Treatment
Treatment depends on the stage cervical cancer has reached by the time it is diagnosed, and the grade of the tumour itself. High grade ‘grade 3’ tumours are more likely to recur than low grade ‘grade 1’ tumours.
Recurrent disease –some women will experience recurrence of their cervical cancer. After treatment cervical cancer may recur either as a growth in the pelvis or somewhere else in the body. For those with locally advanced disease like stage 4 disease, recurrence is very likely even when primary treatment is successful. The aim of treatment in stage 4 disease is to control the disease for as long as possible.
For most women surgery will be the first stage of treatment:
- Removal of the cervix alone – this is called radical trachelectomy. Pelvic lymph nodes may also be removed at the same time using keyhole surgery, this is called Laparoscopic Lymphadenectomy. This operation may enable a woman with early cancer to become pregnant afterwards by preserving the uterus. Recovery time 2 weeks
- Removal of the cervix, uterus, ovaries, lymph nodes and tissues around the womb - radical hysterectomy and bilateral salpingo-oophorectomy, may sometimes be called ‘Wertheim Hysterectomy’. Recovery time 8-12 weeks. Sometimes keyhole surgery is used and recovery is quicker.
- Pelvic exenteration means surgery to remove all of the structures in the pelvis, this can be used at diagnosis when the cancer has spread locally or when the cancer has re-grown in the pelvis. There are three types of exenteration operations:
- Anterior exenteration - remove the cervix, uterus, ovaries, lymph nodes and tissues around the womb and the bladder
- Posterior exenteration removes the cervix, uterus, ovaries, lymph nodes and tissues around the womb and the rectum
- Total exenteration removes the cervix, uterus, ovaries, lymph nodes and tissues around the womb and the bladder and the rectum
Exenteration is major surgery; it may take 3-6 months to recover physically. In addition to physical recovery the woman will need to learn how to manage at least one stoma – a colostomy or a urostomy, if not both.
Radiotherapy – treatment is given to the majority of women with cervical cancer. Only those with very early stage disease (stage 1a) or those with metastases may avoid it. If surgery is being used radiotherapy will be given afterwards.
External beam radiotherapy treatment is given 5 days a week over four to five weeks (20-25 treatments in total). For many women radiotherapy will be combined with cisplatin chemotherapy at the same time. The combination of the two treatments makes side effects from either treatment worse-. Internal radiotherapy or brachytherapy may be given at the end of the external radiotherapy treatment
- ‘Vault brachytherapy’. This is given in outpatients – 2 sessions is the maximum dose. Side effects include soreness and dryness of the vagina which may make walking painful for some weeks after treatment. In the longer term the treatment causes vaginal narrowing ‘stenosis’ which may require the use of a dilator for life.
- ‘Intracavity’ therapy – for this treatment a holder or applicator is placed in the vagina (or uterus if it has not been removed) under anaesthetic. The radioactive source is placed in the holder when the woman is moved to a lead lined treatment room. This treatment may last from 1 to 5 days. She must stay in the lead lined room during the treatment and anyone visiting her must wear radiation protection.
Women, who are unable to have surgery either because they are not fit enough or have too widespread disease for surgery to be used, may have radiotherapy as their main treatment. The treatment plan for radiotherapy is similar whether surgery has been performed or not. Usually a combination of internal radiotherapy and 4-5 weeks of external beam radiotherapy is given. Long term survival results of radiotherapy alone can be as good as surgery.
Particular problems for women who have had cervical cancer treatment are the long term side effects of radiotherapy, especially problems with bowel and bladder function, sexual problems and the psychological effects of any of these. Urinary or faecal incontinence affects 5-10% of women in the 10 years following successful radiotherapy treatment.
Chemotherapy – in primary cervical cancer treatment cisplatin is given to women weekly during radiotherapy treatment. For recurrent or advanced cancer other chemotherapy drugs may be used including ifosfamide, paclitaxel, gemcitabine or combinations of these. This will often be as part of a trial as the best treatment for recurrent or advanced cervical cancer is not known. These are likely to be given monthly instead of weekly.
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Amended February 2009
