Read about Caroline's fight with early-stage cervical cancer
The primary forms of treatment are surgery and combined radiation therapy and chemotherapy. Options for treating cervical cancer depend chiefly on the stage of disease -- the size of the tumor, the depth of invasion, and whether the cancer has spread to other parts of the body. Other factors that are considered are the patient's age and if she wishes to have children. Carcinoma In SituThese cancers are preinvasive and can be treated conservatively. In most cases, it is possible to spare the uterus. Options for treatment include:
These treatments are almost always effective in removing precancers and stopping them from developing into true cancers. Early Cervical Cancer (Stages I-IIA)For early cervical cancers that are confined to the cervix, surgical options may include hysterectomy (removal of the uterus), sometimes encompassing the tissue next to the uterus and cervix. Lymph nodes from the pelvis may also be removed and examined for cancer cells. If the cancer is associated with "high-risk" features -- such as involvement of the pelvic lymph nodes, invasion of the lymph channels or blood vessels of the cervix, or involvement of the tissue along the uterus -- doctor will usually recommend chemotherapy combined with radiation therapy.
For women whose cancer is confined to the cervix and who wish to have children, Memorial Sloan-Kettering surgeons may be able to remove just the cervical tissue and spare the womb (the upper part of the uterus known as the fundus) through a procedure known as radical trachelectomy. This procedure has the potential to preserve a woman's ability to bear children. Using either laparoscopy or "open," traditional surgery, the surgeon removes the cervix and pelvic lymph nodes. If they are free of cancer cells, only a portion of the cervix needs to be removed, rather than the entire uterus. If the patient becomes pregnant, she is still able to have a full-term pregnancy and deliver the baby by cesarean section. For very large cancers of the cervix without evidence of spread beyond the cervix, treatment may include either chemotherapy and radiation therapy or radical hysterectomy. A few clinical studies have demonstrated that primary treatment with chemotherapy and radiation improved the survival of patients with these cancers compared to radiation therapy alone.
Sentinel Lymph Node BiopsyAt Memorial Sloan-Kettering, we are currently evaluating an approach -- called sentinel lymph node biopsy -- that could eliminate the need to remove all the pelvic lymph nodes for analysis. Using a blue dye and a special radioactive substance that can be traced with imaging techniques, doctors can identify during surgery the first lymph node (the sentinel node) to which cancer cells would travel after leaving the cervix. This technique is called intraoperative lymphatic mapping or sentinel node mapping. If this node is free of cancer cells, the goal is to avoid removing additional lymph nodes. If the node does contain cancer cells, the surgeon then removes additional lymph nodes for further examination. Sentinel node mapping may help prevent the unnecessary removal of lymph nodes in some women, leaving these nodes in place to continue their normal functions of draining fluids and fighting infection. BrachytherapyAt Memorial Sloan-Kettering, we have vast clinical experience in combined modality therapy (combination chemotherapy and radiation therapy), including brachytherapy. In high-dose brachytherapy, radioactive material is applied directly to the tumor. Brachytherapy is used in combination with external beam radiotherapy, in which high-energy rays are aimed at the cancer. Advanced Cervical Cancer (Stages IIB-IVA)If cervical cancer has spread beyond the cervix and into the surrounding pelvic tissues, surgery alone is usually not an effective cure. Patients with this degree of invasive cancer have traditionally also been treated with radiation therapy (the use of x-rays or other high-energy waves to kill cancer cells and shrink tumors), either alone or in addition to surgery. In recent years, however, there has been a major shift in the treatment of advanced cervical cancer. Based on the results of large clinical trials, the standard of care for regionally advanced cervical cancer is now chemotherapy combined with radiation therapy. The radiation therapy may be delivered externally and/or internally through brachytherapy (by applying radioactive material directly to the cervix). When chemotherapy drugs (such as cisplatin and 5-fluorouracil) are given with radiation therapy, the tumors are made more sensitive to the effects of the radiation. This combined action improves the survival of advanced cervical patients dramatically -- by as much as 30 to 50 percent. Nearly all patients with invasive cervical cancer can benefit from this combination of radiation therapy and chemotherapy. Stage IVB & Recurrent Cervical CancerFor women whose cancer spreads beyond the pelvis (into the lungs or liver, for example) or who have recurrent disease, treatment is aimed at reducing cancer-related symptoms in order to improve a patient's quality of life, and hopefully to prolong her survival. Chemotherapy is the primary modality of treatment for these patients, and several drugs, such as cisplatin and paclitaxel, are available. Treatment of this group of women -- with a focus on new anticancer drugs and combinations of drugs -- remains a major research priority at Memorial Sloan-Kettering Cancer Center. Some women with recurrent cervical cancer may choose an extensive surgery known as pelvic exenteration that requires Memorial Sloan-Kettering's gynecologic surgeons to remove cancerous tissue and reconstruct the remaining organs so the patient retains optimal function. This is an extremely radical procedure reserved for patients with limited treatment options. Pelvic exenteration may be combined with intraoperative brachytherapy, which is only performed at hospitals such as Memorial Sloan-Kettering. Because this procedure is physically and emotionally demanding, investigators at Memorial Sloan-Kettering have initiated a trial to learn more about the physical, emotional, educational, and sexual needs of women treated with pelvic exenteration. |
