Treatment Options for Cervical Cancer, by Stage

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 if you want to maintain fertility

A cone biopsy is the preferred procedure if you 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 cone biopsy shows that the cancer has grown into blood or lymph vessels, it would then be treated the same as stage IA2 disease (see below).

Treatment options if you 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 (the stroma) that supports organs such as the uterus, bladder, and vagina.

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 if you 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 if you don’t want to maintain fertility

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

 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 (the stroma) that supports organs such as the uterus, bladder, and vagina.

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 if you want to maintain fertility

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

Stage IB1, IB2, and IIA1: Treatment options if you 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 (the stroma) that supports organs such as the uterus, bladder, and vagina. 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 to the pelvis using both brachytherapy and external beam radiation therapy may be an option if a patient is not healthy enough for surgery or decides they do not want surgery. Chemotherapy (chemo) may be given with the radiation (concurrent chemoradiation).

Stages IB3 and IIA2

Stages IIB, III, IVA

Treatment options

Chemoradiation: The chemo may be cisplatin or carboplatin, given concurrently (at the same time) with external beam radiation (EBRT). This may be followed by brachytherapy.

Stage IVB

At this stage, the cancer has spread outside the pelvis to other areas of the body. Stage IVB cervical cancer is not usually considered curable. Treatment options include chemo alone or with pembrolizumab if the tumor is PD-L1 positive. If chemo is given alone, it's usually a combination of cisplatin or carboplatin with paclitaxel and bevacizumab. If chemo is given with pembrolizumab, chemo is usually cisplatin or carboplatin with paclitaxel, with or without bevacizumab. Radiation therapy may be given to help relieve symptoms. For disease that recurrs after initial systemic therapy, other chemo drugs, or immunotherapy alone, or targeted therapy may also be options.

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

Recurrent cervical cancer

New treatments that may benefit patients who have distant recurrence of cervical cancer are being evaluated in clinical trials.

Cervical cancer in pregnancy