How is cervical cancer treated?
Once it has been confirmed that cervical cancer is present there are a number of different treatment pathways available, depending on the type of cancer, which stage it is at, and how far it has spread. The first stage of the treatment process involves speaking with a cancer care team or oncologist about the type or types of treatment that would be most suitable for you. They can advise and guide you through the available options but the ultimate decision rests with you. Factors to take into account when making the decision include your age, your health, your medical history, personal preference and domestic circumstances.
A number of different surgical procedures treat cervical cancer, whether it be pre-cancerous, early stage or advanced.
A therapy called cryosurgery treats cells which are precancerous or at a very early stage. Cryosurgery uses liquid nitrogen to freeze and destroy the cells, which is inserted into the cervix via a probe. This is an outpatient procedure which is usually performed at a clinic or doctor's surgery.
Likewise, laser surgery is another treatment which is used to treat pre-cancerous cells in the cervix. A high-intensity beam is directed into the cervix, whereby the energy of the laser is able to kill any abnormal cells. Like cryotherapy, laser surgery does not require a hospital say but it is usually carried out under a local anesthetic.
If cells have turned cancerous and spread into surrounding tissue of the cervix (but not to nearby lymph nodes) then a hysterectomy is often advised. A hysterectomy removes the entire uterus, including the cervix, but keeps all other components of the reproductive system in place, while the lymph nodes are usually left untouched.
Traditionally the uterus has been removed either through the vagina or the abdomen, but modern techniques such as laparoscopy allow for the procedure to be carried out with minimal invasion. During laparoscopy a thin tube with a camera known as a laparoscope is placed into the abdomen through a number of very small surgical incisions. The laparoscope is then used to control the surgical tool which remove the uterus, meaning there is no need to make a large incision in the abdomen. Having the uterus removed laparoscopically reduces the required hospital stay to 2 or 3 days, as opposed to upwards of a week if the hysterectomy is not laparoscopic.
A radical hysterectomy follows much the same procedure but also removes some of the tissue that surrounds the uterus, and is carried out when there is evidence that cancerous cells have spread further and deeper beyond the cervix.
Full recovery from a hysterectomy takes around 1-2 months. The procedure does not affect sexual pleasure but does result in infertility. This is something to consider if you are thinking about a hysterectomy for cervical cancer but still wish to have children in the future. For women who undergo a hysterectomy but do not wish to become infertile a procedure called a trachelectomy is sometimes offered. A trachelectomy removes the cervix but not the body of the uterus, whilst an artificial opening is inserted. This gives women a chance of a successful pregnancy, although those who have had a trachelectomy are more likely to have a miscarriage.
Many women experience recurrent cervical cancer, meaning the cancer returns at some point after the initial treatment. This often means it has spread beyond the cervix, for example to the pelvis, the bladder, the colon or the rectum. Pelvic exenteration is the name of the procedure which treats a recurrent cervical cancer, which involves a radical hysterectomy alongside the removal of the pelvic lymph nodes and any surrounding organ or tissue that the cancer has spread to.
Radiation therapy can be used alongside surgery and chemotherapy in the treatment of cervical cancer. It can either be external beam therapy, where radiation is applied to the cancerous cells from outside the body, or brachytherapy, which reaches the cells internally through the vagina. Both treatments work very much in the same way, killing cancer cells using very high intensity radiation.
External beam radiation therapy is given over the course of 6 weeks to a month, and you will need 3-5 sessions a week at the hospital. It is performed in a similar way to an x-ray, but the radiation dosage involved is much higher.
Brachytherapy, on the other hand, requires you to undergo sessions of a few minutes once a week, for a period of about 3 or 4 weeks. The radioactive material is placed in a vessel, usually made of metal, and inserted into the vagina where it needs to remain for 10 minutes or so before being removed.
Radiation therapy comes with a range of side-effects, the extent of which depend upon how strong the dosages are. Side-effects include fatigue, nausea, difficulty urinating or more regular urination, blood discharge, stomach upset and changes to the skin.
Like radiotherapy, chemotherapy treatments attacks cancerous cells and stops them reproducing. Chemotherapy uses anti-cancer drugs which are fed into the bloodstream either through a vein or in the form of a tablet, and holds the advantage of being able to reach cells all over the body rather that in a localized area.
Chemotherapy drugs can be given intravenously at a clinic/hospital, but in tablet form it can be taken at home. The side-effects are very similar to those of radiation therapy. The two treatments can also be used in combination, which results in the side-effects being particularly severe.
What is the cervix?
The cervix is a collection of tissue and cartilage in the shape of a cylinder which connects the vagina to the uterus, forming part of the female reproductive system. Measuring only around 1 inch across, the cervix plays an important role in the menstrual cycle, in promoting pregnancy and during childbirth. It widens slightly during menstruation, allowing the menstrual flow to pass freely. During the menstrual cycle it also produces a mucus which works to either prevent or promote successful fertilization. At the end of a pregnancy, the cervix widens to ease the childbirth process.
What is cervical cancer and what are the symptoms?
As with most forms of the disease, cervical cancer occurs when healthy cells turn cancerous and begin to reproduce. It begins in the lining of the cervix in the lower part of the uterus, otherwise known as the uterine cervix.
Cervical cancer starts with cells which a pre-cancerous. This means they are not cancer cells but could potentially mutate at some point the future. The best way to prevent this cancer from developing is early diagnosis, and the most effective method of spotting pre-cancerous cells is known as a pap test, sometimes called a smear test. During this procedure a doctor extracts cells from the cervice and assesses them under a microscope to see if they are cancerous or precancerous, with any precancerous cells treated and removed. Precancerous cells cause no noticeable symptoms.
If precancerous cells in the cervix are not spotted and are allowed to mutate, however, it can result in a number of symptoms developing. These can include:
- Abnormal vaginal bleeding, e.g. discharge that isn't caused by usual menstruation
- Discomfort and pain during sexual intercourse
- Changes to the menstrual cycle – late, early or irregular periods
- Unexplained vaginal discharge
Cervical cancer which has reached a particularly advanced stage displays the above symptoms, plus other signs such as:
- Difficulty urinating due to kidney problems
- Pain in the pelvis, the leg and the lower back over a period of weeks or months
- Unexplained weight loss
How is cervical cancer diagnosed?
If you are experiencing any of the the symptoms of cervical cancer you should consult a doctor or your gynecologist as soon as possible, even if the symptoms are only mild. You will also be sent to a gynecologist for further tests if you return a set of abnormal pap test results, even if you are not experiencing any symptoms.
The doctor carries out a physical exam to check your overall health and also to monitor any signs of abnormality in the lymph nodes. Your gynecologist might also ask you about your family medical history: studies suggest that women with close relatives who have previously contracted cervical cancer have a higher chance of getting the disease.
When symptoms are present or the pap test is abnormal, the first step is usually a test known as colposcopy. An instrument called a colposcope examines the surface of the cervix, with the doctor looking for anything out of the ordinary which needs further inspection. If anything abnormal is observed then the doctor usually advises more tests.
A cervical biopsy confirms whether cancer is present and if so, reveals what the stage the cancer is at. Your gynaecologist removes a small sample of tissue from the cervix and send it away to test for cancerous cells.
There are also a number of diagnostic tests available to check whether the cancer has spread beyond the cervix. These include x-rays, CT scans and MRI scans, alongside invasive exams like cystoscopies, which allow the doctor to examine the bladder and urethra for any signs of cancer spread.
Cervical cancer statistics
- The 5 year survival rate for women with cervical cancer is around 67%
- For early-stage diagnosis, the five year survival rate rises to 95%
- Half of cervical cancer cases occur in women under the age of 45
- Around 40% of women with cervical cancer will have some form of major surgery
- Less than 1% of abnormal screening results are found to be cervical cancer
How much does cervical cancer treatment cost?
With so many different treatments available for cervical cancer it can be tough to get an accurate price quote. Talking through all of your potential options with a care team and deciding on your preferred course of treatment is the only way of assessing how much it will cost.
Cervical cancer treatment in the United States can be expensive – up to $100,000 for advanced cases. Many people choose to look abroad for their care, where prices are more affordable but the quality of treatment remains the same. Patients might also travel for cervical cancer treatment to see a specialist or to cut down on waiting times. Specialist hospitals and clinics for cervical cancer treatment can be found around the world.