TREATMENT
OPTIONS
Surgery
Surgery (removing
the cancer in an operation) is sometimes used to treat cervical cancer. The
following surgical procedures may be used:
·
Conization:
A procedure to remove a cone-shaped piece of tissue from
the cervix and cervical canal.
A pathologist views
the tissue under a microscope to
look for cancer cells.
Conization may be used to diagnose or
treat a cervical condition.
This procedure is also called a cone biopsy.
Conization may
be done using one of the following procedures:
o
Cold-knife conization:
A surgical procedure that uses a scalpel (sharp
knife) to remove abnormal tissue
or cancer.
o
Loop electrosurgical excision
procedure (LEEP): A surgical procedure that uses electrical current
passed through a thin wire loop as a knife to remove abnormal tissue or cancer.
o
Laser surgery:
A surgical procedure that uses a laser beam
(a narrow beam of intense light) as a knife to make bloodless cuts in tissue or
to remove a surface lesion such
as a tumor.
The type of
conization procedure used depends on where the cancer cells are in the cervix
and the type of cervical cancer.
·
Total hysterectomy:
Surgery to remove the uterus,
including the cervix. If the uterus and cervix are taken out through the vagina,
the operation is called a vaginal hysterectomy. If the uterus
and cervix are taken out through a large incision (cut)
in the abdomen,
the operation is called a total abdominal hysterectomy.
If the uterus and cervix are taken out through a small incision in the abdomen
using a laparoscope,
the operation is called a total laparoscopic hysterectomy.
The uterus is surgically removed with or
without other organs or tissues. In a total hysterectomy, the uterus and cervix
are removed. In a total hysterectomy with salpingo-oophorectomy, (a) the uterus
plus one (unilateral) ovary and fallopian tube are removed; or (b) the uterus
plus both (bilateral) ovaries and fallopian tubes are removed. In a radical
hysterectomy, the uterus, cervix, both ovaries, both fallopian tubes, and
nearby tissue are removed. These procedures are done using a low transverse
incision or a vertical incision.
·
Radical hysterectomy:
Surgery to remove the uterus, cervix, part of the vagina, and a wide area of
ligaments and tissues around these organs.
The ovaries, fallopian tubes,
or nearby lymph nodes may
also be removed.
·
Modified radical hysterectomy:
Surgery to remove the uterus, cervix, upper part of the vagina, and ligaments
and tissues that closely surround these organs. Nearby lymph nodes may also be
removed. In this type of surgery, not as many tissues and/or organs are removed
as in a radical hysterectomy.
·
Radical trachelectomy:
Surgery to remove the cervix, nearby tissue and lymph nodes, and the upper part
of the vagina. The uterus and ovaries are not removed.
·
Bilateral salpingo-oophorectomy:
Surgery to remove both ovaries and both fallopian tubes.
·
Pelvic exenteration:
Surgery to remove the lower colon, rectum,
and bladder.
The cervix, vagina, ovaries, and nearby lymph nodes are also removed.
Artificial openings (stoma)
are made for urine and stool to
flow from the body to a collection bag. Plastic surgery may
be needed to make an artificial vagina after this operation.
Radiation
therapy
Radiation therapy is a
cancer treatment that uses high-energy x-rays or other
types of radiation to kill
cancer cells or keep them from growing. There are two types of radiation
therapy. External radiation therapy uses a
machine outside the body to send radiation toward the cancer. Internal radiation therapy
uses a radioactive substance
sealed in needles, seeds, wires,
or catheters that are
placed directly into or near the cancer. The way the radiation therapy is given
depends on the type and stage of the
cancer being treated.
Intensity-modulated radiation
therapy (IMRT) is a type of 3-dimensional (3-D) radiation
therapy that uses a computer to make pictures of the size and shape
of the tumor. Thin beams of radiation of different intensities (strengths) are
aimed at the tumor from many angles. This type of radiation therapy causes less
damage to healthy tissue near the tumor.
Chemotherapy
Chemotherapy is a
cancer treatment that uses drugs to stop
the growth of cancer cells, either by killing the cells or by stopping them
from dividing. When chemotherapy is taken by mouth or injected into
a vein or
muscle, the drugs enter the bloodstream and can reach cancer cells throughout
the body (systemic chemotherapy). When
chemotherapy is placed directly into the cerebrospinal fluid, an organ, or
a body cavity such as
the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). The way the
chemotherapy is given depends on the type and stage of the cancer being
treated.
Targeted
therapy
Targeted therapy is a
type of treatment that uses drugs or other substances to identify and attack
specific cancer cells without harming normal cells.
Monoclonal antibody therapy
is a type of targeted therapy that uses antibodies made in
the laboratory from a single type of immune system cell.
These antibodies can identify substances on cancer cells or normal substances
that may help cancer cells grow. The antibodies attach to the substances and
kill the cancer cells, block their growth, or keep them from spreading.
Monoclonal antibodies are given by infusion. They may be
used alone or to carry drugs, toxins, or
radioactive material directly to cancer cells.
Bevacizumab is a
monoclonal antibody that binds to a protein called vascular endothelial growth
factor (VEGF) and may prevent the growth of new blood vessels that
tumors need to grow. Bevacizumab is used to treat cervical cancer that
has metastasized (spread
to other parts of the body) and recurrent cervical
cancer.
Treatment
Options by Stage
Carcinoma
in Situ (Stage 0)
Treatment of carcinoma in situ (stage 0) may
include the following:
·
Conization,
such as cold-knife conization, loop electrosurgical excision
procedure(LEEP), or laser surgery.
·
Hysterectomy for
women who cannot or no longer want to have children. This is done only if
the tumor cannot be completely
removed by conization.
·
Internal radiation therapy for
women who cannot have surgery.
Stage
IA Cervical Cancer
Stage IA cervical cancer is
separated into stage IA1 and IA2.
Treatment for stage
IA1 may include the following:
·
Conization.
·
Total hysterectomy with
or without bilateral salpingo-oophorectomy.
Treatment for
stage IA2 may include the following:
·
Modified radical hysterectomy and
removal of lymph nodes.
·
Radical trachelectomy.
·
Internal radiation therapy for
women who cannot have surgery.
Stages
IB and IIA Cervical Cancer
Treatment of stage IB and stage IIA cervical cancer may
include the following:
·
Radiation therapy with chemotherapy given
at the same time.
·
Radical hysterectomy and
removal of pelvic lymph nodes with
or without radiation therapy to the pelvis,
plus chemotherapy.
·
Radical trachelectomy.
·
Chemotherapy followed by surgery.
·
Radiation therapy alone.
Stages
IIB, III, and IVA Cervical Cancer
Treatment of stage IIB, stage III, and stage IVA cervical cancer may
include the following:
·
Radiation therapy with chemotherapy given
at the same time.
·
Surgery to
remove pelvic lymph nodes followed
by radiation therapy with or without chemotherapy.
·
Internal radiation therapy.
·
A clinical trial of
chemotherapy to shrink the tumor followed by surgery.
·
A clinical trial of chemotherapy and radiation therapy given at
the same time, followed by chemotherapy.
Stage
IVB Cervical Cancer
Treatment of stage IVB cervical cancer may
include the following:
·
Radiation therapy as palliative therapy to
relieve symptoms caused
by the cancer and
improve quality of life.
·
Chemotherapy and targeted therapy.
·
Chemotherapy as palliative therapy to relieve symptoms caused by
the cancer and improve quality of life.
·
Clinical trials of
new anticancer drugs or
drug combinations.
Treatment
Options for Recurrent Cervical Cancer
Treatment of recurrent cervical cancer may
include the following:
·
Radiation therapy and chemotherapy.
·
Chemotherapy and targeted therapy.
·
Chemotherapy as palliative therapy to
relieve symptoms caused
by the cancer and
improve quality of life.
·
Pelvic exenteration.
·
Clinical trials of
new anticancer drugs or
drug combinations.
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