Cervical cancer is the fourth most common cancer and fourth leading cause of cancer death worldwide, according to Bhavana Pothuri, M.D., a gynecologic oncologist at NYU Langone Health. In the United States, the rate of death is lower due to widespread screening. Still, more than 13,000 women in the United States will be diagnosed with cervical cancer in 2018, while nearly half (45 percent) of those women will catch their cancer before it spreads to nearby lymph nodes or other organs.
Almost all cases of cervical cancer are caused by infection with the human papillomavirus (HPV). Symptoms include vaginal bleeding, discharge, pelvic pain, or pain during intercourse, according to the National Cancer Institute (NCI). Sarah Hosford, M.D., assistant professor at Texas Tech University Health Sciences Center, tells HealthCentral there’s usually a spike of cervical cancers in women in their late 30s and early 40s and another spike in older women, who have slow-growing cancers and often do not undergo regular screenings.
Like most cancers, treatment of cervical cancer depends on the stage, or how advanced it is, at the time you’re diagnosed.
Treatment for early stage cervical cancer
If you have the earliest stage cervical cancer, stage 1A1, your oncologist will likely remove a cone-shaped piece of your cervix (cone biopsy) that contains the tumor. In later, but still early stage cervical cancer (stage 1B1), the treatment is a radical hysterectomy.
“Your gynecological oncologist will remove the cervix, uterus, parametria (tissue next to the cervix), and a portion of the upper vagina,” NYU's Dr. Pothuri tells HealthCentral. “We’ll also sample the lymph nodes to see if the cancer has spread.”
Dr. Hosford says a PET scan is helpful in showing whether the cancer has spread, in which case your oncologist will know surgery won’t be curative.
“If the cancer is still limited and small enough — 4 centimeters or less — it’s likely that surgery is curative,” she says. “The chances it’s spread are much less.” Patients in this scenario tend to be younger and not obese. “If we leave the ovaries, the woman’s hormones will remain steady, and if the rest of vaginal tissue remains healthy, she can [continue to] have sex comfortably.”
The type of surgical treatment also depends on whether a woman wants to preserve her fertility. A specialized procedure called a radical trachelectomy keeps the uterus and upper portion of the cervix intact.
Surgery for cervical cancer is done with the intent to cure the cancer and with the expectation that nothing will come up afterward that shows the surgery was not curative, says Dr. Hosford. In fact, more than 90 percent of early stage cervical cancers are successfully treated with surgery and don’t require additional treatment, according to the Dana-Farber Cancer Institute.
Studies on early stage cervical cancer show the rates of success are the same with surgery compared with chemotherapy and radiation, with far fewer long-term side effects, Dr. Pothuri says.
Your gynecologic oncologist will watch you closely for the first few years following surgery to make sure the cancer doesn't come back and that you don’t need any additional treatment, says Dr. Hosford.
Treatment for advanced cervical cancer
For women with stage 2, 3, or 4 cervical cancer, Dr. Hosford says she hopes the cancer is contained such that radiation will be effective.
“If it’s limited to the pelvic area, we’re usually pretty good at being able to give high enough doses of radiation to kill the cancer cells,” she says. “When we add chemotherapy, it increases the cure rate by about 10 percent. The chemotherapy seems to juice up the radiation.”
If your cervical cancer falls in this category, you’ll receive external beam radiation therapy, usually Monday through Friday, for about five weeks, says Dr. Pothuri. Taking the weekend off allows your cells to recover and prevents toxicity to normal tissue. On Monday or Tuesday, you’ll receive an intravenous dose of Cisplatin, a chemotherapy drug that helps sensitize the radiation therapy for the week.
Once this portion of treatment is complete and the radiation has significantly shrunk the tumor, your radiation oncologist will give you concentrated doses of internal radiation, a procedure called brachytherapy.
“We introduce an implant directly on the cervix and uterus, while minimizing the toxicity to surrounding organs, mainly the bowel and the bladder,” says Dr. Pothuri.
This procedure is difficult for patients, she says. In her cancer center, women receive brachytherapy twice in the operating room under anesthesia, with a week between doses. “Brachytherapy is critical to the curative intent of locally advanced cervical cancer,” Dr. Pothuri says. “Although there are newer forms of radiation therapy, they cannot achieve the dose intensity you need with these alternative modalities.”
“We can do a pretty good job if we give the right amount of radiation doses to the tumor and make sure it hasn’t spread,” says Dr. Hosford. “We can actually cure a fair percent of women even if [the cancer] looks pretty extensive at first.”
Finally, if your cervical cancer has recurred or metastasized and radiation is not an option, you’ll receive a chemotherapy regimen, typically taxol, carboplatin, and Bevacizumab — a form of targeted therapy. Although not curative, many women can control their cancer with chemotherapy, at least for a few years, says Dr. Hosford.
New treatment option for cervical cancer: Immunotherapy
On June 12, 2018, the U.S. Food and Drug Administration approved pembrolizumab (Keytruda), a type of immunotherapy, to treat certain cervical cancers that have recurred or metastasized following treatment with chemotherapy. “This is really exciting,” says Dr. Pothuri.
However, your best bet is to prevent cervical cancer in the first place. According to the U.S. Preventive Services Task Force, screening women between 21 and 65 reduces both the rate and number of deaths from cervical cancer because it removes abnormal cells that might eventually turn into cancer.