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 IA1

Treatment for this stage depends on whether or not you want 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.
  • If the cancer has grown into blood or lymph vessels, one treatment option is a cone biopsy (with negative margins) with removal of pelvic lymph nodes. Another option is a radical trachelectomy along with removal of the pelivc lymph nodes.

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

  • A simple hysterectomy may be an option if the cancer shows no lymphovascular invasion and the edges of the biopsy have no cancer cells. If the edges of the biopsy have cancer cells present, a repeat cone biopsy or a radical hysterectomy with removal of the pelvic lymph nodes might be an option.
  • If the cancer has grown into blood or lymph vessels, you might need a radical hysterectomy along with removal of the pelvic lymph nodes. Sometimes, surgery is not done and external beam radiation to the pelvis followed by brachytherapy is used.

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.

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

 If none of the lymph nodes have cancer cells, radiation may still be 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

Stages IB1 and IB2

Treatment options for women who want to maintain fertility

  • Radical trachelectomy with pelvic lymph node dissection and sometimes removal of the para-aortic lymph nodes

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

  • Radical hysterectomy with removal of lymph nodes in the pelvis and sometimes 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.
  • Radiation 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 she does not want surgery. Chemotherapy (chemo) may be given with the radiation (concurrent chemoradiation).

Stage IIA1

Treatment options

  • Radical 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).
  • Radiation with or without chemotherapy: The radiation therapy includes both external beam radiation and brachytherapy. The chemo may be cisplatin, carboplatin, or cisplatin plus fluorouracil. 

Stages IB3 and IIA2

Treatment options

  • Chemoradiation: The chemo may be cisplatin, carboplatin, or cisplatin plus fluorouracil. The radiation therapy includes both external beam radiation and brachytherapy.
  • Radical 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).
  • Chemoradiation followed by a hysterectomy

Stages IIB, III, IVA

Treatment options

Chemoradiation: The chemo may be cisplatin, carboplatin, 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 with or without 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 or immunotherapy alone with pembrolizumab (Keytruda) may also be an option.

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

Recurrent cervical cancer

Cancer that comes back 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 center of the pelvis only, extensive surgery (such as pelvic exenteration) may be an option for some patients, and offers the best chance for possibly curing the cancer (although it can have major side effects). Radiation therapy (sometimes along with chemo) might be another option. If not, chemo, immunotherapy, or targeted therapy may be used to slow the growth of the cancer or help relieve symptoms, but they aren’t expected to cure the cancer.

No matter which type of treatment your doctor recommends, it's important that you understand the goal of treatment (to try to cure the cancer, control its growth, or relieve symptoms), as well as its possible side effects and limitations. For example, 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 who have distant recurrence of cervical cancer are being evaluated in clinical trials.

Cervical cancer in 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:

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

If the cancer is at a very early stage, such as 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 (C-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.

The American Cancer Society medical and editorial content team

Our team is made up of doctors and oncology certified nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing.

Eifel P, Klopp AH, Berek JS, and Konstantinopoulos A. Chapter 74: Cancer of the Cervix, Vagina, and Vulva. In: DeVita VT, Lawrence TS, Rosenberg SA, eds. DeVita, Hellman, and Rosenberg’s Cancer: Principles and Practice of Oncology. 11th ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 2019.

Jhungran A, Russell AH, Seiden MV, Duska LR, Goodman A, Lee S, et al. Chapter 84: Cancers of the Cervix, Vulva, and Vagina. In: Niederhuber JE, Armitage JO, Doroshow JH, Kastan MB, Tepper JE, eds. Abeloff’s Clinical Oncology. 6th ed. Philadelphia, Pa: Elsevier; 2020.

National Cancer Institute. Physician Data Query (PDQ). Cervical Cancer Treatment – Health Professional Version. 2019. https://www.cancer.gov/types/cervical/hp/cervical-treatment-pdq. Updated February 6, 2019. Accessed on September 5, 2019.

National Comprehensive Cancer Network (NCCN). Clinical Practice Guidelines in Oncology: Cervical Cancer. Version 5.2019. Accessed at https://www.nccn.org/professionals/physician_gls/pdf/cervical.pdf on December 12, 2019.

Skrzypczyk-Ostaszewicz A, Rubach, M. Gynaecological cancers coexisting with pregnancy – a literature review. Contemp Oncol (Pozn). 2016;20:193–198.

 

Last Medical Review: January 3, 2020 Last Revised: January 3, 2020

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