What are the Treatments for Cervical Cancer?

If you were diagnosed with cervical cancer, just know that it’s usually very treatable -- especially if your doctor caught it early. If so, there are several options to treat it, relieve your symptoms, and help you live longer.

First, your doctor will have to determine the cancer’s stage, meaning its size, and whether it has spread to other parts of the body. She will choose a treatment that's most likely to shrink the cancer based on the stage and what type of cervical cancer it is.

She will also consider your age and whether you want to maintain your ability to have children.

Cervical cancer treatments include:

Take time to review all your options. Make sure you understand how each treatment works. If you're not sure about something, ask questions. You can also get a second opinion from another doctor.

Surgery

Surgery is the main treatment for cervical cancers. Sometimes you'll get chemotherapy or radiation to shrink the tumor before surgery, or to kill cancer cells that remain afterward. The type of surgery you have depends on how large the cancer has grown and whether it has spread.

Some types of cervical cancer surgery can affect your ability to have children. Talk to your doctor about the risks before you decide on a procedure.

Conization. This surgery can treat very small cervical cancers that haven't spread. Your surgeon removes a cone-shaped area of abnormal cells from your cervix. Conization is performed with a knife, laser, or a thin, heated wire loop. After conization, you should still be able to have children.

Total hysterectomy. This surgery removes your uterus and cervix. It is the main treatment for small cancers that haven't spread outside your cervix.

This procedure can be done through your:

  • Belly (abdominal hysterectomy)
  • Belly, through very small holes (laparoscopic hysterectomy)

During the procedure, you surgeon might also remove your fallopian tubes and ovaries, as well as the lymph nodes in your pelvis to see if the cancer has spread.

You’ll have to stay in the hospital for 1 to 5 days after a hysterectomy. Recovery time is faster for laparoscopic surgery than abdominal surgery.

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You won’t be able to bear children after a hysterectomy. If you still want children and opt to have this procedure, talk to your doctor about options such as freezing your eggs or embryos.

Modified radical hysterectomy. This surgery is usually for early stage cervical cancer that has not spread outside the cervix. During a radical hysterectomy, your doctor removes the uterus and cervix, along with ligaments that hold the uterus in place, and the top part of the vagina next to the cervix. Pelvic lymph nodes may also be removed.

The surgery is usually done with one large cut in the abdomen, or is laparoscopic-assisted through the vagina.

Your hospital stay after a radical hysterectomy is usually between 5 and 7 days. You could have trouble going to the bathroom after surgery, and you might need a temporary tube called a catheter to urinate. 

Trachelectomy. This procedure, also known as a cervicectomy, is an option if you have early-stage cervical cancer and still want to have children. It removes the cervix and top of the vagina, but leaves most of the uterus.This can be done through an open cut or laparoscopically in the abdomen or can be done vaginally. If you get pregnant you'll have to deliver by C-section.

Pelvic exenteration. This surgery is used when cervical cancer comes back and spreads outside the cervix. Your surgeon will remove your cervix, uterus, and nearby lymph nodes. Other organs, like the bladder, vagina, rectum, and part of the colon might also be removed, depending on where your cancer has spread. If you have your bladder or rectum removed, the surgeon will create new pathways to remove urine and waste from your body.

Radiation

Radiation uses high-energy X-rays to kill cancer cells and stop their growth. You might get radiation before or after surgery, or if your cancer has spread beyond your cervix.

You can get radiation treatments in two ways.

Brachytherapy. You get radiation through a small device placed inside your body, near your cervix. This is done for early-stage cervical cancer. It can be given in the hospital or sometimes at home.

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External beam radiation therapy. EBRT is often combined with brachytherapy to keep advanced cervical cancer from coming back. The radiation is given from a machine outside your body in short bursts once a day, 5 days a week, for 5 to 6 weeks.

Side effects of radiation include:

These side effects will go away once you finish treatment.

Chemotherapy

In “chemo,” drugs are used to kill or slow the growth of cervical cancer cells. You'll usually get chemo through an IV.

For cervical cancer, doctors often give chemo with radiation, called chemoradiation. Adding chemo makes the radiation work better. You might also get chemotherapy if your cancer has spread.

The side effects from chemotherapy depend on which drugs you take, but can include:

  • Changes in your periods
  • Fatigue
  • Hair loss
  • Increased risk for infection
  • Loss of appetite
  • Mouth sores
  • Nausea and vomiting

Getting both radiation and chemo can increase the number of side effects you have. Many of these will go away once you stop treatment. Some can last for a long time, or even permanently. Ask your doctor for ways to relieve your side effects.

Targeted Therapy

Targeted therapy uses drugs that kill cancer cells but spare healthy cells. For example, bevacizumab (Avastin) is a drug that stops new blood vessels from forming. This can slow slow down tumor growth in advanced cervical cancer, because tumors need new blood vessels for nourishment. Doctors often use targeted therapy with chemotherapy. Side effects may include high blood pressure, fatigue, loss of appetite, and blood clots or bleeding.

Immunotherapy

Immunotherapy is the use of medicines to stimulate a person’s own immune system to recognize and destroy cancer cells more effectively. Immunotherapy can be used to treat cervical cancer that has spread or come back (recurred).

Pembrolizumab (Keytruda), an immunotherapy drug given in the vein every 3 weeks, targets PD-1, a protein on immune system cells called T cells that normally helps keep these cells from attacking other cells in the body. By blocking PD-1, these drugs boost the immune response against cancer cells. This can shrink some tumors or slow their growth.

Pembrolizumab can be used in women with certain types of cervical cancer whose cancer starts growing again after chemotherapy or that has spread to other parts of the body.  

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Clinical Trials

If you've tried a few treatments and they didn't work, or the cancer has spread, ask your doctor about a clinical trial. These test new treatments to see if they’re safe and if they work. They’re often ways for people to try new medicines or therapies that aren’t available to everyone. Your doctor can tell you if one of these trials might be a good fit for you.

WebMD Medical Reference Reviewed by Lisa Bernstein, MD on October 21, 2018

Sources

SOURCES:

American Cancer Society: "Chemotherapy for cervical cancer;" "How is cervical cancer treated?;" "Radiation therapy for cervical cancer;" "Surgery for Cervical Cancer;" and "Targeted therapy for cervical cancer."

American Society of Clinical Oncology: "Cervical Cancer -- Treatment Options."

Dana-Farber Cancer Institute: "Cervical Cancer."

National Cancer Institute: "Cervical Cancer Treatment (PDQ) -- Patient Version" and "New Immunotherapy Option Approved for Cervical Cancer, Rare Lymphoma."

UpToDate: "Patient education: Cervical cancer treatment; early stage cancer (Beyond the Basics)."

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