Cervical Cancer (cont.)

Medical Author:

Christopher J Ware, MD

Coauthor:

Michelle S Nathan, MD

Medical Editor:

Patrick Taylor, MD, FAAEM

Medical Editor:

Francisco Talavera, PharmD, PhD

Medical Editor:

Jerry R. Balentine, DO, FACEP

Jerry R. Balentine, DO, FACEP

Dr. Balentine received his undergraduate degree from McDaniel College in Westminster, Maryland. He attended medical school at the Philadelphia College of Osteopathic Medicine graduating in1983. He completed his internship at St. Joseph's Hospital in Philadelphia and his Emergency Medicine residency at Lincoln Medical and Mental Health Center in the Bronx, where he served as chief resident.

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Cervical Cancer Medical Treatment

Treatment for precancerous lesions differs from that of invasive cancer.

Precancerous lesions

Choice of treatment for a precancerous lesion of the cervix depends on a number of factors. These factors include whether the lesion is low or high grade, whether you want to have children in the future, your age and general health, and your preference and that of your health care provider.

• If you have a low-grade lesion, you may not need further treatment, especially if the abnormal area was completely removed during biopsy. You should have regular Pap smears and pelvic exams.
  
  
• When a precancerous lesion requires treatment, cryosurgery (freezing), cauterization (burning, also called diathermy), or laser surgery may be used to destroy the abnormal area without harming nearby healthy tissue.
  
  
• Abnormal tissue also can be removed by LEEP or conization.
  
  
• Treatment for precancerous lesions may cause cramping or other pain, bleeding, or a watery vaginal discharge.

In some cases, you may choose to have a hysterectomy for precancerous changes, particularly if abnormal cells are found inside the opening of the cervix. This surgery is more likely to be done if you do not plan to have children in the future.

Diagnostic procedures, such as LEEP and cone biopsy, sometimes may be treatment as well.

• Both of these procedures involve taking away some of the cervical tissue for evaluation.
  
  
• If that evaluation finds that there were indeed abnormal cells but that those abnormal cells did not extend as far as the level where the tissue was cut, only follow-up may be needed.
  
  
• If there is uncertainty about whether all of the precancerous cells have been removed using a LEEP or cone biopsy procedure, then further treatments may be required.

Cryocautery may be used in some cases.

• In this procedure, a steel instrument is cooled to subzero temperatures by immersion in liquid nitrogen or a similar liquid.
  
  
• This ultracooled instrument is then applied to the surface of the cervix.
  
  
• The cells are frozen, and they eventually die and are sloughed off, to be replaced by new cervical cells.

Tissue may also be removed by laser ablation.

• A laser beam is applied to either specific areas of cervical tissue or a whole layer of tissue at the surface of the cervix.
  
  
• The laser destroys these cells, leaving healthy cells in their place.

The success of cryocautery or laser ablation procedures is determined by a follow-up examination and Pap smear.

Invasive cancer

The most widely used treatments for cervical cancer are surgery and radiation therapy. Chemotherapy or biological therapy is sometimes used.

• Treatment for invasive cervical cancer usually involves a team of specialists. The team generally includes a gynecologic oncologist and a radiation oncologist.
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• These doctors may decide to use one treatment method or a combination of methods.
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• You may choose to take part in a clinical trial (research study) to evaluate new treatment methods. Such studies are designed to improve cancer treatment. Participating in a clinical trial has both benefits and risks. See For More Information to find out about clinical trials on the Internet.

Cancerous cells typically invade surrounding tissues.

• If a biopsy shows that cancerous cells have invaded through a layer called the basement membrane, which separates the surface layers of the cervix from other underlying layers, surgery is usually required.
  
  
• The extent of the surgery varies, depending on the stage of the cancer.

Radiation therapy (also called radiotherapy) is also used to fight cervical cancer at some stages.

• Radiation therapy uses high-energy rays to damage cancer cells and stop them from growing.
  
  
• Like surgery, radiation therapy is local therapy; the radiation affects cancer cells only in the treated area.
  
  
• Radiation may be applied externally or internally. Some women receive both kinds.

External radiation comes from a large machine, which aims a beam of radiation at your pelvis.

• External radiation treatments usually are given 5 days a week for 5-6 weeks. At the end of that time, an extra dose of radiation called a "boost" may be applied to the tumor site.
  
  
• Each treatment takes only a few minutes.
  
  
• Because of safety concerns and expense of equipment, radiation therapy generally is offered only at certain large medical centers or hospitals.

Internal or implant radiation comes from a capsule containing radioactive material which is placed directly in the cervix.

• The implant puts cancer-killing rays close to the tumor while sparing most of the healthy tissue around it.
  
  
• It is usually left in place for 1-3 days, and the treatment may be repeated several times over the course of 1-2 weeks.
  
  
• You stay in the hospital while the implants are in place.

Chemotherapy is the use of powerful drugs to kill cancer cells. In cervical cancer, it is used most often when the cancer has spread to other parts of the body. Just one drug or a combination of drugs may be given.

• Anticancer drugs used to treat cervical cancer may be given via an IV line or by mouth.
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• Either way, chemotherapy is systemic treatment, meaning that the drugs flow through the body in the bloodstream. They can kill cancer cells anywhere in the body.
  
  
• Chemotherapy is given in cycles: each cycle comprises a period of intensive treatment followed by a recovery period. Treatment usually consists of several cycles.
  
  
• Most patients have chemotherapy as an outpatient (in an outpatient clinic at the hospital, at the doctor's office, or at home). Depending on which drugs are given and your general health, however, you may need to stay in the hospital during treatment.