Treatment choices for cervical cancer

The choice of treatment and the long-term outcome (prognosis) of women with cervical cancer depends on the stage of the cancer. Your age, overall health, and quality of life must also be considered. Research studies are ongoing to determine the best treatment choices or combination of treatments that increase survival rates without adversely impacting your quality of life. The most common treatment choices are outlined in the following table.1

Treatment choices for cervical cancer based on stage
Stage (or staging classification) Treatment choices

0

This stage of cervical cancer is called carcinoma in situ, meaning the cancer cells are on the surface of the cervix and do not invade deeper cell layers of the cervix. Since this stage is not invasive, there is no risk of the cancer spreading (metastasizing) to other tissues.

(TisN0M0)

To be sure the cancer cells have not spread beyond the surface of the cervix, cervical biopsy is done before any treatment.

For women who wish to preserve the ability to have children:

For women who do not wish to preserve the ability to have children:

IA

(T1a1N0M0, T1a2N0M0)

For women who wish to preserve the ability to have children:

  • Conization may be an option for squamous cell cancer that extends less than 3 mm into deeper tissues (stromal invasion) and does not involve the blood vessels or lymphatic system.

For women who do not wish to preserve the ability to have children:

  • Total hysterectomy for cancer that extends less than 3 mm into deeper tissues (stromal invasion) and does not involve the blood vessels or lymphatic system
  • Radical hysterectomy and pelvic lymph node biopsy for cancer that extends between 3 mm and 5 mm deep
  • Radiation implants in the vaginal cavity for women who cannot have surgery

IB, IIA

(T1b1N0M0, T1b2N0M0, T2aN0M0)

Radiation , using both an external beam of radiation to the pelvis and implants in the vaginal cavity

Radical hysterectomy and bilateral pelvic lymph node removal

Radical hysterectomy and bilateral pelvic lymph node removal followed by radiation and chemotherapy with cisplatin or cisplatin and fluorouracil (chemoradiation)

Radiation and chemotherapy with cisplatin or cisplatin and fluorouracil

IIB, IIIA, IIIB, IVA

(T2bN0M0; T3aN0M0; T1N1M0; T2N1M0; T3aN1M0; T3b, any N, M0; T4, any N, M0)

Radiation , using both an external beam of radiation to the pelvis and implants in the vaginal cavity and chemotherapy with cisplatin or cisplatin and fluorouracil (chemoradiation)

Stage IVA may also be treated with extensive pelvic surgery (pelvic exenteration) if cancer is contained in the pelvis.2

IVB

(any T, any N, M1)

Palliative chemotherapy or radiation therapy

Clinical trials

Recurrent

Radiation and chemotherapy

Palliative chemotherapy or radiation therapy

Clinical trials

Cervical cancer that has come back can sometimes be treated with extensive pelvic surgery (pelvic exenteration) if cancer is contained in the pelvis.3

Studies show that chemotherapy given at the same time as radiation treatment (chemoradiation) improves survival rates in stages IIB, IIIA, IIIB and IVA cervical cancer without significantly increasing the side effects of either treatment. Chemoradiation may also improve survival rates in stages IB and IIA for women with large tumors.4, 5

Some women with advanced-stage disease that is not curable may choose not to have cancer treatment because the time, costs, and side effects of treatment may be greater than the benefits. Making the decision about when to stop cancer treatment aimed at prolonging life and shift the focus to best supportive care can be difficult. For more information, see the topics Care at the End of Life and Hospice Care.

Citations

  1. National Cancer Institute (2008). Cervical Cancer (PDQ): Treatment—Health Professional Version. Available online: http://www.cancer.gov/cancertopics/pdq/treatment/cervical/healthprofessional.
  2. Janicek MF, Averette HE. (2001). Cervical cancer: Prevention, diagnosis, and therapeutics. CA, A Cancer Journal for Clinicians, 51: 92–114.
  3. Waggoner SE (2003). Cervical cancer. Lancet, 361: 2217–2225.
  4. Thigpen T (2003). The role of chemotherapy in the management of carcinoma of the cervix. Cancer Journal, 9(5): 425–432.
  5. Eifel PJ, et al. (2004). Pelvic irradiation with concurrent chemotherapy versus pelvic and para-aortic irradiation for high-risk cervical cancer: An update of Radiation Therapy Oncology Group Trial (RTOG) 90-01. Journal of Clinical Oncology, 22(5): 872–880.

Last Updated: September 5, 2008

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