DescriptionAn in-depth report on the causes, diagnosis, treatment, and prevention of cervical cancer.
Alternative NamesDysplasia; Human Papillomas Virus; Pap Smear
Treatment for Cervical Cancer
In contrast to CIN, cervical cancer represents true invasion of cells beyond the epithelium into surrounding tissue. Cervical cancer may be detected in a biopsy performed during colposcopy for an abnormal Pap smear, or it may be visible to the naked eye when the doctor performs a speculum exam.
Imaging Tests to Determine Extent of Tumor Spread. If invasive cancer is detected on biopsy, additional tests are performed to determine the tumor spread. The extent of the spread determines whether the cancer is operable.
If these tests detect cancer in any of these surrounding sites, then further tests are used:
Sentinel Node Biopsy. Of interest is a technique known as a sentinel node biopsy, which has been used in breast cancer patients to help determine if cancer has spread beyond the lymph nodes. It is now being investigated for patients with early cervical cancer and may be helpful in determining which patients require lymphadenectomy (removal of the lymph nodes) in the pelvic area:
A 2002 study reported that this technique was able to detect cancer that had spread in 87.5% of cases. More investigation is required before it can be widely used.
General Treatment Guidelines
Once diagnosed, cervical cancer (i.e., invasive disease) is classified into stages according to the extent of the abnormal cells invasion into the lining of the cervix or its spread throughout the cervix or beyond. These classifications are used to determine treatment and outlook.
It is important for patients who have been diagnosed with cervical cancer to know the normal treatments for their particular stage, so that they may compare their doctor's suggestions with these norms.
In stage I patients, the need for more aggressive treatment is correlated with larger tumor size, any involvement of blood or lymph vessels, and deeper invasion into the supportive tissues (the stroma) around the cervix.
In later stages, a greater tumor size, older age and poor general health, and cancer involvement in the pelvic and para-aortic lymph nodes (nodes near the aorta, the major artery in the body) suggest the need for investigative or more aggressive treatments.
Stage 0 and Treatments
Stage 0 is cancer in situ confirmed by biopsy and confined to the first layer of cervical tissue (the epithelium). Treatment Options: Loop electrosurgical excision procedure (LEEP), laser therapy, conization, or cryotherapy.
Stage I (Including Locally Advanced Cancer) and Treatments
Stage I is invasive cancer, but the tumor confined is confined to the cervix. This stage is further categorized as IA and IB.
Stage IA. Five-year survival rates for stage IA can be 95% or more.
Stage IB and Locally Advanced Cancer. Five-year survival rates for stage IB can be 80% to 90% with either radiation or surgery. Survival rates are lower if lymph nodes are involved.
Note on Locally Advanced Cervical Cancer: Stages IB2 through IVA are often referred to collectively as locally advanced cancer and are frequently treated similarly. In addition to standard treatments, notably radiotherapy with concurrent platinum-based chemotherapy, experimental approaches for some women with locally advanced cervical cancer employ radiation therapy with hyperthermia (high heat often provided by ultrasound) and neoadjuvant (preoperative) chemotherapy and radical surgery.
Stage II and Treatments
Stage II invasive cancer extends beyond the cervix, but not does not involve the pelvic side wall. This stage is further categorized as IIA and IIB.
Stage IIA. Cure rates for stage IIA can be as high as 75% to 80% with either radiation or radical hysterectomy. Survival rates are lower if lymph nodes are involved. In stage IIA the upper two thirds of the vagina are involved but not the parametrium (the connective tissue between the pelvic floor and upper part of the cervix). Treatment Options: Same as stage IB1 above unless tumor is bulky. In this latter case, treatment is the same as stage IB2.
Stage IIB. For stage IIB five-year survival rates are about 60%. In stage IIB the cancer has spread to the parametrium. Treatment Options: Radiation therapy with concurrent cisplatin-based chemotherapy.
Stage III and Treatments
In stage III invasive cancer with tumor extending to the lower third of the vagina (stage IIIA) or to the side walls of the pelvis (stage IIIB). The kidney may be affected. Treatment Options: Radiation therapy with concurrent cisplatin-based chemotherapy. Five-year survival rates are about 40%.
Stage IV and Treatments
In stage IV invasive cancer with tumor spread beyond the pelvis or to the mucosal lining of the bladder or rectum. Five-year survival rates are less than 20%.
Stage IV. In stage IVA the cancer involves the inner lining of the bladder or rectum. Treatment Options: Radiation therapy with concurrent cisplatin-based chemotherapy.
Stage IVB. In Stage IVB, the cancer has metastasized beyond the pelvis. Treatment Options: Platinum-based chemotherapy yields short-lived response in 20% of patients. Clinical trial participation is reasonable.
Recurrent or Persistent Cancer and Treatments
Cervical cancer may recur locally in the lymph nodes near the cervix, or it may metastasize to distant sites, such as the lung or bones, or it may appear both locally and in distant locations. Treatment Options: Pelvic exenteration if cancer has spread to only local areas (This involves removal of the cervix, uterus, vagina, and perhaps bladder, lower colon, or rectum. It is an aggressive surgical approach that may lead to cure in a small percentage of patients with recurrent cervical cancer.) Radiotherapy is another option if it is technically possible, generally if patients did not have it previously. If cancer has metastasized, platinum-based chemotherapy is reasonable. Other agents may be useful under certain circumstances.