ON THIS PAGE: You will learn about the different treatments doctors use for people with this type of cancer. Use the menu to see other pages.
This section tells you the treatments that are the standard of care
for this type of cancer. “Standard of care” means the best treatments
known. When making treatment plan decisions, patients are encouraged to
consider clinical trials as an option. A clinical trial is a research
study that tests a new approach to treatment. Doctors want to learn
whether the new treatment is safe, effective, and possibly better than
the standard treatment. Clinical trials can test a new drug, a new
combination of standard treatments, or new doses of standard drugs or
other treatments. Your doctor can help you consider all your treatment
options. To learn more about clinical trials, see the About Clinical Trials and Latest Research sections.
Treatment overview
In cancer care, different types of doctors often work together to
create a patient’s overall treatment plan that combines different types
of treatments. This is called a multidisciplinary team.
Cancer care teams include a variety of other health care professionals,
such as physician assistants, oncology nurses, social workers,
pharmacists, counselors, dietitians, and others.
Descriptions of the most common treatment options for cervical cancer
are listed below. The treatment of cervical cancer depends on several
factors, including the type and stage of cancer, possible side effects,
and the woman’s preferences and overall health. Your care plan may also
include treatment for symptoms and side effects, an important part of
cancer care. Take time to learn about all of your treatment options and
be sure to ask questions about things that are unclear. Talk with your
doctor about the goals of each treatment and what you can expect while
receiving the treatment. Learn more about making treatment decisions.
Women with cervical cancer may have concerns about if or how their treatment may affect their sexual function and ability to have children, called fertility,
and these topics should be discussed with the health care team before
treatment begins. A woman who is pregnant should talk with her doctor
about how treatments could affect both her and the unborn child.
Treatment may be able to be delayed until after the baby is born.
Surgery
Surgery is the removal of the tumor and some surrounding healthy
tissue during an operation. A gynecologic oncologist is a doctor who
specializes in treating gynecologic cancer using surgery. For cervical
cancer that has not spread beyond the cervix, these procedures are often
used:
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Conization is the use of the same procedure as a cone biopsy (see Diagnosis)
to remove all of the abnormal tissue. It can be used to remove cervical
cancer that can only be seen with a microscope, called microinvasive
cancer.
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LEEP is the use of an electrical current passed through a thin wire
hook. The hook removes the tissue. It can be used to remove
microinvasive cervical cancer.
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A hysterectomy is the removal of the uterus and cervix. Hysterectomy
can be either simple or radical. A simple hysterectomy is the removal of
the uterus and cervix. A radical hysterectomy is the removal of the
uterus, cervix, upper vagina, and the tissue around the cervix. A
radical hysterectomy also includes an extensive pelvic lymph node
dissection, which means lymph nodes are removed.
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If needed, surgery may include a bilateral salpingo-oophorectomy.
This is the removal of both fallopian tubes and both ovaries. It is done
at the same time as a hysterectomy.
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Radical trachelectomy is a surgical procedure in which the cervix is
removed, but the uterus is left intact.. It includes pelvic lymph node
dissection. This surgery may be used for young patients who want to
preserve their fertility. This procedure has become an acceptable
alternative to a hysterectomy for some patients.
For cervical cancer that has spread beyond the cervix, this procedure may be used:
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Exenteration is the removal of the uterus, vagina, lower colon,
rectum, or bladder if cervical cancer has spread to these organs after
radiation therapy (see below). Exenteration is rarely required. It is
most often used for some people whose cancer has come back after
radiation treatment.
Complications or side effects from surgery vary depending on the
extent of the procedure. Occasionally, patients experience significant
bleeding, infection, or damage to the urinary and intestinal systems.
Before surgery, talk with your health care team about the possible side
effects from the specific surgery you will have.
Because these surgical procedures affect a woman's sexual health,
women should talk with their doctor about their symptoms and concerns in
detail before the surgery. The doctor may be able to help reduce the
side effects of surgery and provide support resources on coping with any
changes. If extensive surgical procedures have affected sexual
function, other surgical procedures can be used to make an artificial
vagina.
Learn more about the basics of cancer surgery.
Radiation therapy
Radiation therapy is the use of high-energy x-rays or other particles
to destroy cancer cells. A doctor who specializes in giving radiation
therapy to treat cancer is called a radiation oncologist. Radiation
therapy may be given alone, before surgery, or instead of surgery to
shrink the tumor. Many women may be treated with a combination of
radiation therapy and chemotherapy (see below).
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. A radiation therapy
regimen, or schedule, usually consists of a specific number of
treatments given over a set period of time that combines external and
internal radiation treatments. This combined approach often is the most
effective.
Side effects from radiation therapy may include fatigue, mild skin
reactions, upset stomach, and loose bowel movements. Side effects of
internal radiation therapy may include abdominal pain and bowel
obstruction, although it is uncommon. Most side effects usually go away
soon after treatment is finished. After radiation therapy, the vaginal
area may lose elasticity, so some women may also want to use a vaginal
dilator, which is a plastic or rubber cylinder that is inserted into the
vagina to prevent narrowing. Women who have received external-beam
radiation therapy will lose the ability to become pregnant, and unless
the ovaries have been surgically moved out of the pelvis, premenopausal
women will enter menopause.
Sometimes, doctors advise their patients not to have sexual
intercourse during radiation therapy. Women may resume normal sexual
activity within a few weeks after treatment if they feel ready.
Learn more about the basics of radiation therapy or read the American Society for Radiation Oncology’s pamphlet, Radiation Therapy for Gynecologic Cancers (PDF).
Chemotherapy (updated 10/2017)
Chemotherapy is the use of drugs to destroy cancer cells, usually by
ending the cancer cells’ ability to grow and divide. Chemotherapy is
given by a gynecologic oncologist or medical oncologist, doctors who
specialize in treating cancer with medication.
Systemic chemotherapy gets into the bloodstream to reach cancer cells
throughout the body. Common ways to give chemotherapy include an
intravenous (IV) tube placed into a vein using a needle or in a pill or
capsule that is swallowed (orally).
A chemotherapy regimen, or schedule, usually consists of a specific
number of cycles given over a set period of time. A patient may receive 1
drug at a time or combinations of different drugs given at the same
time.
For early stages of cervical cancer, a combination of radiation
therapy and low-dose chemotherapy is often used (see above). The goal of
chemotherapy when given with radiation therapy is to increase the
effectiveness of the radiation treatment. This combination is given to
control the cancer in the pelvis with the intent to cure without
surgery. It may also be given to destroy microscopic cancer that might
remain after surgery.
Chemotherapy may be used in higher doses to treat cervical cancer
that has come back, called recurrent cancer, or for those patients whose
cancer has spread beyond the pelvis, called metastatic disease. A
platinum-based combination therapy is used, and adding the targeted
therapy bevacizumab (Avastin) to this combination has been shown to help women with later stages of cervical cancer to live longer. A drug similar to bevacizumab, called bevacizumab-awwb (Mvasi), received FDA approval in 2017.
Although chemotherapy can be given orally (by mouth), all the drugs
used to treat cervical cancer are given intravenously (IV). IV
chemotherapy is either injected directly into a vein or given through a
thin tube called a catheter, which is a tube temporarily put into a large vein to make injections easier.
The side effects of chemotherapy depend on the woman and the dose
used, but they can include fatigue, risk of infection, nausea and
vomiting, hair loss, loss of appetite, and diarrhea. These side effects
usually go away after treatment is finished.
Rarely, specific drugs may cause some hearing loss. Others may cause
kidney damage. Patients may be given extra fluid intravenously to
protect their kidneys. Talk with your doctor about the possible
short-term and long-term side effects based on the drugs and dosages
you’ll be receiving.
Learn more about the basics of chemotherapy and preparing for treatment.
The medications used to treat cancer are continually being evaluated.
Talking with your doctor is often the best way to learn about the
medications prescribed for you, their purpose, and their potential side
effects or interactions with other medications. Learn more about your
prescriptions by using searchable drug databases.
Getting care for symptoms and side effects
Cancer and its treatment often cause side effects. In addition to
treatments intended to slow, stop, or eliminate the cancer, an important
part of cancer care is relieving a woman’s symptoms and side effects.
This approach is called palliative or supportive care, and it includes
supporting the patient with her physical, emotional, and social needs.
Palliative care is any treatment that focuses on reducing symptoms,
improving quality of life, and supporting patients and their families.
Any person, regardless of age or type and stage of cancer, may receive
palliative care. It works best when palliative care is started as early
as needed in the cancer treatment process. Women often receive treatment
for the cancer at the same time that they receive treatment to ease
side effects. In fact, patients who receive both at the same time often
have less severe symptoms, better quality of life, and report they are
more satisfied with treatment.
Palliative treatments vary widely and often include medication,
nutritional changes, relaxation techniques, emotional support, and other
therapies. You may also receive palliative treatments similar to those
meant to eliminate the cancer, such as chemotherapy, surgery, or
radiation therapy. Talk with your doctor about the goals of each
treatment in your treatment plan.
Before treatment begins, talk with your health care team about the
possible side effects of your specific treatment plan and palliative
care options. During and after treatment, be sure to tell your doctor or
another health care team member if you are experiencing a problem so it
can be addressed as quickly as possible. Learn more about palliative care.
Treatment options by stage
Radiation therapy alone or surgery is generally used for a small
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 or if the lymph nodes have cancer cells. Commonly,
radiation therapy and chemotherapy are used after surgery, when the
patient is at a high risk for the cancer coming back or if the cancer
has spread.
Metastatic cervical cancer
If cancer spreads to another part in the body from where it started,
doctors call it metastatic cancer. If this happens, it is a good idea to
talk with doctors who have experience in treating it. Doctors can have
different opinions about the best standard treatment plan. Also,
clinical trials might be an option. Learn more about getting a second opinion before starting treatment, so you are comfortable with your chosen treatment plan.
Chemotherapy 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 with radiation therapy to relieve pain and other
symptoms.
For most women, a diagnosis of metastatic cancer is very stressful
and, at times, difficult to bear. Patients and their families are
encouraged to talk about the way they are feeling with doctors, nurses,
social workers, or other members of the health care team. It may also be
helpful to talk with other patients, including through a support group.
Remission and the chance of recurrence
A remission is when cancer cannot be detected in the body and there
are no symptoms. This may also be called having “no evidence of disease”
or NED.
A remission may be temporary or permanent. This uncertainty causes
many people to worry that the cancer will come back. While many
remissions are permanent, it’s important to talk with your doctor about
the possibility of the cancer returning. Understanding your risk of
recurrence and the treatment options may help you feel more prepared if
the cancer does return. Learn more about coping with the fear of recurrence.
If the cancer does return after the original treatment, it is called
recurrent cancer. Recurrent cancer may come back in the same place
(called a local recurrence), nearby (regional recurrence), or in another
place (distant recurrence).
When this occurs, a new cycle of testing will begin again to learn as
much as possible about the recurrence. After this testing is done, you
and your doctor will talk about your treatment options. Often the
treatment plan will include the treatments described above, such as
surgery, chemotherapy, and radiation therapy, but they may be used in a
different combination or given at a different pace. Your doctor may
suggest clinical trials that are studying new ways to treat this type of
recurrent cancer. Whichever treatment plan you choose, palliative care
will be important for relieving symptoms and side effects.
Women with recurrent cancer often experience emotions such as
disbelief or fear. Patients are encouraged to talk with their health
care team about these feelings and ask about support services to help
them cope. Learn more about dealing with cancer recurrence.
If treatment doesn’t work
Recovery from cancer is not always possible. If the cancer cannot be
cured or controlled, the disease may be called advanced or terminal.
This diagnosis is stressful, and for many people, advanced cancer is
difficult to discuss. However, it is important to have open and honest
conversations with your doctor and health care team to express your
feelings, preferences, and concerns. The health care team is there to
help, and many team members have special skills, experience, and
knowledge to support patients and their families. Making sure a person
is physically comfortable and free from pain is extremely important.
Women who have advanced cancer and who are expected to live less than
6 months may want to consider a type of palliative care called hospice
care. Hospice care is designed to provide the best possible quality of
life for people who are near the end of life. You and your family are
encouraged to talk with the health care team about hospice care options,
which include hospice care at home, a special hospice center, or other
health care locations. Nursing care and special equipment can make
staying at home a workable option for many families. Learn more about advanced cancer care planning.
After the death of a loved one, many people need support to help them cope with the loss. Learn more about grief and loss.
The next section in this guide is About Clinical Trials. It
offers more information about research studies that are focused on
finding better ways to care for people with cancer. You may use the menu
to choose a different section to read in this guide.