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.