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.
What is a hysterectomy?
A hysterectomy is a common procedure used to treat gynecologic cancers, like ovarian cancer, cervical cancer and endometrial cancer, and other health conditions impacting the uterus. But there are still many myths surrounding this type of surgery. And, if you need a hysterectomy, you may have anxiety or questions about long-term side effects, including the impact on your fertility.
We spoke with gynecologist oncologist Jolyn Taylor, M.D., about what patients planning for a hysterectomy should expect.
What is a hysterectomy?
A hysterectomy is a surgery to remove a patient’s uterus. There are a few types of hysterectomies:
- Total hysterectomy: Removal of the uterus and cervix
- Supracervical hysterectomy: Removal of the uterus only
- Simple hysterectomy: Removal of the uterus and cervix, but not the tissue adjacent to the cervix (called parametria) or the upper vagina. This is the most common type of hysterectomy.
- Radical hysterectomy: Removal of the uterus, cervix, upper part of the vagina and supporting tissues adjacent to the cervix called the parametria
Removal of a fallopian tube is known as a salpingectomy. Removal of an ovary is known as an oophorectomy. Removal of both a fallopian tube and an ovary is a salpingo-oophorectomy. Some patients may have both fallopian tubes and/or both ovaries removed.
It is important to talk to your surgeon about whether your ovaries should be removed at the time of hysterectomy. This decision will be based on your age, the reason you are having the hysterectomy and other medical factors. All women, however, should have their fallopian tubes removed if they are undergoing hysterectomy. This has been shown to decrease the risk of ovarian cancer later, and fallopian tubes have no impact on ovarian or hormonal function.
Hysterectomies may be performed through either:
- open surgery, also called a laparotomy with one larger incision, or
- a minimally-invasive, laparoscopic or robotic hysterectomy performed through multiple smaller incisions
Patients should talk to their health care provider to see which type of procedure is right for them. Most cervical cancer patients should avoid a minimally invasive hysterectomy, as studies show this could increase the risk of recurrence.
Who needs a hysterectomy?
A hysterectomy is a part of the standard treatment for patients who have been diagnosed with cervical, endometrial or ovarian cancer. However, some women who wish to try to get pregnant in the future may have the option for conservative therapy that does not involve a hysterectomy. Some women may need a prophylactic hysterectomy to reduce their chances of developing cancer in the future if they have been diagnosed with some hereditary conditions.
Outside of cancer care, hysterectomies are performed to treat uterine fibroids, heavy vaginal bleeding, some uterine prolapse, endometriosis (when the tissue that lines the uterus grows outside of the uterus) or adenomyosis (when the tissue that lines the uterus grows inside the walls of the uterus where it doesn’t belong) that are unable to be controlled through non-surgical means.
Are there any risks?
Often, especially when used for cancer treatment, a hysterectomy is performed along with other procedures, so the risk is specific to each individual patient. It’s important that you talk to your doctor about your risks.
What should patients expect during a hysterectomy?
Patients receive general anesthesia before a hysterectomy. During the procedure, the surgeon will remove the uterus through an incision in the abdomen or the vagina. Surgery can last anywhere from one to three hours. It may take longer if the surgeon is doing additional procedures.
How long does it take to recover from a hysterectomy?
Historically, recovery from a hysterectomy was a difficult process, but thanks to efforts like MD Anderson’s Enhanced Recovery Program, patients who have a minimally invasive or open hysterectomy both recovery relatively rapidly. But the experience does vary depending on which type of procedure you have. Patients who have an open radical or simple hysterectomy can expect to be in the hospital one to four days. Patients who have a minimally invasive hysterectomy will be able to leave the hospital as early as the same day as the procedure.
Regardless of the type of hysterectomy, patients should expect to be up and walking around the same day as the surgery. Patients often experience discomfort at the incision site for about four weeks. Patients should refrain from any heavy lifting for six weeks and from being fully submerged in water, using tampons, having sex or placing anything in the vagina until their doctor says they’ve healed.
What type of long-term side effects should a patient expect?
Patients who have had a hysterectomy will not be able to become pregnant, so it’s best to consider the hysterectomy relative to your goals surrounding fertility. Outside of fertility, patients will not experience any long-term side effects. A common myth is that hysterectomies cause patients to experience early menopause, but this is not true as hormonal function comes from the ovaries.
Will a patient still have a period after a hysterectomy?
This is a really frequently asked question. No, a patient who has a hysterectomy will not menstruate. Despite this, a patient who has a hysterectomy will not go into menopause unless the ovaries are removed.
What advice do you have for a patient interested in preserving her fertility?
Any patient who has been told they need a hysterectomy can weigh need for hysterectomy with their reproductive goals with their care team or seek a second opinion. Cancer patients who need a hysterectomy but are interested in preserving their fertility should seek care at a center with an oncofertility program, like MD Anderson. Our oncofertility specialists don’t just treat people with gynecologic cancers. They treat anyone whose cancer may impact their fertility. They can help patients who are considering a hysterectomy weigh their options so they can make the best decision for themselves.
Does a hysterectomy affect sexual function?
No, a hysterectomy alone does not impact sexual function. Recovery from surgery and undergoing therapy for cancer, including possibly going into menopause, however, may impact sexual function. Some hormone therapies used to treat cancer may cause sexual side effects. Patients should share their side effects and concerns with their care team.
Overall, hysterectomies are a safe and effective option for treating several types of cancer, and many patients who have them continue to live normal lives after.
Request an appointment at MD Anderson online or by calling 1-877-632-6789.
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.
Request an appointment at MD Anderson online or call 1-877-632-6789.