Cervical Cancer

Treatment

Enlarge

Accurately determining the stage of the cancer (the extent of disease) is the first step in treating cervical cancer. For most Stage I and II cancers of the cervix, patients have a choice of either surgery (radical hysterectomy) or radiation therapy. The gynecologic oncologists and radiation oncologists at Mayo Clinic work together closely to decide which option may be best for each patient. For more advanced stages of disease, a combination of treatments is often needed. For some women, this will mean chemotherapy, surgery and radiation therapy. The collaboration of specialists in each area to provide this aggressive treatment is a unique service provided by Mayo Clinic.

Types of Surgery

• Simple surgery — Using a scalpel, a surgeon removes a cone-shaped piece of cervical tissue where the abnormality is found.
• Laser surgery — A narrow beam of intense light is used to kill cancerous and precancerous cells.
• Loop electrosurgical excision procedure (LEEP) — A wire loop is used to pass electrical current, which cuts diseased tissue from the cervix.
• Cryosurgery — Cancerous and precancerous cells are killed by freezing.
• Simple hysterectomy — The cervix and the uterus are removed.
• Radical hysterectomy — The cervix, uterus and surrounding tissue are removed.
• Lymphadenectomy — The lymph nodes that drain the cervix are removed.
• Exenteration — This treatment for advanced cancers that have not spread to other parts of the body involves removing the uterus, cervix, lymph nodes and possibly the bladder, vagina, rectum and part of the colon.
• Reconstructive surgery — Often used to treat advanced cases of cervical cancer, reconstruction may be necessary for the vagina, the bladder, the pelvic floor and other parts of the pelvis.

Radiation Therapy

Radiation therapy is often the most effective treatment for cervical cancer at any stage of development. At Mayo Clinic, state-of-the-art radiation therapy includes intensity modulated radiation therapy (IMRT). This form of external radiation allows the radiation oncologist to minimize the high-dose radiation applied to nearby healthy tissue. External beam radiation is also aimed at diseased regions in the pelvis to kill lymph node tissue that has been invaded by cancer.

Internal radiation treatment is called brachytherapy. In brachytherapy, radiation is directed into the vagina and uterus. This treatment can be given in the outpatient setting.

Chemotherapy

Studies show that chemotherapy, when combined with radiation therapy, improves survival rates in women with advanced cervical cancer. Studies also show an advantage for some early stage tumors in women who are at high risk. Mayo Clinic physicians often use this combination. Chemotherapy uses anticancer drugs given intravenously or by mouth to destroy cancerous cells.

Reconstructive Surgery

At Mayo Clinic, a gynecologic oncologist and a plastic surgeon work together to restore as much anatomy and function as possible through reconstructive surgery. This teamwork is especially important in radical cancer surgery, in which surgical reconstruction is necessary to the treatment plan. Reconstructive surgical procedures include:

• Rebuilding the vagina after radical cancer treatment
• Using skin grafts to cover large treated areas after radiation therapy or radical surgery for recurrent cancer in the vulva and groin
• Rebuilding vital organs such as a urinary bladder, vagina or pelvic floor that were removed to treat advanced cancer or were damaged during radiation therapy. In the case of bladder reconstruction, for example, it is often possible to create a pouch that holds the urine internally, eliminating the need for an external collection bag.
• Reconstruction of the pelvic floor to correct pelvic prolapse and urinary or rectal incontinence

Physicians at Mayo discuss with each patient all concerns and expectations as well as possible approaches to treatment and reconstruction. Reconstructive surgery techniques can produce cosmetically pleasing and functional results that improve a woman's quality of life.

Prevention

A new vaccine called Gardasil offers protection from the most dangerous types of human papillomavirus (HPV), the virus that causes most cervical cancers. The national Advisory Committee on Immunization Practices recommends routine vaccination for girls ages 11 and 12, as well as girls and women ages 13 to 26 if they haven't received the vaccine already. The vaccine is most effective if given to girls before they become sexually active.

Although the vaccine could prevent up to 70 percent of cervical cancer cases, it can't prevent infection with every virus that causes cervical cancer. Routine Pap tests to screen for cervical cancer remain important.