Cervical cancer Cervical cancer treatment is typically successful if you’re diagnosed in the early stages. Survival rates are very high. Pap smears have led to increased detection and treatment of precancerous cellular changes. This has reduced the incidence of cervical cancer in the Western world. The type of treatment used for cervical cancer depends on the stage at diagnosis. More advanced cancers usually require a combination of treatments. Standard treatments include: surgery

radiation therapy

chemotherapy

other medications

Treatment for precancerous cervical lesions There are several ways to treat precancerous cells found in your cervix: Cryotherapy Cryotherapy involves the destruction of abnormal cervical tissue through freezing. The procedure only takes a few minutes and is performed using local anesthesia. Loop electrosurgical excision procedure (LEEP) LEEP uses electricity that’s run through a wire loop to remove abnormal cervical tissue. Like cryotherapy, LEEP only takes a few minutes and can be performed at your doctor’s office with local anesthesia. Laser ablation Lasers may also be used to destroy abnormal or precancerous cells. Laser therapy uses heat to destroy the cells. This procedure is performed in a hospital, and local or general anesthesia may be needed, depending on the circumstances. Cold knife conization This procedure uses a scalpel to remove abnormal cervical tissue. Like laser ablation, it’s performed in a hospital setting, and general anesthesia may be required.

Surgery for cervical cancer Surgery for cervical cancer aims to remove all of the visible cancer tissue. Sometimes, nearby lymph nodes or other tissues are also removed, where the cancer has spread from the cervix. Your doctor may recommend surgery based on several factors. This includes how advanced your cancer is, whether you want to have children, and your overall health. Cone biopsy During a cone biopsy, a cone-shaped section of the cervix is removed. It’s also called cone excision or cervical conization. It can be used to remove precancerous or cancerous cells. The cone shape of the biopsy maximizes the amount of tissue that’s removed at the surface. Less tissue is removed from below the surface. Cone biopsies can be performed using multiple techniques, including: loop electrosurgical excision (LEEP)

laser surgery

cold knife conization After a cone biopsy, the abnormal cells are sent to a specialist for analysis. The procedure can be both a diagnostic technique and a treatment. When there’s no cancer at the edge of the cone-shaped section that was removed, further treatment may not be necessary. Hysterectomy Hysterectomy is the surgical removal of the uterus and cervix. It greatly reduces the risk of recurrence when compared to more localized surgery. However, a woman can’t have children after a hysterectomy. There are a few different ways to perform a hysterectomy: Abdominal hysterectomy removes the uterus through an abdominal incision.

Vaginal hysterectomy removes the uterus through the vagina.

Laparoscopic hysterectomy uses specialized instruments to remove the uterus through several small incisions in either the abdomen or vagina.

Robotic surgery uses a robotic arm guided by a doctor to remove the uterus through small incisions in the abdomen. A radical hysterectomy is sometimes needed. It’s more extensive than a standard hysterectomy. It removes the upper part of the vagina. It also removes other tissues near the uterus, such as the fallopian tubes and the ovaries. In some cases, the pelvic lymph nodes are removed as well. This is called a pelvic lymph node dissection. Trachelectomy This surgery is an alternative to a hysterectomy. The cervix and upper part of the vagina are removed. The uterus and ovaries are left in place. An artificial opening is used to connect the uterus to the vagina. Trachelectomies allow women to maintain the ability to have children. However, pregnancies after trachelectomy are classified as high-risk, as there’s an increased rate of miscarriage. Pelvic exenteration This surgery is only used if cancer has spread. It’s usually reserved for more advanced cases. Exenteration removes the: uterus

pelvic lymph nodes

bladder

vagina

rectum

part of the colon

Radiation treatment for cervical cancer Radiation uses high-energy beams to destroy cancer cells. Traditional radiation treatment employs a machine outside the body to deliver an external beam that’s aimed at the cancerous site. Radiation can also be delivered internally using a procedure called brachytherapy. An implant containing radioactive material is placed in the uterus or vagina. It’s left in place for a set amount of time before being removed. The amount of time it’s left in can depend on the radiation dose. Radiation can have significant side effects. Most of these go away once treatment is completed. However, vaginal narrowing and damage to the ovaries can be permanent.

Chemotherapy treatment for cervical cancer Chemotherapy uses drugs to kill cancer cells. Drugs may be administered before surgery to shrink tumors. They can also be used afterward to get rid of remaining microscopic cancerous cells. In some cases, chemotherapy combined with radiation is given as the preferred treatment for cervical cancer. This is called concurrent chemoradiation. Chemotherapy can be used to treat cervical cancer that has spread from the cervix to other organs and tissues. Sometimes, a combination of chemotherapy drugs is given. Chemotherapy drugs can cause significant side effects, but these usually go away once treatment is over. According to the American Cancer Society, the chemotherapy drugs most commonly used for treating cervical cancer include: topotecan (Hycamtin)

cisplatin (Platinol)

paclitaxel (Taxol)

gemcitabine (Gemzar)

carboplatin (Paraplatin)

Medications for cervical cancer In addition to chemotherapy drugs, other medications are becoming available to treat cervical cancer. These drugs fall under two different types of therapy: targeted therapy and immunotherapy. Targeted therapy drugs are able to specifically identify and attack cancer cells. Often, targeted therapy drugs are antibodies that are made in a laboratory. Bevacizumab (Avastin, Mvasi) is a antibody that’s FDA-approved to treat cervical cancer. It works by interfering with the blood vessels that help cancerous cells to develop. Bevacizumab is used to treat recurring or metastatic cervical cancer. Immunotherapy drugs use your immune system to help combat cancer cells. A common type of immunotherapy is called an immune checkpoint inhibitor. These drugs attach to a specific protein on cancer cells, allowing immune cells to find and kill them. Pembrolizumab (Keytruda) is an immune checkpoint inhibitor that’s been FDA-approved to treat cervical cancer. It’s used when cervical cancer continues to progress either during or after chemotherapy.

Preserving fertility in women with cervical cancer Many cervical cancer treatments can make it difficult or impossible for a woman to get pregnant after treatment is over. Researchers are developing new options for women who’ve had treatment for cervical cancer to preserve fertility and sexual functioning. Oocytes are at risk of damage from radiation therapy or chemotherapy. However, they can be harvested and frozen before treatment. This allows a woman to get pregnant after treatment using her own eggs. In vitro fertilization is also an option. The women’s eggs are harvested and fertilized with sperm before treatment begins and then the embryos can be frozen and used for pregnancy after the treatment is over. One option that’s still being studied is something called a cortical strip . In this technique, ovarian tissue is transplanted into the body. It continues to produce hormones in the new location, and in some cases, women continue to ovulate.

Preventing cervical cancer There are things that you can do to help prevent cervical cancer. The first thing is to get regular cervical cancer screenings. Screenings can either detect changes in the cells of the cervix (Pap smear) or detect the HPV virus, an important risk factor for cervical cancer. The U.S. Preventive Services Task Force has recently released new recommendations on how often women should be screened for cervical cancer. The timing and type of screening recommended depend on your age: Under age 21: Cervical cancer screenings aren’t recommended. Between ages 21 and 29: Cervical cancer screening via Pap smear should be performed every three years. Between ages 30 and 65: There are three options for cervical cancer screening within this age bracket. They include: Pap smear every three years

high-risk HPV (hrHPV) testing every five years

both Pap smear and hrHPV testing every five years Over age 65: Cervical cancer screenings aren’t recommended as long as you’ve received adequate prior screenings. A vaccine is also available to prevent infection with the types of HPV most likely to cause cancer. Currently, it’s recommended for boys and girls aged 11 and 12. However, it’s also recommended to men through age 21 and women through age 45 that haven’t yet received it. If you’re within this age range and would like to get vaccinated, you should talk to your doctor. There are also a few lifestyle changes you can make to help prevent cervical cancer. Practicing safer sex and quitting smoking can also reduce your risk. If you currently smoke, talk to your doctor about a smoking cessation program to help you quit.