All stages of cancer of the cervix can be treated. The treatment
depends on the stage of the individual's disease; the type of disease; and
the patient's age and overall medical condition. Three kinds of treatment
may be used either on their own or in combination with others, depending
on the these conditions. Treatments include surgery, radiation
therapy and chemotherapy.
An outline of the treatments generally administered at each stage of
the disease is:
Stage 0
This may be treated by either laser,
local
excision (LLETZ), diathermy,
cone
biopsy or simple
hysterectomy.
Stage I and some early Stage II A
While this may be treated either by surgery or radiotherapy,
surgery is usually recommended. This is especially true in younger
patients, as it has fewer long term implications. The operation is called
a radical
hysterectomy and radical
pelvic lymphadenectomy, and involves removal of the uterus,
cervix, a
small portion of vagina,
the tissue on either side of the cervix (parametrium) and the lymph
glands from along the blood vessels in the pelvis.
Depending on the outcome of this operation, further treatment may be
recommended. Generally, if the tumour
is large or aggressive; near other organs; or if there is tumour in the lymph
nodes, then further treatment will be recommended with radiotherapy
and/or chemotherapy.
The ovaries do not need to be removed unless the tumour is of a special
type called an adenocarcinoma.
In this case it is recommended that the ovaries be removed because there
is a 3-5% risk of the cancer being in one or other of the ovaries. Failure
to remove the ovaries may reduce the likeliness of a cure.
Stage IIA, IIB, IIIA, IIIB
Patients with cervical cancer in any of these stages are treated with radiotherapy.
In an increasing number of patients the use of chemotherapy
is also recommended, as recent studies would suggest that this may result
in an improved prognosis.
Stage IV A
Treatment needs to be very carefully individualised at this stage, as
only some patients can be treated by surgery. Surgery at this stage
involves an exenteration,
which is the removal of the uterus and cervix as described above in radical
hysterectomy, however the affected bladder
or segment of bowel
are also removed. If this sort of surgery is contemplated, then it will be
explained in detail to the patient. If surgery is not appropriate, then
patients are treated with radiotherapy,
with or without chemotherapy.
Stage IV B
Patients with cervical cancer in this stage need to have their
treatment planned carefully on an individual basis. They may be treated
with radiotherapy
or chemotherapy.
Recurrent Cervical Cancer
If the cancer has come back then treatment is available. If the
recurrent cancer is in the centre of the pelvis then surgery may be
possible. This would involve removing the lower bowel
(rectum) &/or bladder
along with the cervix,
uterus and vagina
(an exenteration).
If the cancer is not limited to the centre of the pelvis
then treatment is usually by radiotherapy
&/or chemotherapy.
It is important that patients have proper follow-up after treatment for
cancer of the cervix. Follow-up examination involves taking a brief
history covering the time since the last visit. The usual follow-up
protocol is to be seen:
