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Treatments and drugs
By Mayo Clinic staff
Limited, noninvasive cancer
Treatment of cervical cancer that's confined to the outside layer of the cervix typically requires treatment to remove the abnormal area of cells. For most women in this situation, no additional treatments are needed. Procedures to remove noninvasive cancer include:
- Cone biopsy (conization). During this surgery, the doctor uses a scalpel to remove a cone-shaped piece of cervical tissue where the abnormality is found.
- Laser surgery. This operation uses a narrow beam of intense light to kill cancerous and precancerous cells.
- Loop electrosurgical excision procedure (LEEP). This technique uses a wire loop to pass electrical current, which cuts like a surgeon's knife, and remove cells from the mouth of the cervix.
- Cryosurgery. This technique involves freezing and killing cancerous and precancerous cells.
- Hysterectomy. This major surgery involves removal of the cancerous and precancerous areas, the cervix and the uterus. Hysterectomy is usually done only in certain selected cases of noninvasive cervical cancer.
Invasive cancers
Cervical cancer that invades deeper than the outside layer of cells on the cervix is referred to as invasive cancer and requires more extensive treatment. Treatment for cervical cancer depends on several factors, such as the stage of the cancer, other health problems you may have and your own preferences about treatment. Treatment options may include:
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Surgery. Surgery to remove the uterus (hysterectomy) is typically used to treat the early stages of cervical cancer. A simple hysterectomy involves the removal of the cancer, the cervix and the uterus. Simple hysterectomy is typically an option only when the cancer is very early stage — invasion is less than 3 millimeters (mm) into the cervix. A radical hysterectomy — removal of the cervix, uterus, part of the vagina and lymph nodes in the area — is the standard surgical treatment when there's an invasion of greater than 3 mm into the cervix and no evidence of tumor on the walls of the pelvis.
Hysterectomy can cure early-stage cervical cancers and prevent cancer from coming back, but removing the uterus makes it impossible to become pregnant. Expect about six weeks of recovery time. Temporary side effects of radical hysterectomy include pelvic pain and difficulty with bowel movements and urination.
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Radiation. Radiation therapy uses high-powered energy to kill cancer cells. Radiation therapy can be given externally using external beam radiation or internally (brachytherapy) by placing devices filled with radioactive material near your cervix. Radiation therapy is as effective as surgery for early-stage cervical cancer. For women with more advanced cervical cancer, radiation combined with cisplatin-based chemotherapy is considered the most effective treatment.
Side effects of radiation to the pelvic area include upset stomach, nausea, diarrhea, bladder irritation and narrowing of your vagina, which can make intercourse difficult. Premenopausal women may stop menstruating as a result of radiation therapy and begin menopause.
- Chemotherapy. Chemotherapy uses strong anti-cancer medications to kill cancer cells. Chemotherapy drugs, which can be used alone or in combination with each other, are usually injected into a vein and they travel throughout your body killing quickly growing cells, including cancer cells. The chemotherapy drug called cisplatin is often combined with radiation therapy to enhance overall treatment effectiveness. Side effects of chemotherapy depend on the drugs, but generally include diarrhea, fatigue, nausea and hair loss. Certain chemotherapy drugs may cause infertility and early menopause in premenopausal women.
- Warren JB, et al. Cervical cancer screening and updated Pap guidelines. Primary Care: Clinics in Office Practice. 2009;36:131.
- Molpus KL, et al. Gynecologic cancers. In: Goldman L, et al., eds. Goldman: Cecil Medicine. 23rd ed. Philadelphia, Pa.: Saunders Elsevier; 2007. http://www.mdconsult.com/das/book/body/135557788-7/837587224/1492/770.html#4-u1.0-B978-1-4160-2805-5..50214-7_9477. Accessed April 30, 2009.
- Zell JA, et al. Cancer prevention, screening and early detection. In: Abeloff MD, et al. Abeloff's Clinical Oncology. 4th ed. Philadelphia, Pa.: Churchill Livingstone; 2008. http://www.mdconsult.com/das/book/body/135557788-9/837588846/1709/31.html#4-u1.0-B978-0-443-06694-8..50030-0_657. Accessed April 30, 2009.
- How is cervical cancer diagnosed? American Cancer Society. Accessed April 30, 2009.
- What is cervical cancer? American Cancer Society. Accessed April 30, 2009.
- Holschneider CH, et al. Invasive cervical cancer: Management of early stage disease (FIGO IA, IB1, nonbulky IIA) and special circumstances. http://www.uptodate.com/home/index.html. Accessed April 30, 2009.
- Shepherd JH. Conservative surgery for carcinoma of the cervix. Clinical Oncology. 2008;20:395.
- Cervical cancer. Centers for Disease Control and Prevention. http://www.cdc.gov/cancer/cervical/pdf/cervical_facts.pdf. Accessed April 30, 2009.
- Holschneider CH. Invasive cervical cancer: Epidemiology, clinical features, and diagnosis. http://www.uptodate.com/home/index.html. Accessed April 30, 2009.
- Cervical cancer. National Cancer Institute. http://www.cancer.gov/cancertopics/pdq/treatment/cervical/Patient/page2. Accessed April 30, 2009.
- Detailed guide: Cervical cancer treatment options by stage. American Cancer Society. Accessed April 30, 2009.
- Holschneider CH, et al. Invasive cervical cancer: Management of stages IB2, bulky IIA, and locally advanced disease. http://www.uptodate.com/home/index.html. Accessed April 30, 2009.
- The emotional impact of a cancer diagnosis. American Cancer Society. Accessed April 30, 2009.
- Pap test. National Women's Health Information Center. http://www.womenshealth.gov/faq/pap-test.cfm. Accessed April 30, 2009.
- HPV vaccine information for young women. Centers for Disease Control and Prevention. http://www.cdc.gov/std/hpv/STDFact-HPV-vaccine-young-women.htm. Accessed April 30, 2009.
- Your first gynecologic visit. American College of Obstetrics and Gynecology. http://www.acog.org/publications/patient_education/bp150.cfm?printerFriendly=yes. Accessed April 30, 2009.
- Moynihan TJ (expert opinion). Mayo Clinic, Rochester, Minn. May 12, 2009.
- Cervical cytology screening. Washington, D.C.: American College of Obstetricians and Gynecologists. http://journals.lww.com/greenjournal/documents/PB109_Cervical_Cytology_Screening.pdf. Accessed Nov. 20, 2009.
