to relieve symptoms but not expected to cure).

If your cancer has recurred in a distant area chemotherapy or radiation therapy may be used to treat and relieve specific symptoms. If chemotherapy is used, you should understand the goals and limitations of this therapy. Sometimes chemotherapy can improve your quality of life, and other times it can diminish it. You need to discuss this with your doctors. Fifteen percent to 25% of patients may respond at least temporarily to chemotherapy.

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.

Last Medical Review: 03/26/2008
Last Revised: 05/13/2009