Cervical Cancer Treatment
If you are diagnosed with cervical cancer, your doctor will discuss the best options to treat it. This depends on several factors, including:
- Stage of the cancer
- Whether cancer has spread to other parts of the body
- Size of the tumor
- Your desire to have children in the future
- Your age and overall health
If you are pregnant, your therapy for cervical cancer depends on the stage of pregnancy and the stage of cervical cancer.
At?MD Anderson, your treatment for cervical cancer will be customized to your needs. One or more of the following therapies may be recommended to treat the cancer or help relieve symptoms.
Surgery
Small precancerous lesions
These types of?surgery?may be used for precancerous lesions or cervical cancer that has not spread beyond the cervix:
Cryosurgery?(cryotherapy):?A instrument freezes and destroys precancerous tissue.
LEEP (loop electrosurgical excision procedure):?Electrical current is passed through a thin wire hook to remove precancerous lesions.
Cone:?This procedure is the same as a cone biopsy that removes all the cancerous tissue. It may be used when the cancer is small, and the woman wants to be able to have children.
Hysterectomy:?This operation removes the uterus and the cervix, but not the tissue next to the uterus. The vagina and nearby lymph nodes are not removed. The surgery may be done through the vagina or an incision (cut) in the abdomen. Minimally invasive laparoscopic surgery, sometimes with a robotic device, may be an option for some women with cervical cancer.
Bilateral salpingo-oophorectomy:?The fallopian tubes and ovaries are removed at the same time as the hysterectomy. If a woman is close to the age of menopause, her doctor may discuss removing her ovaries and fallopian tubes to reduce the chance the cervical cancer will come back in one of those organs.
Large cervical cancer lesions
These surgeries may be used for larger cervical cancer lesions if the cancer is only in the cervix. In addition to removing the cancer, the surgeon removes the sentinel lymph nodes, which are often key structures in the initial spread of cancer. Any patient who is a candidate for surgical resection of the cervix is also a candidate for sentinel lymph node biopsy as part of the procedure.
If the cancer has spread, doctors usually will recommend chemotherapy and radiation therapy.
Trachelectomy:?The cervix and surrounding tissue are surgically removed but not the uterus. This procedure sometimes is used for young women who have larger tumors (usually up to 2 centimeters) but wish to keep the ability to have children. Lymph nodes may be removed during surgery too. A cerclage or stitch is used to help support the base of the uterus. If more cancer is found during the surgery, a hysterectomy probably will be done.
This is a highly specialized procedure that requires a great deal of skill on the part of the surgeon to be successful. Women considering this surgery should be sure the doctor performing it has a high level of experience in this procedure.
Radical hysterectomy:?The cervix, uterus, part of the vagina, the tissues surrounding the cervix (parametria) and nearby lymph nodes are removed. Depending on the patient¡¯s age and the size of the tumor, she also may have a bilateral salpingo-oophorectomy (removal of the ovaries and fallopian tubes).
Other surgery types include:
Pelvic exenteration:?If cervical cancer returns after treatment, this complex surgery may be performed. Along with the organs and tissues removed in a radical hysterectomy, the bladder, vagina, rectum and part of the colon are removed.
Laparoscopic retroperitoneal lymph node dissection:?an advanced procedure that helps surgeons plan your surgery and determine how far the cancer has spread.
Radiation therapy
Radiation therapy?uses powerful, focused beams of energy to kill cancer cells. There are several different radiation therapy techniques. Doctors can use these to accurately target a tumor while minimizing damage to healthy tissue.
Radiation therapy usually is used to treat cervical cancers that have spread beyond the cervix or very large lesions (larger than 4 centimeters). It may also be used instead of surgery. Sometimes it is necessary to deliver radiation therapy after surgery to treat cancer that has spread or to reduce the risk that a cancer will come back.
Two types of radiation therapy may be used to treat cervical cancer:
- Intensity modulated radiation therapy (IMRT) focuses multiple radiation beams of different intensities directly on the tumor for the highest possible dose.?
- Brachytherapy delivers radiation therapy with small pieces of radioactive material (usually about the size of a grain of rice) that are placed on or inside the patient¡¯s body as close to the tumor as possible. This allows doctors to deliver very high doses of radiation directly to the patient¡¯s tumor while limiting radiation exposure to healthy tissue.
Internal radiation therapy implants deliver radiation via an applicator that is inserted through the vagina. The implants may be inserted under general anesthesia. High-dose treatment, which involves the delivery of brachytherapy treatment for a few minutes each time, may be done on an outpatient basis.
Chemotherapy
Chemotherapy drugs kill cancer cells, control their growth or relieve disease-related symptoms. Chemotherapy may involve a single drug or a combination of two or more drugs, depending on the type of cancer and how fast it is growing.
MD Anderson?offers the most up-to-date and advanced?chemotherapy?options for cervical cancer. We also work with you to provide supportive care for side effects of treatment, including nausea and constipation.
Cervical cancer clinical trials
Since?MD Anderson?is one of the nation¡¯s leading research centers, we¡¯re able to offer?clinical trials?(research studies) of new treatments for cervical cancer. We constantly strive to improve treatment outcomes, which includes tumor response and quality of life. Our?cervical cancer research?is designed to help us continue this mission.
Our Innovative Surgery Working Group is setting the new standard of surgical care for women with cervical cancer through groundbreaking, international trials that are pioneering minimally-invasive and fertility-sparing surgical strategies.
Learn more about cervical cancer:
What is a total pelvic exenteration?
¡°Exenteration¡± refers to a complex surgery in which organs, bones and other structures are removed from the pelvis in order to treat cancer. A pelvic exenteration might involve the bladder, rectum, anus and/or sacrum (tailbone), as well as the prostate gland in men and the vagina and/or uterus in women.??
While this procedure may sound fairly extreme, it is often the best ¡ª and only potentially curative ¡ª option for some types of cancer. It also provides the best possible chance of long-term cancer control.?
But which cancers does a pelvic exenteration typically treat? What makes you a good candidate for one? How will it affect your sex life and bathroom habits? And, what else should you know about this life-changing operation? Read on for answers.?
Which cancers is a total pelvic exenteration used most frequently to treat?
A total pelvic exenteration (TPE) is most commonly used for locally advanced rectal cancer?or another type of cancer that involves the rectum. This is because of the way cancer grows and spreads in the rectum. But TPE is also used to treat:?
In fact, pelvic exenteration was originally designed to treat recurrent cervical cancer. It originated as an operation for this gynecologic cancer because the cervix is located in the center of the pelvis. In the days before HPV vaccinations prevented most cervical cancers and radiation therapy was used to treat it, cervical cancer often grew into the structures around it. This procedure was seen as a way of clearing it out.?
Are there different types of exenterations?
An exenteration used to treat rectal cancer usually involves the removal of the rectum, plus something else. That could be the bladder, the bone behind the rectum (the sacrum), or any of the other structures surrounding it that are not normally removed during rectal surgery. Generally speaking, though, there are three types of exenterations:
Anterior exenteration
In a male, this entails removing the bladder and the prostate, but leaving the rectum intact. In a female, this involves removing the bladder, uterus and possibly the vagina, but leaving the rectum intact.??
Posterior exenteration
This involves the removal of the rectum and sacrum, as well as the uterus (if present) and possibly part of the vagina in a female.?
Total pelvic exenteration
In a male, this involves removal of the rectum, bladder and prostate. In a female, this normally entails the removal of the rectum, bladder and uterus (if present) and can also include the vagina.?
Which patients make the best candidates for an exenteration?
Ideally, we want you to be at your very fittest before an exenteration. That way, you¡¯ll have some strength in reserve if any complications arise. So, any therapies we might recommend before that are all part of a plan to get your body prepared for surgery, not to help you avoid it.??
Your best chance for a cure is when we can do a TPE early as a planned part of your treatment, rather than waiting to do it as a last resort when systemic treatments are no longer working. But a TPE is a long and very complex operation, and the recovery can be prolonged. Not all patients will be able to undergo it. So, the first thing we ask is, ¡°Do you have a cancer that¡¯s resectable?¡± That is: ¡°Can your tumor be removed with surgery? Then, your surgeon will determine if you are fit enough to undergo it.??
Unfortunately, a lot of patients are told elsewhere that this type of surgery is impossible, even when their cancer is not metastatic and is still potentially curable. They only come to MD Anderson after other treatments have failed. Other patients are so leery of the procedure itself that they¡¯ll try almost anything to avoid it.?
The trouble is that while chemotherapy and radiation therapy can sometimes slow a cancer¡¯s growth, the problems caused by a locally advanced tumor in the pelvis often become worse. These can include severe pain, obstructions, infections, blood supply problems, and nerve damage. All of those may end up becoming much bigger issues than they would¡¯ve been if someone had gotten the surgery earlier.?
Cervical cancer survivor finds care and compassion during brachytherapy treatment
My nutritionist and chiropractor suspected something was wrong when I could not lose weight, but I was not concerned. I did not have any cramps or pain anywhere, so what could be wrong? He suggested I get an MRI to see if I had fibroid cysts causing abdominal swelling.
My cervical cancer diagnosis
I had a pelvic MRI near my home in Dallas. The results showed I had fibroid cysts and cells on my cervix that could be cancerous. I made an appointment with my gynecologist and had a routine Pap test. She suggested I see a local gynecologic oncologist to undergo a cervical biopsy.
On April 24, 2023, I received the news that I had cervical cancer. ?
My local oncologist recommended I start chemotherapy and 25 external radiation treatments. After three rounds of chemotherapy, I broke out in hives all over my body. I felt miserable. I was given a steroid and Benadryl to help, but I only slept a few hours each night. They told me my cancer was early stage, but I was not a candidate for surgery. I had questions and did not feel comfortable with my medical team. I decided to get a second opinion at MD Anderson.
In June, I traveled to MD Anderson for my first appointment with gynecologic oncologist Nicole Fleming, M.D., who said I needed brachytherapy. She told me it was standard for cervical cancer patients to receive brachytherapy after external beam radiation based on my clinical stage. To avoid any delays, she recommended I finish the external beam radiation treatments I started in Dallas first given that I was in the middle of my treatment course.
Undergoing brachytherapy to treat cervical cancer
I stayed in Houston in July. On July 14, I received my first of two brachytherapy procedures at MD Anderson under the care of radiation oncologist Anuja Jhingran, M.D. She explained I would receive pulsed-dose rate (PDR) brachytherapy. This is a two-day inpatient procedure that sends a radioactive pellet into an internal applicator for 15 minutes every hour. Two weeks later, the procedure is repeated.
Before each surgery, advanced practice registered nurse (APRN) Tomar Foster-Mills walked me through what to expect in my pre-operative appointment and answered all my questions. A few minutes before the first surgery, I met resident physician Gohar Manzar, M.D., Ph.D. She was very compassionate and put me at ease.
All my nurses were amazing and kept me calm. Dr. Manzar held my hand and talked me through the procedure. Having confidence in my care team made everything so much easier. It was the complete opposite of my experience before coming to MD Anderson.
During the procedure, I had to lie flat on my back for 48 hours while the internal radiation was in place. It would run every hour for 10 minutes. I did not feel anything during those 10-minute intervals. I was kept on a strict diet with soft foods and liquids to prevent constipation since I couldn¡¯t move.
Dr. Manzar plays the ukulele for her patients, and I looked forward to it every day. The day before my last treatment ended, she played ¡°Closing Time¡± at my bedside as a tribute to finishing treatment. She took the time to FaceTime my son, so he was included. The last day was on a Sunday, and Dr. Manzar walked in at 5 a.m. on her day off to visit me. She wanted to ensure I was comfortable during the removal of my implant and congratulate me on finishing treatment. Anyone who has her as a doctor in the future will be lucky.
¡°What makes MD Anderson the top cancer hospital in the nation is giving patients the best treatment experience with experts and personal touches involved in our mission-driven care,¡± Manzar told me. ¡°For me, this extra touch comes in the form of music therapy. It humanizes our relationship and transcends cultural and linguistic barriers.¡±
Why I recommend MD Anderson
By early August, I was able to return home and resume normal activities. I return to MD Anderson for a follow-up every three months for two years. During my recent appointment, my PET scan showed no evidence of disease.
I was blessed to be treated by doctors and medical staff who are experts in their areas of care. If you do not feel comfortable and confident with your doctor or care team, get a second opinion. Sometimes you must advocate for your own care. It can save your life, just like it saved mine.
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