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When diagnosed before cancer cells have spread beyond the cervix, cervical cancer treatment can be very effective. About 91% of patients diagnosed while the cancer is still confined to the cervix survive at least five years. In more advanced cervical cancer, the five-year survivability is about 60%, according to the National Cancer Institute.
Treatment options depend on the stage of your cancer, or how far it has progressed. Treatment can range from removal of very small amounts of tissue that preserves fertility to more aggressive surgery, chemotherapy, radiation therapy, immunotherapy and targeted therapies.
Cervical cancer usually develops slowly. Your gynecologist or primary care provider may have identified precancerous, abnormal cells developing in cervical tissue. A Pap smear or pelvic exam, followed by a laboratory evaluation, can identify these abnormal cells to be removed or killed before they become cancerous.
As many as 90% of cervical cancers start in thin, flat cells squamous cells that cover the outer part of the cervix, which can be seen during a pelvic exam. In these cases, the disease is called squamous cell carcinoma. Adenocarcinoma makes up the rest of cervical cancers. It develops in the mucous producing glandular cells inside the cervical canal connecting the uterus and vagina.
Norton Cancer Institute uses advanced testing options to help your specialist determine a care plan and tailor it for you. Our specialists are gynecological specialists who will coordinate your care with surgical oncologists, medical oncologists and radiation oncologists.
Norton Cancer Institute gynecologic oncologists are also researchers. As principal investigators in a number of clinical trials that could offer innovative approaches, they can provide patients get easier access to appropriate trials. Once experimental treatments are approved for wide use, Norton Cancer Institute oncologists often have years of experience with the therapy.
The Norton Cancer Institute Genomic Testing Lab is a state-of-the art facility providing fast access to information about your specific cancer. The genomic testing guides development of advanced treatments that target the precise genetic composition of your cancer. Because speed is essential in cancer treatment, the genomic testing lab is part of Norton Cancer Institute, saving time that’s lost when working with outside laboratories.
Norton Cancer Institute patient navigators help ease stress and offer emotional support to patients and families. From the point of a suspicious finding through diagnosis, treatment and survivorship, patient navigators help with emotional support, arranging appointments, connecting with resources and more.
Early stage cervical cancer usually describes cancer that is confined to the cervix or upper part of the vagina and has not spread to the tissue around the uterus. This is considered stage I or stage IIa if there is evidence of cancer in the upper two-thirds of the vagina.
At its earliest stages, the cancer may be only a small area on the cervix. Removal of the tissue while leaving the cervix and other structures intact can be successful treatment while preserving fertility. Some may require a hysterectomy to remove the uterus and cervix. Both ovaries and fallopian tubes may also need to be surgically removed.
More advanced stage I cervical cancer may also require removal of the upper part of the vagina as well, along with nearby ligaments, tissues and lymph nodes.
Another surgical oncology option that can preserve the ability to become pregnant involves removal of the cervix, the upper part of the vagina and possibly nearby lymph nodes. This procedure, a radical cervicectomy, leaves the uterus, fallopian tubes and ovaries intact and places a band on the uterus to help keep it closed during pregnancy.
Surgery is typically the first line of treatment for the earliest stage of cervical cancer. For patients who can’t undergo surgery, internal radiation therapy may be an option. Also known as brachytherapy, a radioactive element is placed near the cervix. How long the implant stays in your body will depend on the radiation source and your unique cancer.
In cases of cervical cancer that are still early, but with a larger tumor or spread to the upper part of the vagina and/or tissue surrounding the uterus, radiation therapy may be required along with surgery and chemotherapy.
In these cases, radiation therapy can be delivered internally with a radiation source placed near the cancer. External radiation uses high-energy beams to attack the cancer. The beams aren’t strong enough to damage tissue on their own, but when sent from many angles and directions, their intensity can be focused precisely on the cancer cells.
Medical oncology, which includes chemotherapy, can be given at the same time as radiation therapy for more advanced cases of early stage cervical cancer. In combination, the chemotherapy can improve the effectiveness of radiation therapy.
Chemotherapy drugs can either kill cancer cells or stop them from growing. The chemotherapy drug and how long its administered depends on each patient’s unique condition.
Advanced cervical cancer has spread beyond the cervix to the tissues around the uterus and, in later stages, to the lower vagina and pelvic wall. It may interfere with the ureters that carry urine from the kidneys the bladder. Lymph nodes higher in the abdomen near the aorta may be involved as well as the bladder or rectum.
Late stage II cervical cancer (IIb), stage III and early stage IV (stage IVa) cervical cancer are treated with surgery and radiation therapy, sometimes in combination with chemotherapy.
Late stage IV cervical cancer (stage IVb) means the disease has spread well beyond the pelvis to other organs and structures such as the liver, bones, lungs or distant lymph nodes.
When cervical cancer metastasizes, the cancer cells have spread in the body through lymphatic system or blood to form tumors elsewhere
Surgery for advanced cervical cancer involves aggressive surgery taken for earlier stages of the disease as well as removal of lymph nodes in the pelvis. Patients who can’t have radiation therapy may have surgery to remove tumors that have formed in organs as it metastasized.
External and internal radiation therapy is the typical course of treatment for advanced cervical cancer. Internal radiation therapy implants sources of radiation for a certain period of time to fight the cancer cells. Exterior radiation therapy uses high-energy, precision targeted beams of radiation to destroy cancer while leaving healthy tissue undamaged.
Chemotherapy drugs are typically given at the same time as they can make the radiation therapy more effective.
For advanced stage IV cervical cancer, the standard care is immunotherapy either alone or with chemotherapy and targeted therapy.
Immunotherapy drugs help turn your immune system to attack the cancer.
Working with genomic testing, you and your gynecologic oncologist can determine which immunotherapy is best suited to the unique makeup of your cancer.
Norton Cancer Institute performs its own genomic testing, saving patients precious time from other institutions that send their testing off site.
Targeted is a form of precision medicine that goes after proteins that control how cancer cells grow and spread. Monoclonal antibodies are one drug used in targeted therapy.
Palliative therapy aims to improve quality of life. Chemotherapy, radiation therapy and other treatments can help a patient with a serious or life-threatening disease feel more comfortable.
Once you’ve been referred to Norton Cancer Institute Gynecologic Oncology with a diagnosis, a member of the team will contact you to make an appointment at the Norton Cancer Institute Women’s Cancer Center in downtown Louisville. If your records aren’t already in your free Norton MyChart account, the team will contact the referring physician.
Your appointment will be with the first available physician. You’ll also meet the nurse practitioner, nurse clinician and if available, the patient navigator who will help you through treatment and survival.
At your first appointment, your oncologist will review your records and history, including the symptoms that led to the diagnosis. There will be a pelvic exam and a review of the care plan, including any additional imaging, a date for surgery and the plan for any chemotherapy and immunotherapy.
The date for surgery will be within a couple weeks of your first appointment. Depending on your diagnosis, chemotherapy and immunotherapy may start in about a week.
You’ll have surgery scheduled before you leave your first appointment.
Gynecologic cancer treatment is improving rapidly. Norton Cancer Institute oncologists are also researchers who lead clinical trials into the effectiveness of new therapies.