TREATMENT AND MANAGEMENT OF CERVICAL CANCER

Treatment of cervical cancer varies depending on the stage of the disease when diagnosed.

Common treatment options are surgery, radiation therapy and chemotherapy.

Surgery
Typical surgery options include:
 Conization (cone biopsy): a cone shaped portion of cervix tissue is removed using
different surgical techniques. This procedure may also be used to diagnose cervical
cancer or treat other cervical conditions
 Radical trachelectomy: removes cervix, upper part of vagina, lymph nodes and
surrounding tissue. Better option for maintaining fertility
 Hysterectomy
1. Simple/total: removes the uterus and cervix
2. Radical: removes uterus, cervix and tissues at the edges of the uterus and
often lymph nodes in the pelvis area and surroundings.

 Cryosurgery

Radiation Therapy
The use of high x-rays and other radiation to kill cancer cells or stop them from growing.
 External: uses a machine outside the body to send radiation toward the cancer.
 Internal: uses radioactive material sealed in needles, seeds, wires, or catheters that
are placed directly into or near the cancer. (brachytherapy)

Chemotherapy
Targeted Therapy
Immunotherapy

Stage 0
Carcinoma in situ

At this stage, surgical options are preferred.

Includes
Cryosurgery: freezing of the abnormal cells
Hysterectomy: for women who no longer wish to have children
Conization

EARLY
Stage 1
Pre-clinical carcinoma, diagnosed only by microscopy
A
1. (stromal invasion no deeper than 3mm, no wider than 7mm)Conization and total
hysterectomy
 2. (invasion deeper than 3mm but less than 5mm)Internal radiation therapy (woman
that can’t have surgery), radical trachelectomy, radical hysterectomy (modified) and
removal of lymph nodes.

Stages 1b and 2a
1B: Histologically invasive carcinoma confined to cervix and greater than 1a2
2A: Carcinoma extends beyond the cervix but not to the pelvic wall. Involves upper two
thirds of vagina
 Combined radiation therapy and chemotherapy
 Radical hysterectomy and bilateral pelvic lymphadenectomy
 Radical trachelectomy
 Radiation therapy
 Chemotherapy then surgery

ADVANCED
Stages 2b, 3, 4a
2B: parametrium involvement but not to pelvic wall
3: Carcinoma has extended to pelvic wall and involves lower third of the vagina. Also
hydronephrosis or non-functioning kidney
4a: Spread to adjacent organs. May involve bladder or rectal mucosa
 Combined radiation therapy and chemotherapy (Cisplatin is standard)
Other
 Internal radiotherapy
 Bilateral pelvic lymphadenectomy

METASTATIC
Stage 4b
Spread beyond true pelvis and includes metastasis to distant organs.
 Radiotherapy and chemotherapy on a palliative basis to ease symptoms and improve
quality of life

Pelvic Exenteration
 Major procedure which removes the lower colon, rectum, and bladder. The cervix,
vagina, ovaries, and nearby lymph nodes are also removed. Artificial openings are
made for urine and stool to flow from the body to a collection bag. Procedure is
uncommon and is performed to treat a recurrence of the cancer.

COMPLICATIONS

Complications of cervical cancer can occur as a result of advanced cancer or as side effects
of its treatment.

Kidney Failure
 Cervical cancer can result in kidney failure when the tumour invades and obstructs
the ureters, leading to hydronephrosis. The kidneys continue to produce urine but it
cannot drain into the bladder. The urine builds up and causes distention of renal
 pelvis and kidney. This can further lead to (due to increase in ureteral pressure)
changes which impair proper kidney function, for example, decreased glomerular
filtration rate and transport of electrolytes and waste filtration. A progressive decline
in kidney function will result in kidney failure.
Associated: uraemia

Pain
 Pain can occur in cervical cancer if the tumour grows and spreads into nerve endings,
bones or muscles.

Blood Clots
 Cancers can make our blood more prone to clotting. Being on bed rest after
treatment (like surgery or chemotherapy) can increase the risk of blood clots. If a
deep vein thrombosis develops, there is a higher risk of pulmonary embolism

Bleeding
 Bleeding can occur is the cancer invades areas like the vagina, bowel or bladder and
grows into nearby blood vessels, causing damage.

Fistulae
 (A fistula is an abnormal channel connecting two or more organs or spaces of the
body). Fistulae may develop when the cancer invades and grows into surrounding
areas. In cervical cancer, fistulae commonly develop between the bladder and vagina
and sometimes between the vagina and rectum.

Abnormal Vaginal Discharge

 Unusual, foul smelling discharge may result from the breakdown of tissue or
bladder/bowel leakage from the vagina (through fistulae). Discharge may also be
white, pale, watery, brown or tinged with blood.

COMPLICATIONS FROM SIDE EFFECTS

Early menopause
 Early menopause can occur if the ovaries are removed in a surgical procedure or if
they are damaged during treatment, radiotherapy, for example.

Vaginal Narrowing
 Treatments like radiotherapy can cause abnormal tightening and shortening of the
vagina due to the formation of fibrosis (radiation-induced vaginal stenosis).
Lymphoedma
 Can occur if:
 Lymph nodes are surgically removed as a part of treatment.
 The tumour obstructs lymphatic vessels.
 Lymph vessels become scarred or inflamed by radiotherapy.
Fluid doesn’t flow as it should and lymph fluid cannot drain properly. As a result, fluid
accumulates in the surrounding tissue.

Decreased quality of life/emotional turmoil

1. Dealing with cancer can lead to emotional distress. Patients often experience,
sadness and depression

References

Cervical cancer. (n.d.). Health Direct. Retrieved March 12, 2021, from

https://www.healthdirect.gov.au/cervical-cancer#complications

Cervical cancer | Cancer Research UK. (n.d.). Cancerresearchuk.Org. Retrieved March 12,

2021, from https://www.cancerresearchuk.org/about-cancer/cervical-cancer

Cervical Cancer Treatment (PDQ®)–Patient Version. (2020, May 13). National Cancer

Institute. https://www.cancer.gov/types/cervical/patient/cervical-treatment-pdq#_142