Treatment of cervical cancer varies considerably based on many factors, including how advanced the cancer is, the age and health of the patient and whether or not the cancer has spread. Based on these and other factors, Dr. Ivy will determine the best course of action for you. Treatment of cervical cancer may involve surgery, radiation, or a combination of the two. Treatment will generally depend on the following factors:
- Stage of the tumor
- Grade of the tumor
- Size of the tumor
- Extent of local spread
- Age of the patient
- Health of the patient
How is cervical cancer staged?
Stage IA–tumor is confined to the cervix and minimally invasive
Stage IB–tumor is confined to the cervix and is more than minimally invasive
Stage IIA–tumor is present on the uppermost vagina
Stage IIB–tumor is present in the tissue surrounding the cervix
Stage IIIA–tumor is present in the lowermost vagina
Stage IIIB–tumor has extended to the pelvic sidewall
Stage IVA–tumor has invaded the bladder or bowel
Stage IVB–tumor has spread to distant sites
For some stage IA tumors, a simple hysterectomy can be curative. For young women and others who wish to preserve their fertility, a cervical conization may be performed. This procedure removes only a small portion of the cervix and is usually associated with only minimal risk to future pregnancies.
For more advanced Stage IA tumors and most Stage IB tumors, radical hysterectomy with lymph node dissection is the treatment of choice. This involves removing the uterus and cervix along with the tissue surrounding the cervix. The most common complaint after this procedure is bladder dysfunction.
After surgery, the ovaries may be left in place to attempt to prevent menopause. Although studies have shown a low risk of ovarian metastasis, the risk is increased with adenocarcinomas, and the ovaries are typically removed if you have a diagnosis of adenocarcinoma of the cervix.
For tumors that have spread locally (Stage IIA-IIIB), radiation with the addition of chemotherapy is the standard of care. This treatment involves daily radiation treatments, 5 days a week, for up to 6 weeks. Weekly chemotherapy is often used in this setting as well and has been shown to improve overall survival as compared to radiation alone.
For more advanced cases (Stage IV), curing the cancer is difficult and systemic chemotherapy is the treatment used most often. In select cases, ultra-radical surgery may be attempted.
Newer Surgical Techniques
For women that wish to retain their fertility and have small cancers confined to the cervix, a radical trachealectomy may be performed. In this procedure, the uterus is left in place but the cervix and all surrounding tissues are removed. This procedure is best reserved for squamous cell lesions measuring less than 2 centimeters in size.
Survival is variable and is most strongly associated with stage of disease and presence of lymph node metastasis. 5-year survival can range from 90% with stage I disease to 20% with stage IV.