|How Is Cervical Cancer Treated?
The type of treatment used will depend mainly on the staging of the cancer, the woman's age, overall health and any wish to save her ovarian function. The 3 most common types of treatment for cervical cancer are surgery, radiation therapy and chemo (see our chemotherapy guide).
What Are The Chances of Survival?
Cervical cancer survival rates are nearly 100 percent in stages 0 to IA (see cervical cancer stages) and this falls to as low as 5 percent for stage IV, the most invasive stage. For this reason, early detection is critical and this is best achieved by having a regular Pap test.
Surgery For Cervical Cancer
Surgery is most effectively used for small tumors. If a tumor is larger then radiation will probably be used instead as it offers fewer problems than an extensive surgical procedure. Surgery is generally only considered an option for women who are in otherwise physical good health, so women over 70 or those with heart or lung problems are more likely to be offered radiation. In general cancer surgery is performed in stages O to IIA of cervical cancer, while those in stages IIB and III are more likely to receive radiation therapy. See also, Cancer surgery recovery.
Surgery Types For Treating Cervix Cancer
This is only used to treat the pre-cancer stage 0 (CIN) and is not used to treat invasive cancer. A laser beam is directed through the vagina to burn off abnormal cells or remove a small piece of tissue for examination. This is also used for vulva cancer treatment.
Also a method for cervical cancer diagnosis conization (cone-biopsy) is another option for treating early stages of the cancer. It is a good option for women who may not be able to endure surgery or who would like to preserve fertility. It is performed in hospital on an out-patient basis under general anesthesia. A cone shaped piece of tissue is removed from the cervix using a thin wire heated with electricity (LEEP or LEETZ procedure, loop electrosurgical) or laser knife (cold knife cone biopsy). The biopsy can work as a cure by removing the affected cells. It also offers a way to check for further problems. It will be carefully examined under a microscope. If the edges reveal cancer or pre-cancer cells (this is known as positive margins) further treatments will be necessary to ensure that all the cancer is removed. For experimental medical options, see: Cancer clinical trials.
A hysterectomy is the surgical removal of the uterus which includes the cervix. It usually leaves the ovaries and fallopian tubes in place unless there is another other reason to remove them. It is used to treat some stage 0 cancer cases (carcinoma and adenocarcinoma in situ) if cancer were found at the edge of a cone biopsy. It is also used to treat stage 1A1 of cervical cancer. The procedure is carried out under either general or regional (epidural) anesthesia and can be performed in several ways. If the uterus is removed via a surgical incision in the abdomen, this is known as an abdominal hysterectomy. The uterus can also be removed through the vagina (vaginal hysterectomy) or using laparoscopy (laparoscopic hysterectomy, or da Vinci surgery). A hospital stay for a vaginal or laparoscopic hysterectomy is normally 1-2 days and an abdominal hysterectomy is 3 to 5 days. Complete recovery takes about 6 weeks. Any type of hysterectomy leaves the woman infertile. See also, cervical cancer in pregnancy.
If there is evidence of deeper spread of cancer a radical hysterectomy may be considered. It is a form of treatment for stages IA2, IB, and less commonly IIA of cervical cancer, particularly in younger women. A radical hysterectomy involves the removal of the uterus, upper third of the vagina, supporting ligaments and tissues and pelvic lymph nodes. Removal of the fallopian tubes and ovaries (salpingo-oophorectomy) may be recommended, particularly if the woman is over 40 and postmenopausal. It should be noted that the cure rates are the same for women who have hysterectomies as those who have radiation. A hospital stay of 5 to 7 days is typical.
A hysterectomy is used to treat most women with stages IA2 and IB cervical cancer. Another procedure called radical trachelectomy allows some of these women to be treated without resulting in loss of fertility. It works by removing the cervix and upper part of the vagina, but leaves the body of the uterus (womb) still in place. One study showed that women who had the procedure had a pregnancy rate of 50 percent after 5 years. The risk of miscarriages is higher than in normal healthy women but at least pregnancy is still possible. Also, the risk of cancer returning is low after the surgery.
This procedure is only used for recurrent cervical cancer. In addition to removing the same organs and tissues as in a radical hysterectomy and pelvic lymph node dissection, the vagina, rectum, bladder and part of the colon may also be removed (depending how far the cancer has spread). If the rectum or part of the colon is removed a colostomy bag will be necessary. If the vagina is removed a new one can be surgically created using intestinal tissue or skin grafts. This is a very serious operation, and 10 percent of women who have the surgery die during or soon after the procedure. Complications of the heart and lungs are most common. The surgery is lengthy and can take up to 7 hours. Despite the risks, it may be some women's only hope of cure - particularly in the instance of cervical cancer recurrence.
Pelvic Lymph Node Dissection
If a surgeon suspects that cervix cancer has spread to the lymph nodes in the pelvis, he may remove some for testing. This procedure is known a lymph node dissection or sampling.
For general information on female cancers, see Cancer Guide.
Early and advanced stages of the disease can be treated with radiation therapy. Radiation can be used alone or in combination with surgery or chemotherapy. It can be administered with a machine (external beam radiation) or given internally by inserting radioactive substances directly into the affected area (brachytherapy). If a machine is used, this treatment usually takes 6 to 7 weeks (5 days a week) and is usually combined with low doses of the chemotherapy drug cisplatin. If brachytherapy is the chosen treatment, radioactive material is inserted in a cylinder in the vagina.
Systemic chemotherapy uses drugs to reduce cancers which may have spread to distant organs (metastasis). Drugs can be injected or taken orally. Those used for treating cervical cancer include cisplatin, topotecan, paclitaxel (Taxol), ifosfamide (Ifos) and 5-fluorouracil (5-FU). Usually chemo is combined with radiation therapy for best effects. To date, chemo has not proven particularly effective in treating cancer which has spread beyond the pelvis. Some studies have reported a 'good response', but not necessarily a lasting one. The cancer is not completely destroyed. While combining chemo and radiation can improve a patient's survival rate their quality of life may be affected because combining therapies seems to cause worse side effects. Increasingly chemo is being used as a palliative measure to help control some of the distressing symptoms of advanced stages of the disease.
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