Cervical cancer starts in the cervix, the bottom part of the uterus that connects to the vagina. Treatments for this cancer include surgery, radiation therapy, chemotherapy, targeted drugs, and immunotherapy. The choice of treatment is based on how far the cancer has spread, whether you want to have children, and your age and health.
A gynecologic oncologist is a specialist who treats
cervical cancer. Together, you and your doctor will decide on the treatment plan that’s most appropriate for your cancer and lifestyle.
Surgery to remove part or all of the cervix and nearby tissues is the main treatment for early-stage cervical cancer. Cervical cancer surgery can be performed in a few ways, depending on the extent of your cancer and whether you want to have children someday.
Conization, or Cone Biopsy
During this procedure, a doctor removes a cone-shaped wedge of tissue from the cervix using one of the following tools:
- Surgical blade during a cone knife biopsy
- Laser beam during a laser conization
- Heated wire during a loop electrical incision procedure
Conization is used to diagnose and treat early cervical cancer. This procedure may be an option if your cancer hasn’t spread, and it could preserve your ability to get pregnant.
Radical Trachelectomy
This procedure is used for smaller cervical cancers and also preserves the ability to get pregnant. A surgeon removes the cervix, the tissue around it, the upper part of the vagina, and sometimes nearby lymph nodes, but the uterus remains in place.
During pregnancy, a stitch is put in the uterus to keep it closed in place of the cervix.
Hysterectomy
Hysterectomy is a treatment for invasive cervical cancer that has spread deeper into the cervix and maybe the surrounding tissues.
A surgeon removes the uterus, cervix, and sometimes nearby organs and tissues.
A
hysterectomy can be performed through the belly (abdominal hysterectomy) or vagina (vaginal hysterectomy). A laparoscopic hysterectomy is a minimally invasive procedure done through small incisions in the belly instead of one large cut.
After a hysterectomy, you will not be able to get pregnant.
The type of hysterectomy performed is based on how much tissue is removed:
- Total hysterectomy removes the uterus and cervix.
- Modified radical hysterectomy takes out the uterus, cervix, part of the vagina, and some tissues and ligaments close to these organs. It’s less extensive than a radical hysterectomy.
- Radical hysterectomy removes the uterus, cervix, part of the vagina, and a wide area of tissues around these organs. This surgery may also include removal of the ovaries, fallopian tubes, and nearby lymph nodes.
Pelvic Exenteration
Pelvic exenteration is a more extensive surgery to remove the uterus, cervix, vagina, ovaries, and lymph nodes. Other pelvic organs may also come out, such as the colon, rectum, and bladder, if the cancer has spread to those areas.
Pelvic exenteration is a major operation that’s done only after other treatments haven’t worked and the cancer has spread. Depending on which organs are removed, you may need another procedure to create a channel for waste to leave your body and to reconstruct the vagina.
This treatment uses powerful medicines to kill cancer cells or stop them from growing. You get chemotherapy as a pill or through a needle into a vein (IV).
The chemotherapy drug you receive depends on the stage and location of the cancer.
The following
chemotherapy drugs treat cervical cancer:
- carboplatin (Paraplatin)
- cisplatin (Platinol)
- docetaxel (Taxotere)
- fluorouracil (Adrucil)
- gemcitabine (Gemzar)
- ifosfamide (Ifex)
- irinotecan (Camptosar)
- mitomycin
- paclitaxel (Taxol)
- topotecan (Hycamtin)
- vinorelbine (Navelbine)
You may get one chemotherapy drug or a combination of these medicines. Possible side effects include hair loss, mouth sores, nausea and vomiting, appetite loss, and diarrhea. Your treatment team has ways to manage these and other side effects.
If you haven’t had surgery to remove your uterus or ovaries, you may experience changes in your menstrual cycle, premature menopause, or infertility.
Radiation therapy uses high-energy rays like X-rays to stop cancer cells from growing. It can be part of the treatment for cervical cancer (sometimes combined with chemotherapy), or it may be used as
palliative care to relieve symptoms.
The radiation is delivered either from a machine outside the body (called external beam radiation) or a device placed inside the vagina (called internal radiation therapy or brachytherapy). The most common side effects are fatigue, diarrhea, nausea, upset stomach, and irritation of the bladder, vagina, or skin where the radiation is given.
Targeted Therapy for Cervical Cancer
Targeted therapies block proteins or other substances that help cancer cells grow. Your doctor may recommend a targeted therapy if your cervical cancer doesn't respond to other treatments or comes back after treatment.
The following targeted therapies are used for cervical cancer.
Monoclonal Antibodies
Monoclonal antibodies are lab-made antibodies that target a certain protein.
Bevacizumab (Avastin) is a monoclonal antibody that targets and blocks the VEGF protein on cancer cells. Blocking the VEGF protein stops the cancer from growing blood vessels and getting a blood supply, so the cancer can’t grow. It can be used with chemotherapy.
Antibody-Drug Conjugates
Antibody-drug conjugates are a type of targeted therapy that includes two drugs in one: a monoclonal antibody linked to a chemotherapy drug. The monoclonal antibody finds and attaches to a protein on the cancer cell, delivering the linked chemotherapy drug directly to the cell to destroy it.
Two antibody-drug conjugates treat cervical cancer:
- Fam-trastuzumab deruxtecan (Enhertu) is for late-stage cervical cancer that's positive for the human epidermal growth factor receptor 2 protein.
- Tisotumab vedotin (Tivdak) targets the tissue factor protein that sits on cancer cells. This treatment is also used for late-stage cervical cancer.
RET Inhibitors
Some cervical cancer cells have an abnormal form of a protein called RET, which helps cancer cells grow. RET inhibitors target and block these abnormal proteins.
Selpercatinib (Retevmo) is a RET inhibitor used to treat advanced cervical cancer in people who have the abnormal form of the RET protein.
NTRK Inhibitors
A small number of people with cervical cancer make abnormal TRK proteins as a result of changes to their NTRK genes. NTRK inhibitors target these abnormal proteins to stop cancer cell growth. Larotrectinib (Vitrakvi) and entrectinib (Rozlytrek) are NTRK inhibitors used to treat cervical cancer.
Side effects of targeted therapies include fatigue, nausea, vomiting, diarrhea, hair loss, and low blood cell counts.
Immunotherapy helps your immune system target and kill cancer cells.
PD-1 inhibitors are a type of immunotherapy that blocks a protein called PD-1. Normally, this protein puts the brakes on immune cells to stop them from attacking your healthy cells. Cancer cells use PD-1 to hide from your immune system. By blocking PD-1, the brakes are taken off your immune system so it’s free to attack the cancer.
PD-1 inhibitors are given through an IV infusion every few weeks. Your doctor may prescribe one of the following drugs if the cancer cells test positive for the protein PD-L1:
- cemiplimab (Libtayo)
- nivolumab (Optivo)
- pembrolizumab (Keytruda)
Side effects include infusion reactions, fatigue, fever, cough, nausea, itching, and rash. Sometimes pembrolizumab causes the immune system to mistakenly attack a person’s own body, which can lead to serious complications.
According to the Centers for Disease Control and Prevention, almost all cervical cancers are preventable.
Getting
vaccinated against human papillomavirus (HPV) is an important part of prevention, but lifestyle changes can also reduce your risk for this cancer. Some of the same healthy habits also reduce the odds that the cancer will spread or come back after treatment.
- Eat a plant-based diet. Multicolored fruits and vegetables (broccoli, spinach, onions, carrots, sweet potatoes) are good sources of antioxidants like flavonoids and carotenoids that protect against cervical cancer.
- Get regular exercise. Adding a few aerobic workouts to your routine each week could help you avoid cervical cancer or live longer if you’ve already been diagnosed.
- Quit smoking. Tobacco smoke increases the risk for cervical cancer and many other cancer types.
- Limit the number of your sexual partners. Having multiple partners makes you more likely to get HPV, the virus that causes most cases of cervical cancer.
Chemotherapy, radiation therapy, and surgery are standard treatments for cervical cancer, but complementary and integrative approaches are sometimes used along with standard treatments. Complementary and integrative approaches can help you feel better while you’re undergoing treatment and relieve side effects of treatment.
Complementary and integrative therapies include these examples:
- Acupuncture, which may help relieve pain and nausea
- Aromatherapy, which may help relieve pain, nausea, and stress
- Massage to promote relaxation and help relieve anxiety, fatigue, and stress
- Meditation, which may improve mood and help relieve anxiety and stress
- Relaxation techniques such as deep breathing, creative visualization, and progressive muscle relaxation to help with anxiety, fatigue, and better sleep
- Tai chi and yoga for stress relief, reduced fatigue, and better sleep
Many of these therapies are considered safe, but because you’re undergoing cancer treatment, always check with your oncologist before trying any of the above therapies.
Cancer treatments can cause pain and other distressing side effects, as well as anxiety and depression. Palliative care helps you feel better and improves your quality of life while you’re going through treatment.
A team of care providers will work together to manage your symptoms, relieve your pain, and provide you with emotional support. Palliative care isn’t the same as
hospice care given at the end of life. Instead, palliative care is given alongside your cancer treatments to improve your physical and emotional wellness.
If a palliative care specialist isn’t already part of your cancer care team, ask your doctor to refer you to one.
Cancer affects your mind as well as your body. Up to 70 percent of women with cervical cancer have depression, according to a study in
Frontiers in Psychology.
Worries about your future, stress over your family and job, and changes to your body can all contribute to mental health issues. Your oncologist can point you to these sources of support:
- A cervical cancer support group
- One-on-one therapy with a psychologist, psychiatrist, or social worker
A cervical cancer diagnosis can feel frightening and overwhelming, but your oncologist has many effective treatments to slow or stop your cancer. Along with traditional treatments like surgery, chemotherapy, and radiation therapy, there are new approaches like immunotherapy and targeted therapy.
The outlook for this cancer continues to improve, and the earlier you start treatment, the better. When cervical cancer is caught early, the odds of surviving for at least five years are more than 90 percent, according to the National Cancer Institute.
