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Cervical cancer Treatment Informatio for Patients

Table of Contents

DESCRIPTION

What is cancer of the cervix?

STAGE EXPLANATION

Stages of cancer of the cervix

Stage 0 or carcinoma in situ

Stage I

Stage II

Stage III

Stage IV

Recurrent

TREATMENT OPTION OVERVIEW

 

How cancer of the cervix is treated

Treatment by stage

STAGE 0 CERVICAL CANCER

STAGE I CERVICAL CANCER

STAGE II CERVICAL CANCER

STAGE III CERVICAL CANCER

STAGE IV CERVICAL CANCER

RECURRENT CERVICAL CANCER

DESCRIPTION

Cancer of the cervix, a common kind of cancer in women, is a disease in which cancer (malignant) cells are found in the tissues of the cervix. The cervix is the opening of the uterus (womb). The uterus is the hollow, pear-shaped organ where a baby develops. The cervix connects the uterus to the vagina (birth canal).

Cancer of the cervix usually grows slowly over a period of time. Before cancer cells are found on the cervix, the tissues of the cervix go through changes in which cells that are not normal begin to appear (known as dysplasia). A Pap smear will usually find these cells. Later, cancer cells start to grow and spread more deeply into the cervix and to surrounding areas.

Since there are usually no symptoms associated with cancer of the cervix, a doctor should do a series of tests to look for it. The first of these is a Pap smear, which is done by using a piece of cotton, a brush, or a small wooden stick to gently scrape the outside of the cervix in order to pick up cells. Pressure is sometimes felt and it is usually not accompanied by pain.

If cells that are not normal are found, the doctor will need to cut a sample of tissue (this procedure is called a biopsy) from the cervix and look at it under a microscope to see if there are any cancer cells. A biopsy that needs only a small amount of tissue may be done in the doctor's office. A person may need to go to the hospital if the doctor needs to remove a larger, cone-shaped biopsy specimen (conization).

The prognosis (chance of recovery) and choice of treatment depend on the stage of the cancer (whether it is just in the cervix or has spread to other places) and the patient's general health.

STAGE EXPLANATION

Once cancer of the cervix is found (diagnosed), more tests will be done to find out if cancer cells have spread to other parts of the body. This testing is called staging. To plan treatment, a doctor needs to know the stage of the disease. The following stages are used for cancer of the cervix.

Carcinoma in situ is very early cancer. The abnormal cells are found only in the first layer of cells of the lining of the cervix and do not invade the deeper tissues of the cervix.

Cancer involves the cervix but has not spread nearby.

stage IA: a very small amount of cancer that is only visible under a

microscope is found deeper in the tissues of the cervix

stage IB: a larger amount of cancer is found in the tissues of the cervix

Cancer has spread to nearby areas but is still inside the pelvic area.

stage IIA: cancer has spread beyond the cervix to the upper two thirds of

the vagina

stage IIB: cancer has spread to the tissue around the cervix

Cancer has spread throughout the pelvic area. Cancer cells may have spread to the lower part of the vagina. The cells also may have spread to block the tubes that connect the kidneys to the bladder (the ureters).

Cancer has spread to other parts of the body.

stage IVA: cancer has spread to the bladder or rectum (organs close to the

cervix)

stage IVB: cancer has spread to faraway organs such as the lungs

Recurrent disease means that the cancer has come back (recurred) after it has been treated. It may come back in the cervix or in another place.

TREATMENT OPTION OVERVIEW

There are treatments for all patients with cancer of the cervix. Three kinds of treatment are used:

• surgery (removing the cancer in an operation)
• radiation therapy (using high-dose x-rays or other high-energy rays to kill cancer cells)
• chemotherapy (using drugs to kill cancer cells)

Cryosurgery kills the cancer by freezing it.

Laser surgery is the use of a narrow beam of intense light to kill
cancerous cells.

Conization is the removal of a cone-shaped piece of tissue
where the abnormality is found. Conization may be used to take out a piece of tissue for biopsy, but it can also be used to treat early cancers of the cervix.

Alternatively, a doctor may perform a loop electrosurgical excision
procedure (LEEP) to remove the abnormal tissue. LEEP uses an electrical current passed through a thin wire loop to act as a knife.

A laser beam can also be used as a knife to remove the tissue.

A hysterectomy is an operation in which the uterus and cervix are taken out along with the cancer. If the uterus is taken out through the vagina, the operation is called a vaginal hysterectomy. If the uterus is taken out through a cut (incision) in the abdomen, the operation is called a total abdominal hysterectomy. Sometimes the ovaries and fallopian tubes are also removed, which is called a bilateral salpingo-oophorectomy.

A radical hysterectomy is an operation in which the cervix, uterus, and part of the vagina are removed. Lymph nodes in the area are also removed. This is called lymph node dissection. (Lymph nodes are small bean-shaped structures that are found throughout the body. They produce and store cells that fight infection).

If the cancer has spread outside the cervix or the female organs, a
doctor may take out the lower colon, rectum, or bladder (depending on where the cancer has spread) along with the cervix, uterus, and vagina. This is called an exenteration and is rarely needed. Plastic surgery may be needed to make an artificial vagina after this operation.

Chemotherapy is the use of drugs to kill cancer cells. Chemotherapy may be taken by pill, or it may be put into the body by a needle inserted into a vein. Chemotherapy is called a systemic treatment because the drugs enter the bloodstream, travel through the body, and can kill cancer cells outside the cervix.

Treatments for cancer of the cervix depend on the stage of the disease, the size of the tumor, and the patient's age, overall condition, and desire to have children.

Treatment of cervical cancer during pregnancy may be delayed depending on the stage of the cancer and how many months a patient has been pregnant.

Standard treatment may be considered because of its effectiveness in patients in past studies, or participation in a clinical trial may be considered. Not all patients are cured with standard therapy and some standard treatments may have more side effects than are desired. For these reasons, clinical trials are designed to find better ways to treat cancer patients and are based on the most up-to-date information. Clinical trials are ongoing in most parts of the country for most stages of cancer of the cervix. To learn more about clinical trials, call the Cancer Information Service at 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615.

STAGE 0 CERVICAL CANCER

Stage 0 cervical cancer is sometimes called carcinoma in situ.

Treatment may be one of the following:

1. Conization.

2. Laser surgery.

3. Loop electrosurgical excision procedure (LEEP).

4. Cryosurgery.

5. Surgery to remove the cancerous area, cervix, and uterus (total abdominal or vaginal hysterectomy) for those women who cannot or no longer want to have children.

STAGE I CERVICAL CANCER

Treatment may be one of the following depending on how deep the tumor cells have invaded into the normal tissue:

For stage IA cancer:

1. Surgery to remove the cancer, uterus, and cervix (total abdominal hysterectomy). The ovaries may also be taken out (bilateral salpingo- oophorectomy), but are usually not removed in younger women.

2. Conization.

3. For tumors with deeper invasion (3-5 millimeters): Surgery to remove the cancer, the uterus and cervix, and part of the vagina (radical hysterectomy) along with the lymph nodes in the pelvic area (lymph node dissection).

4. Internal radiation therapy.

For stage IB cancer:

1. Internal and external radiation therapy.

2. Radical hysterectomy and lymph node dissection.

3. Radical hysterectomy and lymph node dissection followed by radiation therapy plus chemotherapy.

4. Radiation therapy plus chemotherapy.

STAGE II CERVICAL CANCER

Treatment may be one of the following:

For stage IIA cancer:

1. Internal and external radiation therapy.

2. Radical hysterectomy and lymph node dissection.

3. Radical hysterectomy and lymph node dissection followed by radiation therapy plus chemotherapy.

4. Radiation therapy plus chemotherapy.

For stage IIB cancer:

1. Internal and external radiation therapy plus chemotherapy.

STAGE III CERVICAL CANCER

Treatment may be one of the following:

1. Internal and external radiation therapy plus chemotherapy.

STAGE IV CERVICAL CANCER

Treatment may be one of the following:

For stage IVA cancer:

1. Internal and external radiation therapy plus chemotherapy.

For stage IVB cancer:

1. Radiation therapy to relieve symptoms caused by the cancer.

2. Chemotherapy.

RECURRENT CERVICAL CANCER

If the cancer has come back (recurred) in the pelvis, treatment may be one of the following:

1. Radiation therapy combined with chemotherapy.

2. Chemotherapy to relieve symptoms caused by the cancer.