Cervical Cancer Treatment

Introduction

About the Cervix

Cervical cancer starts in the cervix, which is the lower, narrow part of the uterus. The uterus holds the growing fetus during pregnancy. The cervix connects the lower part of the uterus to the vagina and, with the vagina, forms the birth canal.

About Abnormal Cells in the Cervix that can become Cancer

Cervical cancer begins when healthy cells on the surface of the cervix change or get infected with human papillomavirus (HPV) and grow out of control, forming a mass called a tumor. Long-term infection of HPV on the cervix can result in cancer, leading to a mass or tumor on the cervix.

At first, the changes in a cell are abnormal, not cancerous, and are sometimes called “atypical cells.” Some of the atypical cells go away without treatment, but others can become cancerous.

Treatment of a lesion, which is a precancerous area, depends on the following factors:

  • Size of the lesion and the type of changes that have occurred in the cells
  • The desire to have children in the future
  • Age
  • General health
  • Preferences of the patient and the doctor

If the precancerous cells change into cancer cells and spread deeper into the cervix or to other tissues and organs, then the disease is called cervical cancer or invasive cervical cancer.

Risk Factors

The following factors may raise a person’s risk of developing cervical cancer:

  • Human papillomavirus (HPV) infection.The most important risk factor for cervical cancer is infection with HPV.
    Starting to have sex at an earlier age or having multiple sexual partners puts a person at higher risk of being infected with high-risk HPV types.
  • Immune system deficiency. 
  • Herpes
  • Smoking. Women who smoke are about twice as likely to develop cervical cancer as women who do not smoke.
  • Age. People younger than 20 years old rarely develop cervical cancer. The risk goes up between the late teens and mid-30s. Women past this age group remain at risk and need to have regular cervical cancer screenings, which include a Pap test and/or an HPV test.
  • Socioeconomic factors. Cervical cancer is more common among groups of women who are less likely to have access to screening for cervical cancer.
  • Oral contraceptives. Some research studies suggest that oral contraceptives, which are birth control pills, may be associated with an increased risk of cervical cancer and may be associated with higher-risk sexual behaviour.
  • Exposure to diethylstilbestrol (DES). Women whose mothers were given this drug during pregnancy to prevent miscarriage have an increased risk of developing a rare type of cancer of the cervix or vagina

Screening and Prevention

Prevention

Cervical cancer can often be prevented by having regular screenings with Pap tests and HPV tests to find any precancers and treat them. It can also be prevented by receiving the HPV vaccine.

Additional actions people can take to help prevent cervical cancer include:

  • Delaying first sexual intercourse until the late teens or older
  • Limiting the number of sex partners
  • Practicing safe sex by using condoms and dental dams
  • Avoiding sexual intercourse with people who have had many partners
  • Avoiding sexual intercourse with people who are infected with genital warts or who show other symptoms
  • Quitting smoking

Screening information for cervical cancer

The following tests and procedures may be used to screen for cervical cancer:

  1. HPV test: This test is done on a sample of cells removed from the cervix, the same sample used for the Pap test. This sample is tested for the strains of HPV most commonly linked to cervical cancer.
  2. Pap test: The Pap test has been the most common test for early changes in cells that can lead to cervical cancer.

Visual inspection with acetic acid (VIA). VIA is a screening test that can be done with a few tools and the naked eye.

Symptoms and Signs

Precancer often does not cause any signs or symptoms. Symptoms do typically appear with early-stage cervical cancer.

With advanced cancer or cancer that has spread to other parts of the body, the symptoms may be more severe depending on the tissues and organs to which the disease has spread.

Any of the following could be signs or symptoms of cervical cancer:

  • Blood spots or light bleeding between or following periods
  • Menstrual bleeding that is longer and heavier than usual
  • Bleeding after intercourse, douching, or a pelvic examination
  • Increased vaginal discharge
  • Pain during sexual intercourse
  • Bleeding after menopause
  • Unexplained, persistent pelvic and/or back pain

Treatment

Surgery

  • The use of the same procedure as a cone biopsy to remove all of the abnormal tissue.
  • The use of an electrical current passed through a thin wire hook. The hook removes the tissue.
  • The removal of the uterus and cervix. Hysterectomy can be either simple or radical.
  • Bilateral salpingo-oophorectomy. If needed, this surgery is the removal of both fallopian tubes and both ovaries.
  • Radical trachelectomy.A surgical procedure in which the cervix is removed, but the uterus is left intact.
  • The removal of the uterus, vagina, lower colon, rectum, or bladder if cervical cancer has spread to these organs after radiation therapy.

Radiation therapy

The most common type of radiation treatment is called external-beam radiation therapy, which is radiation given from a machine outside the body. When radiation treatment is given using implants, it is called internal radiation therapy or brachytherapy.

For early stages of cervical cancer, a combination of radiation therapy and low-dose weekly chemotherapy is often used. The goal of radiation therapy combined with chemotherapy is to increase the effectiveness of the radiation treatment.

Therapies using medication

Common ways to give systemic therapies include an intravenous (IV) tube placed into a vein using a needle or in a pill or capsule that is swallowed (orally).

The types of systemic therapies used for cervical cancer include:

  • Chemotherapy
  • Targeted therapy
  • Immunotherapy

Treatment options by stage

Radiation therapy alone or surgery is generally used for an early-stage tumor. These treatments have been shown to be equally effective at treating early-stage cervical cancer.

Chemoradiation (a combination of chemotherapy and radiation therapy) is generally used for women with a larger tumor, an advanced-stage tumor found only in the pelvis, or if the lymph nodes have cancer cells.

Metastatic cervical cancer

If cancer spreads to another part in the body from where it started, doctors call it metastatic cancer.

Chemotherapy, immunotherapy, and surgery may be used to treat or remove newly affected areas in both the pelvic area and other parts of the body. Palliative care will also be important to help relieve symptoms and side effects, especially to relieve pain and other side effects from radiation therapy.