Cervical Cancer Treatment
Cervical cancer begins in the cells of the cervix, which connects the lower end of the uterus to the vagina. In most cases, the cancer develops gradually over time. Before a tumor forms in the cervix, healthy cells undergo abnormal changes (dysplasia). If not destroyed or removed, the abnormal cells may transform into cancerous cells, which can potentially grow and spread more deeply into the cervix and surrounding tissues.
Cervical cancer treatment can vary depending on the location and stage of the tumor and the patient’s health and preferences, including whether she would like to preserve her fertility. For early-stage cervical cancer, the first-line treatment is usually surgery. However, many patients receive a customized combination of surgery, radiation therapy, chemotherapy, targeted therapy and/or immunotherapy.
Surgery for cervical cancer
There are several surgical approaches to treating cervical cancer, including:
- Surgery to remove the precancerous cells only - Cervical dysplasia may be addressed with laser surgery, which involves inserting a thin laser into the vagina and generating a focused beam of intense light to vaporize the abnormal cells on the surface of the cervix.
- Surgery to remove the cancerous cells only - A very small cervical tumor can sometimes be completely removed with a cone biopsy, such as a cold knife conization, laser conization or loop electrosurgical excision procedure (LEEP). These fertility-preserving procedures involve removing a cone-shaped piece of cervical tissue while leaving the remainder of the cervix intact.
- Surgery to remove the cervix - A small cervical tumor can sometimes be addressed with a radical trachelectomy. This fertility-preserving procedure involves removing the entire cervix and some surrounding tissues while leaving the uterus intact.
- Surgery to remove the cervix and uterus - A cervical tumor that has not spread beyond the cervix may be treated with a hysterectomy, which involves removing the cervix, uterus, part of the vagina and some surrounding structures and lymph nodes. In some cases, the surgeon will perform the procedure using minimally invasive techniques and/or robotic assistance for heightened precision.
- Surgery to remove the ovaries and fallopian tubes - If a cervical tumor has spread beyond the cervix and uterus to the ovaries and fallopian tubes, a unilateral or bilateral salpingo-oophorectomy may be performed along with a hysterectomy to remove the cancerous structures.
- Surgery to remove the bladder, rectum and part of the colon - If a cervical tumor has spread throughout the pelvis, a pelvic exenteration and pelvic lymph node dissection may be performed along with a hysterectomy.
Radiation therapy for cervical cancer
Radiation therapy involves the use of high-energy beams, such as X-rays, to destroy cancerous cells or prevent their growth by damaging their DNA. The types of radiation therapy that can be used to treat cervical cancer and relieve its symptoms include:
- External beam radiation therapy (EBRT) - A machine located outside the patient’s body (linear accelerator) is used to generate the beams and aim them at the tumor site.
- Intensity-modulated radiation therapy (IMRT) - A type of three-dimensional (3D) radiation therapy, IMRT uses a computer to create a detailed rendering of the tumor. Thin beams of radiation of varying intensities are then aimed directly at the tumor from many different angles.
- Internal radiation therapy (brachytherapy) - A small amount of a radioactive substance is sealed within seeds, pellets or wires, which are surgically placed at or near the tumor site.
Chemotherapy for cervical cancer
Chemotherapy may be considered to address cervical cancer that has spread beyond the cervix to distant organs and tissues. This systemic treatment involves the intravenous or oral administration of powerful cancer-fighting drugs, which enter the bloodstream and travel throughout the body to target and destroy rapidly dividing cells, such as cervical cancer cells.
Immunotherapy for cervical cancer
Immunotherapy is a class of treatments that capitalize on the power of the body’s own immune system to target and destroy cancerous cells. Currently, three immunotherapy options are approved by the U.S. Food and Drug Administration (FDA) for treating cervical cancer:
- Bevacizumab (Avastin®) - A monoclonal antibody, bevacizumab targets the VEGF/VEGFR pathway and inhibits tumor blood vessel growth. Its use in combination with chemotherapy is FDA-approved for certain patients with advanced cervical cancer.
- Tisotumab vedotin (Tivdak™) - An antibody-drug conjugate, tisotumab vedotin targets tissue factor (TF) and is FDA-approved for certain patients with advanced cervical cancer.
- Pembrolizumab (Keytruda®) - A checkpoint inhibitor, pembrolizumab targets the PD-1/PD-L1 pathway and is FDA-approved for certain patients with advanced cervical cancer that has PD-L1 expression, high microsatellite instability (MSI-H), DNA mismatch repair deficiency (dMMR) or high tumor mutational burden (TMB-H).
Clinical trials for cervical cancer
The driving force behind all medical advances, clinical trials are important research studies that are carefully designed in a laboratory. The goal is to allow scientists to evaluate the effectiveness of promising new medical interventions—such as diagnostic tests, surgical tools and techniques, chemotherapy drugs and drug combinations and medical devices—compared to the current standard of care.
Every medical intervention used today was once the subject of a clinical research study. In addition to helping all current and future patients, participants in cervical cancer clinical trials can be among the first to benefit from groundbreaking therapies that are not yet available in other settings. Participants can feel confident that they will receive the new therapy or the current standard of care. They can also opt out of the trial at any time, even after they have signed a consent form. If a patient chooses to leave an ongoing study, their team will help them explore other options to ensure the best possible care.
Frequently asked questions about cervical cancer treatment
The following FAQs-related articles provide additional information about cervical cancer treatment:
- How treatable is cervical cancer?
- What are the risks of cervical cancer surgery?
- Four things you should know about chemotherapy for cervical cancer
- How do I manage the side effects of cervical cancer treatment?
Benefit from world-class care at Moffitt Cancer Center
The latest options in cervical cancer treatment are available from the multispecialty team in the renowned gynecological clinic at Moffitt. In a single, convenient location, our patients have access to gynecologic oncologists, medical oncologists and radiation oncologists, as well as social workers, dietitians and other supportive care specialists.
If you or a loved one is in need of cervical cancer treatment, you can request an appointment with a specialist in our gynecological clinic by calling 1-888-663-3488 or submitting a new patient registration form online. We do not require referrals.