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. Suring 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 he 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 the areas inside the body. Other procedures that may be used to check organs inside the body are ultrasonography and MRI.
Our James Care for Life Gynecology Oncology Patient Education notebook has a special section for recording symptoms, salutation and care diary, and listing of questions for the physician.
Here are some questions a woman with cervical cancer may want to ask the doctor before her treatment begins:
What is the sage (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 checkups?
Most often, treatment for cervical cancer involves surgery, radiation therapy and/or chemotherapy. Patients are often treated by a team of specialist. The team should include gynecologic oncologist and radiation oncologist. A The James Cancer Hospital the gynecologic oncologist is considered the primary care oncology physician for patients with gynecologic malignancy. The doctors may decide to use one treatment method or a combination of methods. Some patients take part in clinical trials (research study) using new treatment methods. Such studies are designed to improve cancer treatments.
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 most cases, however, a woman needs specialized hysterectomy (radical hysterectomy). The gynecologic oncologist is specially trained to perform this complicated surgical procedure. In this procedure, the gynecologic oncologist removes the entire uterus and cervix as well as tissues in the immediate area. Sometimes the ovaries and fallopian tubes are removed as well. In addition, the gynecologic oncologist usually removes lymph nodes in the pelvis (pelvic Lymphadenectomy) as a therapeutic measure and to determine whether the cancer has spread to this area.
Radiation Therapy (also called radiotherapy) uses high-energy x-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). Most patients receive both types of radiation therapy.
Chemotherapy is the use of drugs to kill cancer cells. It is most often use when cervical cancer has spread to other parts of the body. The doctor may use just one drug or a combination of drugs. However, recent large randomized trials (studies) have shown that the addition of chemotherapy to irradiation improves the treatment results and survival in patients with bulky, large early stage or advanced cervical cancer. Anticancer drugs used to treat cervical cancer maybe 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.
