The cervical cancer treatment depends on various factors including the type of cervical cancer, the overall stage assigned to the disease with the help of the investigational tests, age and health condition of the patient, and on the patient’s preference (to retain fertility or not). Surgery to remove most of the tumor is considered as the first-line treatment for most of the cervical cancers. However, in the case of advanced disease where surgery is not possible, treatment with chemotherapeutic drugs with or without other radiotherapy is usually employed. Based on the results obtained from various clinical research studies carried out so far, following are the preferred treatment approach for different stages of cervical cancers:
|FIGO STAGE||Preferred Treatment|
|Stage 0 cervical cancer can be treated by removal of the pre-cancerous lesion with the help of LEEP or cold knife technique as the preferred treatment option. Total hysterectomy (surgical removal of the uterus) is the standard treatment for women with cervical adenocarcinoma in situ and post-reproductive.|
|In case of Stage I cervical cancer, hysterectomy is generally preferred in most of the cases. However, if patient wants to retain fertility and in early stage of disease, radical trachelectomy may be done. Radiotherapy with/without chemotherapy may be used in some cases.|
|In case of Stage II cervical cancer, concurrent chemoradiotherapy is done in most of the cases. However in early stage disease, hysterectomy may be done, which may/may not be followed by chemoradiotherapy.|
|In case of Stage III cervical cancer, concurrent chemo radiotherapy is considered in most of the cases.|
|In case of Stage IV cervical cancer, chemotherapy with/without radiotherapy may be considered depending upon the extent of disease.|
Following is the brief description of various treatment types employed for cervical cancer:
1.Surgery: Surgery is the choice of treatment for early-stage cervical cancer. There are mainly 2 aims of surgery in cervical cancer: first is to stage the disease and the second is to remove all possible cancerous tissue to treat the disease. Following are the commonly employed surgical techniques for the management of cervical cancer:
-Cryosurgery/Laser surgery/Conization: This technique is used for the treatment of certain very early-stage cervical cancers that are limited to superficial cervical layer. Cells in the affected are killed with the help of supercooled metal probe (cryosurgery), focused laser beam (laser surgery), or a cone-shaped tissue is removed with the help of a biopsy device (conization).
-Hysterectomy: In a total hysterectomy procedure, the entire uterus containing the cervix is removed. In a radical hysterectomy, the uterus along with associated tissues like parametria, uterus ligaments, part of the vagina, pelvic lymph nodes, and fallopian tubes and ovaries are removed.
-Trachelectomy: For women who wish to retain fertility, a trachelectomy procedure can be performed, where only the cervix along with the upper part of the vagina is removed keeping the uterus in place. This surgery allows a woman to have a child in future.
2.Radiation Therapy: Radiation therapy (or radiotherapy) uses high-energy radiation directed to the affected area to kill cancerous cells. It can be employed either by using an external radiation source (external beam radiation therapy) or by directly placing the source of radiation near the cancer tissue (brachytherapy). It is commonly used as first-line treatment of certain early stage cervical cancers or in conjunction with surgery/chemotherapy for the treatment of advanced-stage cervical cancer to prevent recurrence. It may sometimes be used for palliation of symptoms such as pain, bleeding, etc.
3.Chemotherapy: Chemotherapy means treatment with anti-cancer drugs that kill or decrease the growth of rapidly growing cancer cells. It is considered to be the mainstay of treatment for advanced stage disease that has spread to distant body parts. Depending on the physician’s preference and patient’s condition, it may also be combined with other treatment options to accelerate the benefit achievement. It may be associated with side effects due to its effect on normal body cells apart from cancerous cells. Common side effects of chemotherapy include nausea, vomiting, hair-loss, diarrhea, mouth ulcers, increased chances of infection, fatigue, decrease in the number of blood cells, etc.
4.Targeted Therapy: Targeted drugs work differently than chemotherapy drugs that they target a specific gene or protein characteristic of the cancer cells, for example, bevacizumab targets vascular endothelial growth factor (VEGF) that stimulates the formation of blood vessels in the cancerous tissue. They are generally used alone or in combination with chemotherapy for the treatment of advanced-stage disease. The side effects associated with targeted therapy vary according to the drug used.
It is very important to assess the benefits of each treatment option versus the possible risks and side effects before making a treatment decision. Sometimes patient’s choice and health condition are also important to make a treatment choice. Following are ultimate goals of treating cervical cancer:
- To prolong the overall life
- To reduce the symptoms and discomfort arise from the disease
- To improve the overall quality of life of the cancer patient
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