Cervical cancer

Treatment

Today, women facing cervical cancer have better treatment options than they did even a few years ago. If detected in the precancerous stage (dysplasia), cervical cancer can often be halted with a simple procedure such as  a loop electrosurgical excision procedure (LEEP) or cone biopsy can be used.

Each woman's cancer is different, as are her circumstances, preferences and beliefs. A treatment that works well for another woman may not be right for you.

The examination of these tissues will show whether your cancer is likely to grow slowly or quickly, whether it is likely to recur, and whether it is likely to respond to certain types of treatment. The treatment recommended by your doctors will depend to a large degree on the "stage" of your cancer.

Some women will have a hysterectomy to remove cervical cancer that has spread within the cervix. Other women, whose cancer has spread beyond the cervix and into surrounding tissues, will need radiation and chemotherapy in addition to surgery. And some women will be treated with radiation and chemotherapy but not surgery. 

Treatment types

Chemotherapy

Your doctor may recommend chemotherapy as treatment for your cervical cancer. Chemotherapy is used to treat cervical cancer to enhance the effectiveness of radiation therapy or to treat disease that has spread too widely to be treated with surgery or radiation.

"Chemotherapy" means treating cancer with drugs. You may receive one drug or a combination of two or more. Your chemotherapy will be given by injection into a vein. It works by killing fast-growing cells, but the drug cannot discriminate between cancer cells and other fast-growing cells such as hair follicles. That is one reason for many of the typical side effects of chemotherapy treatment, including hair loss.

Chemotherapy Treatments
Cervical cancer is usually treated with a combination of chemotherapy drugs given intravenously, including:

  • Carboplatin, or Paraplatin® 
  • Cisplatin, or Platinol® 
  • 5-FU, brand names are Flourouracil®, Adrucil®, and Efudex® 
  • Paclitaxel, or Taxol®
  • Topotecan (Hycamin).

The most common combinations given at SCCA are carboplatin and Taxol, cisplatin and Taxol, and cisplatin and ifosfamide.

Treatment Schedule
Chemotherapy is given on various schedules. If you are receiving chemotherapy in conjunction with radiation therapy, you will probably receive cisplatin intravenously once a week for six weeks. You will receive daily radiation therapy treatments during that six weeks as well.

Or you may receive chemotherapy once every three or four weeks for a period of three to six months.
 
Some women will receive chemotherapy after they have undergone surgery and radiation if some cancer still remains. In this situation, the chemotherapy is used to slow the progress of the cancer or shrink it temporarily. Unfortunately, it is rare for chemotherapy to completely kill cervical cancer.

Chemotherapy is given in the Infusion Suite on the fifth floor of SCCA. You may bring a friend or family member to sit with you during your treatment, which may last several hours.

Chemotherapy

Your doctor may recommend chemotherapy as treatment for your cervical cancer. Chemotherapy is used to treat cervical cancer to enhance the effectiveness of radiation therapy or to treat disease that has spread too widely to be treated with surgery or radiation.

Radiation Therapy

If you have cervical cancer, your doctor may recommend that you have radiation therapy. The radiation may be given following initial surgery, or it may be used in place of surgery. You may have only radiation therapy, or you may have radiation in combination with chemotherapy.

Recent research has shown that chemotherapy makes cervical cancer cells more sensitive to radiation and thus makes the treatment more effective. The chemotherapy may be given prior to radiation or at the same time. This combination of radiation and chemotherapy may be all the treatment you need, or you may need surgery as well.

Cervical cancer is treated with both external and internal radiation therapy. Some women will be treated with both types.

External radiation
External radiation therapy typically is given five days a week for a period of five or six weeks, using a machine that looks much like a regular X-ray machine. The procedure is not painful, and each treatment lasts only a few minutes.

You may have your radiation therapy at the SCCA clinic on an outpatient basis, under the supervision of SCCA/UW Medicine radiation oncologist Dr. Wui-Jin Koh, who specializes in treating women with gynecologic cancers.

Internal radiation
Internal radiation therapy, also known as brachytherapy, is a procedure that delivers radiation to a cervical tumor using radioactive material--not X-rays--sealed in a rod that is inserted into the uterus.
 
Your doctor may recommend that you have about four of these treatments. This type of radiation is done at SCCA, also under the supervision of Dr. Koh.

Adding chemotherapy
SCCA's parent organizations, UW Medicine and Fred Hutchinson Cancer Research Center, have been active in conducting research that has shown that adding chemotherapy to radiation therapy makes the treatment more effective. This is an example of research conducted at the parent organizations that benefits patients at SCCA and elsewhere.

The National Cancer Institute says adding chemotherapy to radiation therapy dramatically improves the survival rates of women with advanced cervical cancer by as much as 30 to 50 percent.

Radiation Therapy

If you have cervical cancer, your doctor may recommend that you have radiation therapy. The radiation may be given following initial surgery, or it may be used in place of surgery. You may have only radiation therapy, or you may have radiation in combination with chemotherapy.

Surgery

Pre-treatment surgical staging
Your doctor may recommend that you have an operation to remove several lymph nodes before your cancer surgery. This is done in order to biopsy the lymph nodes to determine the spread of your cancer and to help make a decision about the best treatment for you.

If your doctor has recommended surgery to treat your cervical cancer, you may have a complete hysterectomy, which is surgery to remove the uterus and cervix.

If your cancer has spread within the cervix, your doctor may recommend a radical hysterectomy, which involves removing the upper part of the vagina as well as the uterus, cervix, lymph nodes, and some tissues surrounding the uterus.  The lymph nodes are removed so that they can be examined to determine if the cancer has spread.

If biopsies and other tests determine that your cancer has spread beyond the cervix, then your doctors may recommend adding radiation with chemotherapy to control the disease following surgery. 

Surgery for SCCA patients is performed at UW Medical Center, by surgeons who provide care at both UW Medical Center and SCCA.

Robotically assisted minimally invasive hysterectomy
There are two surgical options to performing the hysterectomy. Traditional open surgery or by minimally invasive robotically assisted approach.  Dr. Ron Swensen leads the robotic surgery team of gynecologic oncology surgeons at SCCA trained to offer this innovative approach which has been shown to benefit patients by decreasing pain, recovery time, blood loss, infection, and time in the hospital.  Discussion about which approach may be right for you will take place at your pre-operative appointment with your SCCA gynecologic oncologist. 

Surgery

Your doctor may recommend that you have an operation to remove several lymph nodes before your cancer surgery. This is done in order to biopsy the lymph nodes to determine the spread of your cancer and to help make a decision about the best treatment for you.

Treatment for recurrent Cervical cancer

The treatment your doctors suggest for a recurrence of your cervical cancer will depend on a number of factors, including the type of treatment you received in the past, and the symptoms you are experiencing with the new cancer.

If the disease is in multiple sites, then your doctors will probably recommend that you have chemotherapy. If you haven't had radiation therapy previously, radiation plus chemotherapy is often the most effective treatment. If you have had radiation previously, then your doctors may recommend surgery.

Women whose cancer has recurred in the pelvis may need a surgery called pelvic exenteration. In this procedure, the uterus, cervix and vagina are removed, as well as other organs to which the cancer has spread, such as the lower colon, rectum or bladder.

Sometimes radiation therapy is given during surgery (intra-operatively) to treat a small, localized area that cannot be removed surgically.

You may want to read the Physician Data Query (PDQ) summary on the National Cancer Institute website for more detailed information about cervical cancer.

National Cancer Institute website