Cervical Cancer Treatment
Contents:
- Treatment by stage
- Follow up
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:
