Booklet: What You Need to Know about Cervical Cancer

Treating Cancer of the Cervix

Staging

The choice of treatment for cervical cancer depends on the location and size of the tumor, the stage (extent) of the disease, the woman's age and general health, and other factors.

Staging is a careful attempt to find out whether the cancer has spread and, if so, what parts of the body are affected. Blood and urine tests usually are done. The doctor also may do a thorough pelvic exam in the operating room with the patient under anesthesia. During this exam, the doctor may do procedures called cystoscopy and proctosigmoidoscopy. In cystoscopy, the doctor looks inside the bladder with a thin, lighted instrument. Proctosigmoidoscopy is a procedure in which a lighted instrument is used to check the rectum and the lower part of the large intestine. Because cervical cancer may spread to the bladder, rectum, lymph nodes, or lungs, the doctor also may order x-rays or tests to check these areas. For example, the woman may have a series of x-rays of the kidneys and bladder, called an intravenous pyelogram. The doctor also may check the intestines and rectum using a barium enema. To look for lymph nodes that may be enlarged because they contain cancer cells, the doctor may order a CT or CAT scan, a series of x-rays put together by a computer to make detailed pictures of areas inside the body. Other procedures that may be used to check organs inside the body are ultrasonography and MRI.

Getting a Second Opinion

Before starting treatment, the patient may want a second pathologist to review the diagnosis and another specialist to review the treatment plan. Some insurance companies require a second opinion; others may cover a second opinion if the patient requests it. It may take a week or two to arrange for a second opinion. This short delay will not reduce the chance that treatment will be successful. There are a number of ways to find a doctor who can give a second opinion:

• The woman's doctor may be able to suggest pathologists and specialists to consult.
• The Cancer Information Service, at 1-800-4-CANCER, can tell callers about treatment facilities, including cancer centers and other programs supported by the National Cancer Institute.
• Women can get the names of specialists from their local medical society, a nearby hospital, or a medical school.

Preparing for Treatment

Most women with cervical cancer want to learn all they can about their disease and treatment choices so they can take an active part in decisions about their medical care. Doctors and others on the medical team can help women learn what they need to know.

When a person is diagnosed with cancer, shock and stress are natural reactions. These feelings may make it difficult for patients to think of everything they want to ask the doctor. Often it helps to make a list of questions. Also, to help remember what the doctor says, patients may take notes or ask whether they may use a tape recorder. Some people also want to have a family member or friend with them when they talk to the doctor--to take part in the discussion, to take notes, or just to listen.

Patients should not feel they need to ask all their questions or remember all the answers at one time. They will have other chances to ask the doctor to explain things and to get more information.

Here are some questions a woman with cervical cancer may want to ask the doctor before her treatment begins:

• What is the stage (extent) of my disease?
• What are my treatment choices? Which do you recommend for me? Why?
• What are the chances that the treatment will be successful?
• Would a clinical trial be appropriate for me?
• What are the risks and possible side effects of each treatment?
• How long will treatment last?
• Will it affect my normal activities?
• What is the treatment likely to cost?
• What is likely to happen without treatment?
• How often will I need to have checkups?

Methods of Treatment

Most often, treatment for cervical cancer involves surgery and radiation therapy. Sometimes, chemotherapy or biological therapy is used. Patients are often treated by a team of specialists. The team may include gynecologic oncologists and radiation oncologists. The doctors may decide to use one treatment method or a combination of methods. Some patients take part in a clinical trial (research study) using new treatment methods. Such studies are designed to improve cancer treatment. More information about clinical trials is in the Clinical Trials section.

Surgery is local therapy to remove abnormal tissue in or near the cervix. If the cancer is only on the surface of the cervix, the doctor may destroy the cancerous cells in ways similar to the methods used to treat precancerous lesions. If the disease has invaded deeper layers of the cervix but has not spread beyond the cervix, the doctor may perform an operation to remove the tumor but leave the uterus and the ovaries. In other cases, however, a woman may need to have a hysterectomy or may choose to have this surgery, especially if she is not planning to have children in the future. In this procedure, the doctor removes the entire uterus, including the cervix; sometimes the ovaries and fallopian tubes also are removed. In addition, the doctor may remove lymph nodes near the uterus to learn whether the cancer has spread to these organs.

Here are some questions a woman may want to ask the doctor before surgery:

• What kind of operation will it be?
• How will I feel after the operation?
• If I have pain, how will you help me?
• When can I return to my normal activities?
• How will this treatment affect my sex life?

Radiation therapy (also called radiotherapy) uses high-energy rays to damage cancer cells and stop them from growing. Like surgery, radiation therapy is local therapy; the radiation can affect cancer cells only in the treated area. The radiation may come from a large machine (external radiation) or from radioactive materials placed directly into the cervix (implant radiation). Some patients receive both types of radiation therapy.

A woman receiving external radiation therapy goes to the hospital or clinic each day for treatment. Usually treatments are given 5 days a week for 5 to 6 weeks. At the end of that time, the tumor site very often gets an extra "boost" of radiation.

For internal or implant radiation, a capsule containing radioactive material is placed directly in the cervix. The implant puts cancer-killing rays close to the tumor while sparing most of the healthy tissue around it. It is usually left in place for 1 to 3 days, and the treatment may be repeated several times over the course of 1 to 2 weeks. The patient stays in the hospital while the implants are in place.

The National Cancer Institute booklet Radiation Therapy and You, contains more information about this form of treatment.

Here are some questions a woman may want to ask the doctor before radiation therapy:

• What is the goal of this treatment?
• How will the radiation be given?
• How long will treatment last?
• How will I feel during therapy?
• What can I do to take care of myself during therapy?
• Can I continue my normal activities?
• How will this treatment affect my sex life?

Chemotherapy is the use of drugs to kill cancer cells. It is most often used when cervical cancer has spread to other parts of the body. The doctor may use just one drug or a combination of drugs.

Anticancer drugs used to treat cervical cancer may be given by injection into a vein or by mouth. Either way, chemotherapy is systemic treatment, meaning that the drugs flow through the body in the bloodstream.

Chemotherapy is given in cycles: a treatment period followed by a recovery period, then another treatment period, and so on. Most patients have chemotherapy as an outpatient (at the hospital, at the doctor's office, or at home). Depending on which drugs are given and the woman's general health, however, she may need to stay in the hospital during her treatment.

Here are some questions a woman may want to ask the doctor before chemotherapy begins:

• What is the goal of this treatment?
• What drugs will I be taking?
• Do the drugs have side effects? What can I do about them?
• How long will I need to take this treatment?

Biological therapy is treatment using substances to improve the way the body's immune system fights disease. It may be used to treat cancer that has spread from the cervix to other parts of the body. Interferon is the most common form of biological therapy for this disease; it may be used in combination with chemotherapy. Most patients who receive interferon are treated as outpatients.

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