How Cervical Cancer Is Treated

Cervical cancer is treated with surgery, radiation, chemotherapy, or a combination of the three. The treatment depends on the stage of cancer, and the goal at early stages is to completely eradicate the tumor. At late stages with extensive metastasis, the goal may only be to improve quality of life.

Often, home remedies, over-the-counter treatments, and complementary alternative therapies can help reduce the side effects of chemotherapy, but these treatments cannot help shrink or eradicate cervical cancer itself. 

Surgeries

Some cervical cancer treatments may be used alone or in combination, and that depends on the stage of cervical cancer and other factors. Surgery may be the only treatment needed if cervical cancer has not spread.

Removal of cancer is the goal of surgery. If possible, the whole tumor is removed. Surgery can be a small procedure with a quick recovery, or it can involve a major surgical procedure if cervical cancer has spread beyond the cervix into the pelvis.

In general, surgical treatment for cervical cancer can impact your chances of becoming pregnant and of carrying a baby to full term. If you have a large section of your cervix removed, this will have a more significant impact your chances of getting pregnant than having a small area removed. 

Often, even if the tumor has metastasized, surgical removal of the tumor is done prior to chemotherapy and/or radiation (see below). 

There are several surgical methods used for removal of cervical cancer, including:

  • Cryosurgery: This is a procedure in which your doctor places a very low-temperature device on the cancerous area to destroy the cancer cells by freezing them. Generally, local anesthesia is needed, and this procedure may be done as an outpatient. 
  • Laser surgery: This procedure uses a focused laser to direct intense light that destroys the cancer cells. This procedure may be done as an outpatient and local anesthesia is used. 
  • Conization: This procedure is often both a diagnostic tool and a method of treatment. If you have a conization procedure, the cancerous tissue is removed in a cone-like shape and examined under a microscope to determine whether the whole tumor was removed. If necessary, you may need another surgery to remove remaining areas of cancer. You need to have local anesthesia for a conization procedure, and it may be done as an outpatient procedure. 
  • LEEP: A loop electrosurgical excision removes tissue using a wire that is heated by an electrical current. A LEEP may be used to remove tissue during a conization procedure. 
  • Laparoscopy: A laparoscopic surgical procedure is done without a large surgical incision and typically requires general anesthesia. One or more small openings are made in the skin, and a camera, which can send images onto a screen, is inserted so that the surgeon can visualize the inside of the body. Generally, the benefit of a laparoscopy is avoidance of a large incision or scar, and recovery may not take as long as that of an extensive surgical procedure. 
  • Open surgery: The traditional approach to surgery is often described as open surgery. With open surgery, a larger incision than that of a laparoscopic procedure is made to better visualize your pelvic region and give your surgeon access to remove what may be a more extensive spread of your cervical cancer. Healing may take a bit longer than it would take with laparoscopic surgery, but most people recover well. 

Depending on how much your cervical cancer has enlarged, you may need to have extensive surgery to remove your cervix or uterus. Procedures that involve more than just removal of a small amount of tissue include:

  • Trachelectomy: Surgical removal of the whole cervix may be necessary to achieve complete removal of cervical cancer. 
  • Hysterectomy: Removal of the uterus in addition to the cervix is necessary if cervical cancer has spread beyond the cervix into the uterus. 

Radiation

Radiation therapy uses energy from radiation to shrink tumors or eliminate cancer cells. It does this by damaging cancer cells, which are highly sensitive to radiation and typically die when they are exposed. Healthy cells are also damaged by radiation and, over time, they are expected to recover. Radiation therapy may decrease your chances of becoming pregnant. 

Radiation therapy may be given:

  • By itself as the sole treatment method
  • After surgery
  • After or in conjunction with chemotherapy treatment (see below). Some chemotherapy medications, such as 5-FU and cisplatin, make cervical cancer more sensitive to radiation. 

Two types of radiation therapy are used to treat cervical cancer: external radiation and internal radiation. One or both types of radiation treatment may be used to treat cervical cancer.

External Beam Radiation 

Also called systemic therapy, this type of radiation is given on an outpatient basis. A typical treatment schedule is five days per week for six to seven weeks. 

It uses X-ray or gamma ray energy to deliver treatment to the affected area. In women with cervical cancer, pelvic external radiation is given by a machine that resembles an X-ray machine but delivers a much stronger dose of radiation. Each treatment lasts only a few minutes and does not cause any pain.

It is usually combined with chemotherapy, and this regimen is called concurrent chemoradiation.

Internal Radiation 

This type of radiation therapy is also called brachytherapy. It uses an implant (a seed, catheter, or rod) that is sealed with a radioactive substance. The implant is placed into the uterus through the vagina for delivery of treatment.

Low-dose-rate brachytherapy is done on an inpatient basis, with the radiation-containing instruments in place for a few days. High-dose-rate brachytherapy, which is given in several treatments, is an outpatient procedure. With this, the radioactive material is placed for a brief time and then removed, and then you return after a week or longer for another treatment.

Brachytherapy is often done right after external beam radiation.

Side Effects

Side effects of radiation can vary depending on the intensity and frequency of treatment. The most common side effects are:

  • Fatigue: Almost all cancer survivors experience some degree of fatigue during and for months after radiation treatment. 
  • Skin problems: Skin that has been exposed to treatment may appear red, sunburned, tan, or irritated. 
  • Loss of appetite: Decreased appetite can lead to fatigue and nutritional deficiencies. It is very important to keep up strength during any cancer treatment, and good nutrition is one of the best ways to do that.

Chemotherapy

Chemotherapy is often prescribed prior to radiation therapy treatments as a way to shrink the tumor, which can make radiation therapy more effective. It is also prescribed for the treatment of cervical cancer when it has spread to other organs.

There are several types of chemotherapy used to treat cervical cancer. They can be administered intravenously or by mouth, alone or in combination. Some women undergo chemotherapy for cervical cancer for weeks, while others may receive it for months. 

Your doctor will develop a treatment plan according to the stage of your disease, your overall health, and any other medical conditions that you have. For example, you may need daily radiation treatments combined with weekly chemotherapy sessions. If you have chemotherapy for any type of cancer, including cervical cancer, this can affect your chances of becoming pregnant and carrying a healthy baby. Some women opt to store eggs prior to chemotherapy, and you should discuss your plans for having children prior to starting chemotherapy. 

Common cervical cancer chemotherapy medications include:

  • Carboplatin
  • Cisplatin
  • Paclitaxel
  • Fluorouracil, 5-FU
  • Topotecan
  • Cyclophosphamide
  • Ifosfamide

Side Effects

Chemotherapy is an important and potent treatment for cancer. Because it is a systemic option, meaning the whole body is treated, the medications tend to destroy healthy cells along with the cancerous cells, causing side effects like hair loss and stomach upset. The bone marrow, which produces blood, is affected by the treatment, increasing the risk of infection, anemia (decreased quantity and function of oxygen-carrying red blood cells), and bleeding. 

Home Care and Lifestyle

Cancer treatment, in general, can cause a number of side effects, some of which may be managed with home remedies. Recovery after surgery is smoother and easier with at-home attention to your post-surgical care. Some side effects of chemotherapy and radiation may be alleviated with lifestyle adjustments.

Some suggestions to keep in mind:

  • Take care of surgical wounds: As you are recovering from surgery, be sure to be attentive to your surgical wounds by keeping them clean and changing dressings as directed. 
  • Maintain a cancer-fighting diet: Studies show that a diet rich in vegetables may aid in fighting cancer. This is not a substitute for medical and surgical therapy, but it can be a good adjunct as you undergo treatment for cervical cancer. 
  • Stop smoking: Smoking has been found to exacerbate most types of cancer, including cervical cancer. If you smoke, it can interfere with your immune system function and impede your recovery from cervical cancer. 
  • Avoid infection: Chemotherapy and radiation therapy also interfere with your immune system, which makes you susceptible to frequent and aggressive infections. If you are undergoing these treatments, you should avoid contact with people who have infectious illnesses that can be passed on; an infection that is only mild for someone else could become severe for you. Also avoid eating undercooked seafood or meat, which can carry infectious organisms that your body can't fight during your cancer treatment. Some doctors also advice to avoid raw fruits and vegetables, as they can also transmit infections, which your body cannot fight when you have a weak immune system. 

    Over-the-Counter Therapies

    Over-the-counter medications can help relieve some of the discomfort and side effects of cervical cancer treatment, but you should check with your doctor before taking any non-prescription medication—especially when you are receiving chemotherapy or radiation. 

    • Anti-fever medications: If you have a fever with or without an infection, over-the-counter medications such as Tylenol (acetaminophen) can reduce the fever. Be sure to check with your doctor before you take medications that reduce fever because some of them can increase your chances of bleeding or may interact with your chemotherapeutic medication in other ways. 
    • Pain relievers: You may experience pain as you are recovering from surgery, during and after weeks or months of radiation and chemotherapy, and if you have metastasis to the bones. Over-the-counter pain relievers such as Aleve (naproxen) may help. However, many of them are also blood thinners or can interact with your chemotherapeutic medications.  
    • Multivitamins: Often, chemotherapy and radiation interfere with your appetite. It is important to try to maintain as healthy a diet as possible during your cancer treatment. While multivitamins do not replace calories, they can provide you with important vitamins and minerals if you are lacking. 

      Complementary Medicine (CAM)

      While there is not strong evidence, preliminary studies suggest that complementary and alternative medicine may help alleviate some of the symptoms of late-stage cervical cancer, improving comfort and quality of life for some people.

      There are also studies looking at the effectiveness of complementary treatments specifically in the treatment of cervical cancer, and so far the results are promising in a laboratory setting, but not definitive, and there are no formal or well-accepted recommendations about complementary alternative treatment approaches at this time. 

      • Chinese herbal medicine: Chinese herbal medicine has been evaluated for a variety of cancer types, including cervical cancer. Researchers who gathered evidence from a large number of studies found that use of Chinese herbal medicine may improve quality of life of cancer patients. But it is not clear which types of herbal remedies, at what doses or which methods of use could be most beneficial. Chinese herbal medicine has not been found to improve survival or to shrink cancerous tumors. 
      • Blueberries: An interesting research study looked at the effect of the blueberry extract on cervical cancer cells exposed to radiation. The study showed that blueberry extract helped to make the impact of radiation more effective on cervical cancer cells. However, this was done in a laboratory setting and has not been used in people who have cervical cancer. 
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