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. Treatment may be delayed until the baby is born if you are in your third trimester of pregnancy or if the cancer is in the early stages and has not spread.
At MD Anderson, your treatment for cervical cancer will be customized to your particular 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 (usually up to 4 to 5 centimeters in width) if the cancer is only in the cervix. 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 cancer (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, either through the vagina or a cut on the abdomen. 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).
The surgery can be done with a laparoscope, using robotic equipment or through a larger incision (cut) in the abdomen.
Other surgery types include:
Pelvic exenteration: If cervical cancer returns after treatment, this complex surgery may be performed. As well as the organs and tissues removed in a radical hysterectomy, the bladder, vagina, rectum and part of the colon are removed.
- If the bladder is removed, a piece of intestine may be used to make a new bladder. Then urine may be drained through a catheter (tube) into a urostomy, which is a small opening on the abdomen, or into a small plastic bag worn on the outside of the body.
- If the rectum and part of the colon are removed, you may have a colostomy, which is an opening on the abdomen that allows solid waste (stool) to pass into a small bag worn on the outside of the body. Sometimes the colon may be reconnected so that a colostomy is not needed.
- If the vagina is removed, the surgeon may be able to form a new one from skin or other tissue.
To learn more about the surgery, watch Total Pelvic Exenteration: What You Need to Know.
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 usually is used to treat cervical cancers that have spread beyond the cervix or very large lesions (larger than 4 centimeters). New radiation therapy techniques and remarkable skill allow MD Anderson doctors to target tumors more precisely, delivering the maximum amount of radiation with the least damage to healthy cells. Radiation therapy may also be used instead of surgery. Sometimes it is necessary after surgery to treat cancer that has spread or to reduce the risk that a cancer will come back.
Three types of radiation therapy may be used to treat cervical cancer:
- External radiation therapy uses a machine outside the body to send radiation toward the cervical cancer.
- Internal radiation therapy implants (brachytherapy) are inserted through the vagina into the cervix, where they are placed next to the tumor. The implants stay in place for a few days while you stay in the hospital. High-dose treatment, which involves leaving the radioactive material in place for a few minutes each time, may be done on an outpatient basis.
- Intensity-modulated radiotherapy (IMRT), which tailors treatment to the specific shape of the tumor or enlarged lymph nodes.
Chemotherapy
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.
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.
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.
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