Therapy is based on the stage and type of cervical cancer and the patient’s age and overall health. Staging is critical, and ranges from early-stage disease to stage IV cervical cancer, which means the cancer cells have already spread to nearby organs or distant sites in the body.
All patients' cases are discussed at Wilmot's gynecological oncology multidisciplinary tumor board — a conference that is attended by gynecological oncologists, radiation oncologists, and pathologists, among other specialties required for your care.
Four treatments are commonly used for cervical cancer: surgery, radiation, chemotherapy, and targeted therapy.
This is often the first treatment considered for cervical cancer. For very early, non-invasive cancers, doctors can perform minimally cone biopsies. For invasive cancer, Wilmot oncologists can offer a number of surgical options at Highland Hospital, the hub for our gynecologic cancer team. Highland was the first hospital in the Finger Lakes region to have new technology that provides virtually scarless surgery. Our surgeons also use the daVinci robotic surgical system, which offers precision and enhanced 3D, high-definition views of the tumor and surrounding operative field.
Our team is also pioneering the new field of sentinel lymph node dissections using a technology known as the Fire Fly system. This helps our specialists to detect cancers that have spread to the lymph nodes with greater sensitivity. The Wilmot Cancer Institute is the only place in upstate New York to use the Fire Fly technology.
Surgery for invasive cervical cancer includes:
- Conization, in which a cone-shaped piece of tissue is removed and examined to see if the outer margins still contain cancer cells. If the margins are clear, this might be the only treatment necessary for early-stage cancer. If cancer cells are still present at the outer margins, additional treatment is usually needed.
- Hysterectomy, which removes the uterus and the cervix. This type of operation can be performed through an abdominal incision or laparoscopically with smaller instruments and special tools. There are pros and cons to each method, and it’s very important to thoroughly discuss the surgical options with your doctor and to understand the risks and benefits. Wilmot surgeons have expertise in both procedures.
- Radical hysterectomy, in which the surgeon removes the uterus, cervix, the upper part of the vagina and a wide area of other nearby tissue, including pelvic lymph nodes. Sometimes the ovaries and fallopian tubes are also removed.
- Modified radical hysterectomy, which is similar to a radical hysterectomy but not as many surrounding tissues or organs are removed.
- Trachelectomy, which allows women to be treated without losing their ability to have children. The surgeon removes the cervix and part of the vagina and keeps the uterus intact; the surgeon also creates an artificial opening inside the uterus. After this procedure, women have a higher risk of miscarriage but many women are able to carry a pregnancy to full term and deliver a baby by cesarean section.
- Pelvic exenteration, a procedure that is only necessary when cervical cancer returns. It involves more extensive surgery than a radical hysterectomy and often involves the removal of the bladder, vagina, rectum and part of the colon, depending on where the cancer is located. The surgeon creates artificial openings for urine and stool.
Radiation therapy uses energy from radiation beams, radio isotopes, or charged particles to target tumors and to eradicate cancer cells. For cervical cancer, radiation is sometimes used in combination with chemotherapy. Brachytherapy is another type of radiation therapy that can be used to treat cervical cancer: Doctors use a special device to place a radioactive material into the body directly near the cancer in the cervix.
Chemotherapy uses drugs or combinations of drugs — given intravenously or as pills — to destroy cancer cells. It can be given in combination with radiation therapy as the initial treatment; chemotherapy can also be offered if cervical cancer returns.
These are newer drugs designed to target specific gene changes that result in cervical cancer. They single out cancer cells and usually have less severe side effects compared to chemotherapy. Avastin is an example of a targeted therapy that can be used to treat advanced cervical cancer, and it can be used in combination with other drugs.
Many standard cancer treatments cause side effects such as hair loss or fatigue, but not everyone experiences side effects the same way.
The American Cancer Society also offers a free online class to help patients manage the side effects of their illness.
Wilmot's Cancer Control & Survivorship program is one of the oldest and most highly regarded research programs in the country to investigate the management of side effects.