A cervical cancer diagnosis can be devastating, but you can overcome the symptoms with the right treatment. After diagnosis, the doctor conducts staging tests to determine the cancer stage, which plays a part in determining the ideal treatment option. Other factors that can influence your treatment options include the type of cervical cancer (adenocarcinoma or squamous cell), the location of cancer within the cervix, your age, whether or not you intend to bear kids in the future, and your overall health.
Here is an overview of the typical stage-by-stage treatment options for cervical cancer.
When you undergo Hong Kong cervical cancer screening, and the doctor says you have stage 1 cancer, the high chances are that you have several viable treatment options. But the treatment is based on whether or not you want to bear kids in the future. It also depends on whether the cancer has invaded the lymph vessels or blood.
A cone biopsy
A cone biopsy is preferable for Hong Kong cervical cancer patients who want to maintain their fertility after the treatment. Here are some terms to understand about cone biopsy.
- Negative margins mean that the edges of the cone biopsy do not contain cancer cells. The doctor must watch the patient closely without further treatment if the cancer doesn’t recur.
- Positive margins mean that the cone biopsy edges contain cancer cells, so the cancer is not completely treated. A repeat cone biopsy or a treatment known as radical trachelectomy is necessary.
- A cone biopsy with negative margins plus the removal of pelvic lymph nodes is one of the viable treatment options if the cancer has spread into the lymph vessels or blood vessels. The other one is radical trachelectomy plus the removal of the pelvic lymph nodes.
Hysterectomy is the treatment option for patients who don’t have a problem losing their fertility. There are two types:
- A basic hysterectomy applies when the edges of the biopsy cone have no cancer cells or when there is no sign of lymphovascular invasion. But if the cone biopsy has cancer cells, radical hysterectomy and a repeat cone biopsy along with the removal of lymph nodes are an option.
- Radical hysterectomy plus the removal of lymph nodes is necessary if the cancer cells have spread into the blood or lymph vessels. In some Hong Kong cervical cancer cases, external beam radiation to the pelvis plus brachytherapy is viable.
Radiation (EBRT) and chemotherapy
A cervical cancer doctor may discuss external beam radiation therapy as an option if the tumor is large and has grown into lymph vessels, blood or affects the surrounding tissues such as the vagina and uterus. If the cancer cells have invaded the parametria (tissues next to the uterus), lymph nodes and have positive margins after a cone biopsy, EBRT plus chemotherapy is recommended.
There are different treatment options for cervical cancer in stage 2, similar to treatment options in late-stage one cervical cancer. Radical trachelectomy and pelvic node dissection are used for women who don’t want to lose their fertility. It may also involve the removal of para-aortic lymph nodes.
The treatment options for patients who do not wish to maintain their fertility include:
This is done along with removing pelvic lymph nodes and sometimes the nodes from the para-aortic area. Radiation is still an option if none of the lymph nodes have cancer, but the tumor is large or has grown into the blood, lymph vessels, or has invaded the surrounding connective tissues to the uterus, vagina, or bladder.
EBRT plus chemotherapy are necessary if the cancer has invaded the tissues next to the uterus, lymph nodes or if the tissues have shown positive margins. The doctor may also recommend brachytherapy after the two procedures are complete.
EBRT or brachytherapy is a viable option if the patient is not healthy enough for surgery or decides she doesn’t want surgery. Concurrent chemotherapy is given with the radiation in such cases.
Chemo comes in different forms including, carboplatin, cisplatin, and cisplastin+fluorouracil. If cancerous cells are discovered in the lymph nodes after a radical hysterectomy, surgery may be necessary, followed by radiation therapy, often done with concurrent chemoradiation.
The treatment for cervical cancer in stage 3 is chemoradiation, and the radiation includes both external beam radiation therapy and brachytherapy.
At stage 4, cervical cancer has invaded other body areas and is considered incurable. However, there are several management options, including radiation therapy with chemo or without, to try and slow the spread of the cancer and minimize the symptoms. A combination of chemo drugs may be necessary to manage the cancer. The treatment doesn’t come cheap, but Hong Kong cancer patients can access treatment through the Hong Kong cancer fund.
Recurrent cervical cancer
Recurrent cervical cancer comes back even after treatment. It can reappear locally (where it started) in the cervix, uterus, or the surrounding tissues in the pelvic organs, and it can also appear in distant body organs such as the lungs or bone.
In such cases, extensive surgery such as pelvic exenteration is a treatment option for some patients, even though it has severe side effects. It offers the best option for possibly curing the cancer. Another treatment option is radiation therapy along with chemo. Alternatively, chemotherapy, targeted therapy, and immunotherapy may slow down the spread of the tumor.
Cervical cancer in pregnancy
Some pregnant women are found with a small number of cervical cancers, although rarely. Several factors play a part in determining the treatment, including:
- How far along the pregnancy is.
- Type of cervical cancer.
- Tumor size and whether the cancerous cells have reached the lymph nodes.
For early-stage cancer, a cone biopsy, hysterectomy, and radical trachelectomy after birth are some of the surgery options. You and your doctor have to determine whether or not to continue the pregnancy and the risks involved.
It is important to understand the goal of the treatment your doctor recommends for cervical cancer, whether trying to cure the cancer, relieve the symptoms, or control the growth of the cancer. You also need to discuss the risks of the treatment with your doctor.