Treatment of cervical cancer by stage

January 15, 2020 | by Katarina Petras, MD

Cervical cancer originates in the cells of the cervix, which is the lower part of the uterus that connects to the upper vagina.

The majority of cervical cancer is caused by the human papilloma virus (HPV), which is transmitted sexually. Most HPV infections will go away on their own, but if it persists, it can cause changes in the cells of the cervix that may progress into cervical cancer.

Early stage cervical cancer usually doesn’t have symptoms, so prevention and early detection are key. The HPV vaccine can help protect patients against common strains of HPV that are associated with cervical cancer. Also, routine PAP tests help doctors monitor changes in cervical cells that might lead to cancer and HPV tests look for strains of the virus that can cause these cell changes.

As the disease advances, symptoms of cervical cancer may include vaginal bleeding after intercourse (between menstrual cycles or after menopause), watery/bloody/malodorous vaginal discharge, pelvic pain or pain during intercourse.

Treatment of cervical cancer depends on the size of the tumor and how far it has spread. A woman’s desire to have children in the future also plays an important role in treatment decisions.

Early stage

Early stage cervical cancer hasn’t yet spread beyond the cervix to other parts of the body. The earliest stage of disease can be treated with surgery alone. Examples of early stage cervical cancer surgeries include: cone biopsy, trachelectomy (a fertility-sparing surgery) or hysterectomy.

Cervical cancer research has revealed that minimally invasive surgical techniques are associated with worse outcomes than standard open surgical approaches, so gynecologic oncologists are moving away from minimally invasive surgeries.

Doctors can help reduce the risk of complications like lymphedema by performing a sentinel lymph node biopsy during surgery, which involves removing just a few lymph nodes that have the highest probability of being cancerous.

Advanced stage

When the cancer has spread beyond the cervix, surgery may not be an option. More advanced cervical cancer is best treated with a combination of chemotherapy and radiation therapy.

Radiation therapy is commonly delivered using a specialized form of internal radiation therapy called brachytherapy, which allows doctors to deliver high radiation doses from implants placed close to, or inside, the cervical tumor. This may also be combined with external radiation treatments.

Radiotherapy techniques are advancing and allowing us to decrease both short-term and long-term side effects. This is done with the use of MRI-guided treatment planning for brachytherapy and daily cone-beam imaging for external radiotherapy. 

Additional chemotherapy after concurrent chemo-radiation therapy has been shown to improve survival outcomes for women with advanced cervical cancer.

There are ongoing investigations into the usefulness of immunotherapy in cervical cancer. Also, new types of treatment for cervical cancer are currently being tested in clinical trials.

Every cancer diagnosis is unique. It’s important to consult your healthcare team to determine what treatment options are right for you.

Learn more about comprehensive cancer care at Edward-Elmhurst Health.

Related blog:

What’s new in cervical cancer prevention?

Fact or fiction: 10 misconceptions about the HPV vaccine

My Pap test came back abnormal. Should I be worried?


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