There are two main types of cancer of the cervix; each one develops from different tissue types. The most common (about 80 percent to 90 percent) are squamous cell carcinomas. The other 10 percent to 20 percent are adenocarcinomas.
Squamous cell carcinoma develops in the lining of the cervix.
Treatment options are the same regardless if a cervical cancer is squamous or adenocarcinoma.
Cystoscopy and Proctoscopy
If advanced cancer is diagnosed and your doctor suspects the cancer may have spread beyond the cervix, a cytoscopy or proctoscopy may be done using a lighted tube to view the inside of the bladder (cystoscopy) or the anus, rectum, and lower colon (proctoscopy).
To learn more about the extent of disease and suggest a course of treatment, the doctor may order some of the following imaging tests:
Chest X-ray: This is a picture of the chest that shows your heart, lungs, airway, blood vessels and lymph nodes. A chest X-ray can often show whether cancer has spread to the lungs.
Computed tomography (CT) scan: This diagnostic test uses an X-ray machine and a computer to create detailed pictures of the body, including 3-D images. It is used to detect disease outside the cervix or abnormal organ structure. CT scans also can be used to guide a needle into a mass if a biopsy is needed.
Magnetic resonance imaging (MRI): This diagnostic test uses magnetic fields and radio waves to create computerized pictures of the pelvis and abdomen. You may have to be placed in a tube, which can feel confining to people who have a fear of enclosed spaces.
Treatment for Cervical Cancer
Treatment of cervical cancer will depend on a number of factors, including:
The stage of the cancer
The size of the tumor
The patient's desire to have children
The patient's age and overall health
Surgery for Large, Cervical Cancer Lesion
The following surgical procedures may be used for larger cervical cancer lesions (usually up to 4 to 5 centimeters in width), but only if the cancer is all within the cervical tissue. If the cancer has spread beyond the cervix, doctors will usually recommend chemotherapy in combination with radiation therapy.
Trachealectomy: This procedure removes the cervix and surrounding tissue but not the uterus. It is used for women who have a larger cancerous area but wish to preserve the ability to have children. The procedure may include removal of lymph nodes. Typically patients considered for this procedure have to have tumors less than 2 centimeters in size.
Radical hysterectomy: The surgeon removes the cervix, uterus, part of the vagina and the tissues surrounding the cervix called the parametria. At the same time, the surgeon also removes nearby lymph nodes. Depending on a woman's age and the size of the tumor, she may also have a bilateral salpingo-oophorectomy (removal of the ovaries and fallopian tubes).
Radiation therapy is used for cancers that have spread beyond the cervix (II, III, or IV) or very large lesions (larger than 4 centimeters).Radiation therapy uses high-energy X-rays or other types of radiation to kill cancer cells or shrink the tumor. Radiation therapy is used instead of surgery in most cases. However, it is sometimes necessary after surgery if it is discovered that the cancer has spread outside the cervix, or to reduce the risk that a cancer will come back after surgery.There are two types of radiation therapy: external and internal.
External radiation therapy uses a machine outside the body to send radiation toward the cervical cancer. Internal radiation therapy uses a small amount of radioactive material that is delivered directly to the tumor using implants.Internal radiation therapy implants are inserted through the vagina into the cervix, where they are placed next to the tumor while the patient is under anesthesia. The implants stay in place for a few days.
Chemotherapy uses drugs to stop the growth of cancer cells either by killing the cells or by stopping them from dividing. Chemotherapy can be given by mouth or injected into a vein or muscle. In most cases, it is given to a patient through a vein during an outpatient visit using systemic chemotherapy. The drugs enter the bloodstream and can reach cancer cells throughout the body.
Regional chemotherapy is chemotherapy is placed directly into an organ or a body cavity, such as the abdomen. Almost all cervical cancer patients in good medical condition and receiving radiation for stage IIA or higher will be offered chemotherapy in addition to radiation therapy.
Women with endometrial, cervical and ovarian cancers have the option of treating their disease with laparoscopic surgery, a minimally invasive procedure with advantages over traditional surgery, experts say.
“Laparoscopic surgery offers patients the benefit of faster recovery, less pain medication and quicker return to daily activities without compromising outcome and prognosis," says Pedro Ramirez, M.D., an assistant professor in M. D. Anderson’s Department of Gynecologic Oncology and director of Minimally Invasive Surgery.
Laparoscopic surgery is currently performed in the treatment of gynecologic cancers in just a few of the country’s cancer centers. “It provides patient safety that is comparable with traditional “open” surgery,” Ramirez says. Laparoscopy’s role in treating cancer has grown by leaps and bounds as more surgeons have become experienced at performing the procedure.
The laparoscope is a long, slender tube with a tiny camera on the end. An incision about an inch in length is made to insert the laparoscope, which gives surgeons a view of the treatment area. Other incisions, tiny enough to be covered with a Band-Aid, are made to insert miniature surgical instruments that can remove a cancerous tumor or an entire diseased organ, in some cases.
M. D. Anderson performs laparoscopic surgeries for:
Cervical cancer – Cervical cancer patients have the option of laparoscopic radical hysterectomy and staging. (Staging involves tests and procedures that determine the extent of the cancer.) Patients can be discharged from the hospital, potentially, the first day after surgery. Ramirez says that the “length of stay for a traditional abdominal radical hysterectomy usually is four to five days, and the recovery period is usually four to six weeks.”
Laparoscopy also can be used to evaluate spread of locally advanced cervical cancers to the lymph nodes. Besides removing malignant lymph nodes, the procedure allows radiation oncologists to determine the treatment field for radiation therapy with higher accuracy, which may ultimately reduce the risk of cancer recurrence.
When cervical cancer is detected early it is one of the most successfully treatable cancers. The five-year relative survival rate of localized cervical cancer is 92%, according to the American Cancer Society.