To explain the standard kinds of treatment options available to cervical cancer patients, the following treatments will be grouped by the stage of the cancer. The stage of a cancer tells a clinician how far the cancer has spread and helps to determine a treatment plan. Different systems can be used to stage your cancer, although, they are usually numbered from 1 to 4.
Carcinoma in situ (CIS)
Carcinoma in situ, also referred to as stage 0 cervical cancer, means that some of the cells in the cervix have undergone cancerous changes [9]. CIS is non-invasive; as the cancerous cells remain on the surface of your cervix and have not infiltrated more deeply into your tissue. Treatment for CIS is similar to that for cervical dysplasia, as it is not yet invasive, it is usually treated as a precancerous condition [10].
For that reason, cryosurgery, laser surgery or loop electrosurgical excision procedure (LEEP) are surgical options available for CIS. Cone biopsies are used, but less often than the other procedures [11]. Once CIS is treated, follow-up visits and Pap smears are required every three to six months [12].
Stage 1
Stage 1 means the cancer is situated in the neck of the cervix. It is often divided into Stage 1A and Stage 1B, which are then subdivided into stage 1A1 and stage 1A2 and stage 1B1 and stage 1B2. In Stage 1A, the growth is so small it can only be seen with a microscope [13]:
- Stage 1A1 means that the cancer has grown less than 3 mm into the tissues of the cervix, and it is less 7 mm wide
- Stage 1A2 means the cancer has grown between 3 and 5 mm, but it is still less than 7 mm wide
- In stage 1B, the cancerous areas are larger, but the cancer is still only in the tissues of the cervix and has not usually spread:
- In stage 1B1, the cancer is no larger than 4 cm
- In stage 1B2, the cancer is larger than 4 cm across
Stage 2
In stage 2 cervical cancer, the cancer has begun to spread outside the neck of the cervix into the surrounding tissues. It has not yet grown into the muscles or ligaments that line pelvic wall or to the lower part of the vagina. In stage 2A, the cancer has spread down into the top of the vagina and, in stage 2B, there is spread up into the tissues around the cervix. As with stage 1, stage 2 can be divided in stage 2A and stage 2B and then subdivided (2A1, 2A2, 2B) based on the growth [16].
[17][18] Cervical cancer stages 2A-B
Treatment for very early cervical cancer
Early cervical cancer is defined as cancer that is located only in the neck of the cervix (stage 1A or 1B) or a cancer that has begun to grow into the top of the vagina (stage 2A). Depending on the stage of your cancer, you will work with your healthcare team to develop a treatment plan that is appropriate for you. For example, treatment for very early cervical cancer may involve a cone biopsy or a radical trachelectomy (the removal of the cervix) [19].
For a small number of women, in the very early stages of cervical cancer, a radical trachelectomy can leave behind enough of the cervix so that a patient may still be able to become pregnant and have a baby. However, a clinician cannot guarantee that you will be able to have children afterwards [20]. A discussion will need to happen with your specialist to find out if this type of treatment is an option.
Radical trachelectomy
Radical trachelectomy means that a surgeon will try to remove all of the cancer, but leave an internal opening of the cervix. A small opening is left to allow the flow of menstruation. The idea is that a stitch will support a pregnancy until a baby can born caesarian section. As mentioned previously, however, this is only possible if you have very early small stage cervical cancer [21]. In some instances, a radical trachelectomy may not be possible and a hysterectomy may be necessary, especially if the cancer has spread further.
Keyhole surgery
More and more hysterectomies for early cervical cancer are being performed using keyhole surgery, alternatively called minimal access or laparoscopic surgery. This minimizes the wound impact, leaving the patient with several smaller wounds as opposed to one large wound site. The doctor uses those smaller wounds site to insert small surgical instruments and laparoscope, a telescope-like device [22].
Treatment for early cervical cancer
Early cervical means that the cancer is located only in the neck of the uterus (stage 1A or 1B) or that the cancer has started to grow into the top of the vagina (stage 2A). The main treatments for stage 1A, 1B and 2A cervical cancer are surgery and radiotherapy or a combination of both of those treatments.
Surgery involves having both your cervix and uterus removed, which is called a hysterectomy. If the cancer has progressed into the tissues of the cervix (stage 1A2 and further), you will need to have your lymph nodes in the pelvis removed—this is called a lymphadenectomy. This surgery is performed because there is a risk that the cancer may have spread from the cervix to nearby lymph nodes [23].
Radiotherapy uses high energy waves to treat cervical cancer by treating the uterus, cervix and surrounding tissues. To ensure that all of the cancer cells have been removed after surgery, your clinician may recommend radiotherapy to lower the chance of the cancer coming back [24]. In larger early stage cancers, such as stage 1B or stage 2A, combined chemotherapy and radiotherapy (chemoradiation) may be suggested [25].
If you have the option to choose the kind of treatment to receive, between either a hysterectomy or radiotherapy, doing research, considering the benefits and drawbacks of both kinds of treatment and discussing which one suits you best with your clinician may help you in making an informed decision. A surgeon may prefer you to have radiotherapy if your health would be further compromised by surgery, or if your surgeon thinks that the surgery may not remove all the cancer cells and you would require radiotherapy afterwards regardless [26]. Furthermore, if your clinician thinks you may need radiotherapy after surgery, radiotherapy may be your best option as having both treatments increases your risk of long-term side effects [27].
References
[9] “Cervical Cancer Stages.” Cervical Cancer Stages. Cancer Research UK, 2015. Web. 24 Sept. 2015.
[10] “Treatment for Cervical CIS.” Cervical Carcinoma In Situ. Healthline, 23 July 2012. Web. 24 Sept. 2015.
[11] ibid.
[12] ibid.
[13] “Cervical Cancer Stages.” Cervical Cancer Stages. Cancer Research UK, 2 June 2014. Web. 24 Sept. 2015.
[14] Stage 1A. Digital image. Cervical Cancer Stages. Cancer Research UK, 2 June. 2014. Web. 24 Sept. 2015.
[15] Stage 1B. Digital image. Cervical Cancer Stages. Cancer Research UK, 2 June. 2014. Web. 24 Sept. 2015.
[16] “Cervical Cancer Stages.” Cervical Cancer Stages. Cancer Research UK, 2 June 2014. Web. 24 Sept. 2015.
[17] Stage 2A. Digital image. Cervical Cancer Stages. Cancer Research UK, 2 June 2014. Web. 24 Sept. 2015.
[18] Stage 2B. Digital image. Cervical Cancer Stages. Cancer Research UK, 2 June 2014. Web. 24 Sept. 2015.
[19] “Treating Early Cervical Cancer.” Treating Early Cervical Cancer. Cancer Research UK, 17 June 2014. Web. 25 Sept. 2015.
[20] ibid.
[21] “Radical Trachelectomy.” Surgery for Cervical Cancer. Cancer Research UK, 2 June 2014. Web. 29 Sept. 2015.
[22] “Keyhole surgery.” Surgery for Cervical Cancer. Cancer Research UK, 2 June 2014. Web. 29 Sept. 2015.
[23] “About Cervical Cancer Radiotherapy.” About Cervical Cancer Radiotherapy. Cancer Research UK, 20 Aug. 2014. Web. 25 Sept. 2015.
[24] “Treating Early Cervical Cancer.” Treating Early Cervical Cancer. Cancer Research UK, 17 June 2014. Web. 25 Sept. 2015.
[25] ibid.
[26] ibid.
[27] “Cervical Cancer Stages.” Cervical Cancer Stages. Cancer Research UK, 2 June 2014. Web. 25 Sept. 2015.