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.
At UT MD Anderson, your treatment for cervical cancer will be customized to your 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 if the cancer is only in the cervix. In addition to removing the cancer, the surgeon removes the sentinel lymph nodes, which are often key structures in the initial spread of cancer. Any patient who is a candidate for surgical resection of the cervix is also a candidate for sentinel lymph node biopsy as part of the procedure.
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 tumors (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. 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).
Other surgery types include:
Pelvic exenteration: If cervical cancer returns after treatment, this complex surgery may be performed. Along with the organs and tissues removed in a radical hysterectomy, the bladder, vagina, rectum and part of the colon are removed.
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 uses powerful, focused beams of energy to kill cancer cells. There are several different radiation therapy techniques. Doctors can use these to accurately target a tumor while minimizing damage to healthy tissue.
Radiation therapy usually is used to treat cervical cancers that have spread beyond the cervix or very large lesions (larger than 4 centimeters). It may also be used instead of surgery. Sometimes it is necessary to deliver radiation therapy after surgery to treat cancer that has spread or to reduce the risk that a cancer will come back.
Two types of radiation therapy may be used to treat cervical cancer:
- Intensity modulated radiation therapy (IMRT) focuses multiple radiation beams of different intensities directly on the tumor for the highest possible dose.
- Brachytherapy delivers radiation therapy with small pieces of radioactive material (usually about the size of a grain of rice) that are placed on or inside the patient’s body as close to the tumor as possible. This allows doctors to deliver very high doses of radiation directly to the patient’s tumor while limiting radiation exposure to healthy tissue.
Internal radiation therapy implants deliver radiation via an applicator that is inserted through the vagina. The implants may be inserted under general anesthesia. High-dose treatment, which involves the delivery of brachytherapy treatment for a few minutes each time, may be done on an outpatient basis.
Chemotherapy
Chemotherapy drugs kill cancer cells, control their growth or relieve disease-related symptoms. Chemotherapy may involve a single drug or a combination of two or more drugs, depending on the type of cancer and how fast it is growing.
UT 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.
Cervical cancer clinical trials
Since UT 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.
Our Innovative Surgery Working Group is setting the new standard of surgical care for women with cervical cancer through groundbreaking, international trials that are pioneering minimally-invasive and fertility-sparing surgical strategies.
Learn more about cervical cancer:
What is a total pelvic exenteration?
“Exenteration” refers to a complex surgery in which organs, bones and other structures are removed from the pelvis in order to treat cancer. A pelvic exenteration might involve the bladder, rectum, anus and/or sacrum (tailbone), as well as the prostate gland in men and the vagina and/or uterus in women.
While this procedure may sound fairly extreme, it is often the best — and only potentially curative — option for some types of cancer. It also provides the best possible chance of long-term cancer control.
But which cancers does a pelvic exenteration typically treat? What makes you a good candidate for one? How will it affect your sex life and bathroom habits? And, what else should you know about this life-changing operation? Read on for answers.
Which cancers is a total pelvic exenteration used most frequently to treat?
A total pelvic exenteration (TPE) is most commonly used for locally advanced rectal cancer or another type of cancer that involves the rectum. This is because of the way cancer grows and spreads in the rectum. But TPE is also used to treat:
In fact, pelvic exenteration was originally designed to treat recurrent cervical cancer. It originated as an operation for this gynecologic cancer because the cervix is located in the center of the pelvis. In the days before HPV vaccinations prevented most cervical cancers and radiation therapy was used to treat it, cervical cancer often grew into the structures around it. This procedure was seen as a way of clearing it out.
Are there different types of exenterations?
An exenteration used to treat rectal cancer usually involves the removal of the rectum, plus something else. That could be the bladder, the bone behind the rectum (the sacrum), or any of the other structures surrounding it that are not normally removed during rectal surgery. Generally speaking, though, there are three types of exenterations:
Anterior exenteration
In a male, this entails removing the bladder and the prostate, but leaving the rectum intact. In a female, this involves removing the bladder, uterus and possibly the vagina, but leaving the rectum intact.
Posterior exenteration
This involves the removal of the rectum and sacrum, as well as the uterus (if present) and possibly part of the vagina in a female.
Total pelvic exenteration
In a male, this involves removal of the rectum, bladder and prostate. In a female, this normally entails the removal of the rectum, bladder and uterus (if present) and can also include the vagina.
Which patients make the best candidates for an exenteration?
Ideally, we want you to be at your very fittest before an exenteration. That way, you’ll have some strength in reserve if any complications arise. So, any therapies we might recommend before that are all part of a plan to get your body prepared for surgery, not to help you avoid it.
Your best chance for a cure is when we can do a TPE early as a planned part of your treatment, rather than waiting to do it as a last resort when systemic treatments are no longer working. But a TPE is a long and very complex operation, and the recovery can be prolonged. Not all patients will be able to undergo it. So, the first thing we ask is, “Do you have a cancer that’s resectable?” That is: “Can your tumor be removed with surgery? Then, your surgeon will determine if you are fit enough to undergo it.
Unfortunately, a lot of patients are told elsewhere that this type of surgery is impossible, even when their cancer is not metastatic and is still potentially curable. They only come to MD Anderson after other treatments have failed. Other patients are so leery of the procedure itself that they’ll try almost anything to avoid it.
The trouble is that while chemotherapy and radiation therapy can sometimes slow a cancer’s growth, the problems caused by a locally advanced tumor in the pelvis often become worse. These can include severe pain, obstructions, infections, blood supply problems, and nerve damage. All of those may end up becoming much bigger issues than they would’ve been if someone had gotten the surgery earlier.
Cervical cancer survivor: Why I trust UT MD Anderson
Do you know that stress scale that ranks traumatic life events? Like the death of a close family member or a major illness? Well, I had three of the top five life-altering events all at once during the summer of 2011.
The first stressor was my younger sister dying of colon cancer. The second was parenting three kids under age 5 alone because my husband had just started a new job in South Carolina and we were in the process of relocating. The third was when I found out I had two types of early stage cervical cancer — at the same time and in the same spot.
“Overwhelmed” doesn’t even begin to describe how I felt. I was emotionally and physically exhausted. All I really heard after the word “cancer” was the “wah wah wah” of the adult characters speaking in a Peanuts cartoon.
Thankfully, my gynecologist referred me to UT MD Anderson for my cervical cancer treatment. They really protected and guided me when I needed them.
Trusting my care team to determine the best cervical cancer treatment
My sister Angela was seven years younger than me. I did her hair, fixed her lunch and got her on the school bus when we were growing up. So, when she died, it almost felt like I was losing my own child. Helping her through the last two weeks of her life left me emotionally spent.
I was physically drained from unexpected breakthrough bleeding before my diagnosis, too. All the while, I was caring for three young children, marketing our current home, purchasing a new home and getting ready to move to another state.
Normally, I am a very high-energy person. I run marathons and am super active. But I fully leaned into my dedicated husband to tie up every loose end and accepted support for our everyday needs.
I didn’t have the capacity to discern the multiple options being presented. So, when it came time to figure out my cervical cancer treatment, I put my faith in God. I looked at gynecologic surgical oncologist Dr. Michael Bevers and said, “I am a mother, and I need you to fix it.”
He heard me. And, that’s exactly what he did.
Straightforward guidance was just what I needed
The pathology report from a biopsy showed I had both poorly differentiated adenocarcinoma and a large-cell neuroendocrine cervical cancer. Both types of cancer were present in the small growth on my cervix.
To treat them, Dr. Bevers recommended a radical hysterectomy, followed by five weeks of chemoradiation and a course of brachytherapy under radiation oncologist Dr. Anuja Jhingran that overlapped with six rounds of chemotherapy. He said, “Look, if we can get out ahead of this thing, I really think you stand a good chance of living a long, healthy life.”
I appreciated Dr. Bevers’ clear and straightforward approach. It was exactly what I needed — not a bunch of different alternatives to consider and analyze myself.
Cervical cancer treatment from people who truly cared about me
I didn’t have the bandwidth to question anything. But I trusted Dr. Bevers’ expertise 100%. So, I did everything he said. I started my cancer treatment in November 2011 and finished everything up by February 2012. By God’s grace, I’ve shown no evidence of disease since then.
Going from non-stop to full stop brings immeasurable anxiety. Dr. Bevers and his staff were incredibly kind and understanding. He and Dr. Jhingran worked very closely together to help me balance everything, so I could keep caring for my kids while my husband was 1,000 miles away.
Various doctors, nurses and other care team members guided me on how to navigate the unrelenting nausea and intestinal sensitivities I experienced. It was a fully integrated team effort to ensure I could get the nourishment I needed to keep going.
I will always be grateful to Dr. Bevers’ APRN, Misty White. She is the most caring, compassionate and encouraging person I interacted with during my treatment. There were also many other staff members who made sure I didn’t feel alone. Small gestures, kind words and simply showing up make a big difference to someone who is at their lowest point.
My kids are now 17, 19 and 20. I am active, healthy and cancer-free. I feel really fortunate to have been treated by people who truly cared about me and really listened when I told them what I needed. In return, they gave me clear, reliable guidance I could trust.
Request an appointment at UT MD Anderson online or call 1-877-632-6789.