Cervical Cancer Treatment

We may perform one or more of the following tests to determine if you have cervical cancer and if it has spread:

• Biopsy: A biopsy for cervical cancer involves removing a small amount of cervical tissue to examine under a microscope. These include:
  • Endocervical curettage: Uses a curette, or a soft brush, to scrape a tissue sample from the opening of the cervix.
  • LEEP (loop electro-surgical excision procedure): Uses a small wire that is heated with low-voltage, high-frequency radio waves to remove cervical cells.
  • Punch biopsy: Uses biopsy forceps to remove a tissue sample from the cervix.
• Cone biopsy: Removes a cone-shaped tissue sample to determine if abnormal cells appear in the tissue beneath the surface of the cervix. This procedure may involve one of the following methods:
  • Knife cone biopsy: Uses a scalpel in a surgical suite with local or general anesthesia.
  • Laser: Uses a carbon dioxide laser to remove tissue.
  • LEEP cone biopsy: Uses LEEP in the physician’s office under local anesthesia.
• Colposcopy: Uses a colposcope, a type of microscope, to examine abnormal tissue on the cervix, vagina or vulva.

A pathologist will review the abnormal cells under a microscope to see if they are slow-growing or have invaded other tissue. If the cells are slow-growing and not likely to spread, no further treatment may be necessary. Be sure to continue getting regular pelvic exams and Pap tests.

If we find cancer, treatment will depend on your:

• Cancer stage
• Cancer grade (how likely it is to grow quickly or come back)
• Age
• General health

If we think your cervical cancer has spread, we may recommend a cystoscopy, proctoscopy or both. These tests allow us to view the inside of the bladder, anus, rectum and lower colon.

Imaging tests we may use include:

• Chest X-ray
• CT scans
• MRI scans
• PET scans
• PET/CT (combined PET-CT imaging)

Our gynecologic oncologists will perform surgery to remove abnormal tissue in or near the cervix. If the cancer is only on the surface of the cervix, the surgeon may remove the cells using techniques similar to those used to treat precancerous lesions.

If the disease has invaded deeper layers of the cervix but has not spread beyond the cervix, the surgeon may remove the tumor but leave the uterus and ovaries. This is called a radical trachelectomy. The procedure is done to preserve fertility in young women with early cervical cancer.

In other situations, it may be necessary to remove the uterus, including the cervix, and sometimes the ovaries and fallopian tubes. This is called a radical hysterectomy. The surgeon may also remove lymph nodes near the uterus to learn whether the cancer has spread to other organs. In some instances, the ovaries and fallopian tubes may not need to be removed.

Whenever possible, our gynecologic oncologists use minimally invasive robotic surgery techniques. One such procedure is a robotic retroperitoneal lymph node dissection. This minimally invasive surgical procedure removes lymph nodes to determine if cancer has spread.

Other surgical procedures we perform include:

• Conization
  Conization involves removing a cone-shaped piece of tissue from the cervix. We do this using a surgical or laser knife or with a thin wire heated by electricity (the loop electrosurgical, LEEP or LEETZ procedure). After the procedure, we examine the tissue with a microscope. If the margins of the tissue contain cancer or precancerous cells, some cancer may have been left behind, so we determine necessary further treatment.
• Trachelectomy
  We also perform radical trachelectomy, which allows women being treated for cervical cancer to preserve their fertility. The surgery is done either through the vagina or the abdomen and is sometimes done laparoscopically.
  
  During the procedure, we remove the cervix and the upper part of the vagina but not the body of the uterus. We then place a “purse-string” stitch to act as an artificial cervical opening inside the uterine cavity. We also remove nearby lymph nodes using laparoscopy.
  
  After trachelectomy, some women can carry a pregnancy to term and deliver a healthy baby by cesarean section. Oftentimes, women who have had this procedure have a higher risk of miscarriage.

Most often, treatment for invasive cervical cancer involves surgery and/or radiation therapy.

Radiation therapy, also called radiotherapy, is a precise, local treatment of high-energy rays that can be delivered externally or internally. External radiation often involves several weeks of treatment. It is a highly targeted and effective way to destroy cancer cells in the cervix that may linger after surgery. Radiation therapy and its side effects are limited to the treated area. Your care team’s radiation oncologist will oversee your radiation treatments.

For internal or implant radiation, a capsule containing radioactive material is placed directly inside the cervix. The implant emits cancer-killing radiation close to the tumor while sparing healthy tissue around it. The implant can emit low-dose or high-dose radiation, but we generally use HDR. Implants remain in place for a specified length of time.

We use the most advanced technology and techniques to deliver radiation to your cervical cancer, while avoiding exposure to healthy tissues. Your radiation oncologist will work closely with you and others on the team to determine the best course of radiation treatment for your personal needs.

Cervical cancer may also be treated with chemotherapy, a medication that stops or slows the growth of cancer cells throughout the body. Your gynecologic oncologist may use one drug or a combination of chemotherapy medications to supplement the cancer-killing effects of the radiation.