Gynecologic Oncology Program

Cervical Cancer

Stages and Treatment Options

If a patient has cancer of the cervix, the doctor will order more tests to find out if the cancer cells have spread to other parts of the body. This process is called staging. Knowing the stage of the disease helps the doctor plan treatment. The following stages are used to describe cancer of the cervix:

Stage 0 or carcinoma in situ (dysplasia): Carcinoma in situ is a precancerous condition. Abnormal cells are found only in the first layer of cells of the lining of the cervix and do not invade the deeper tissues of the cervix. Treatment at this stage may be one of the following:

Conization (or cone biopsy)
Laser surgery
Loop electrosurgical excision procedure (LEEP)
Surgery to remove the cancerous area, cervix, and uterus (total abdominal or vaginal hysterectomy) for those women who cannot or no longer want to have children

Stage IA: Stage IA cancer involves the cervix but has not spread to nearby tissue. A very small amount of cancer that is only visible under a microscope is found deeper in the tissues of the cervix. Treatment may be one of the following, depending on how deeply the tumor cells have invaded the normal tissue:

Surgery to remove the cancer, uterus, and cervix (total abdominal hysterectomy). The ovaries may also be taken out (bilateral salpingo-oophorectomy), but they are usually not removed in younger women.
Conization.
For deeper tumors (3-5 millimeters), surgery to remove the cancer, the uterus and cervix, and part of the vagina (radical hysterectomy), along with the lymph nodes in the pelvic area (lymph node dissection).
Internal radiation therapy.

Stage IB: Cancer involves the cervix but has not spread nearby. A larger amount of cancer is found in the tissues of the cervix. Treatment may be one of the following, depending on how deeply the tumor cells have invaded the normal tissue:

Internal and external radiation therapy
Radical hysterectomy and lymph node dissection
Radical hysterectomy and lymph node dissection with or without chemotherapy
Radiation therapy plus chemotherapy

Stage IIA: Cancer has spread to nearby areas but is still inside the pelvic area. Cancer has spread beyond the cervix to the upper two thirds of the vagina. Treatment may be one of the following:

Internal and external radiation therapy
Radical hysterectomy and lymph node dissection
Radical hysterectomy and lymph node dissection with or without radiation or chemotherapy
Radiation therapy plus chemotherapy

Stage IIB: Cancer has spread to nearby areas but is still inside the pelvic area. Cancer has spread to the tissue around the cervix. Treatment may be internal or external radiation therapy plus chemotherapy.

Stage III: Cancer has spread throughout the pelvic area. Cancer cells may have spread to the lower part of the vagina. The cells also may have spread to block the tubes that connect the kidneys to the bladder (the ureters). Treatment may be internal or external radiation therapy plus chemotherapy.

Stage IVA: Cancer has spread to other parts of the body, such as the bladder or rectum (organs close to the cervix). It is unusual for cervical cancer to reach this stage. If it does, treatment may be internal or external radiation therapy plus chemotherapy.

Stage IVB: Cancer has spread to distant organs such as the lungs. It is unusual for cervical cancer to reach this stage. If it does, treatment may be radiation to relieve symptoms caused by the cancer plus chemotherapy.

Recurrent: Recurrent disease is cancer has come back (recurred) after it has been treated. It may come back in the cervix or in another part of the body. If the cancer has come back in the pelvis, treatment may be one of the following:

Radiation therapy combined with chemotherapy
Chemotherapy to relieve symptoms caused by the cancer

If the cancer has come back outside of the pelvis, the patient may choose to go into a clinical trial of systemic chemotherapy.

About the Treatments and Side Effects

There are three primary treatment options for patients with cervical cancer: surgery, radiation therapy, and chemotherapy. Side effects occur with most cancer treatments because it is very difficult to destroy the cancer without also affecting healthy tissue. The treatments and their side effects are outlined below:

Surgery

A doctor may use one of several types of surgery for precancerous conditions (dysplasia or carcinoma in situ) to destroy the cancerous tissue:

Laser surgery is the use of a narrow beam of intense light to kill cancerous cells.
Conization is the removal of a cone-shaped piece of tissue where the abnormality is found. Conization may be used to take out a piece of tissue for biopsy, but it can also be used to treat early cancers of the cervix.
A loop electrosurgical excision (LEEP) procedure is the use of an electrical current passed through a thin wire loop to act as a knife to remove the abnormal tissue.
A laser beam can also be used as a knife to remove the tissue.
A hysterectomy is an operation in which the uterus and cervix are taken out along with the cancer. If the uterus is taken out through the vagina, the operation is called a vaginal hysterectomy. If the uterus is taken out through a cut (incision) in the abdomen, the operation is called a total abdominal hysterectomy. Sometimes the ovaries and fallopian tubes are also removed, which is called a bilateral salpingo-oophorectomy.

For invasive cancer, a doctor may consider the following types of surgery:

A radical hysterectomy is an operation in which the cervix, uterus, and part of the vagina are removed. Lymph nodes in the area are also removed. This is called lymph node dissection. (Lymph nodes are small bean-shaped structures that are found throughout the body. They produce and store cells that fight infection.)
If the cancer has spread outside the cervix or the female organs, a doctor may take out the lower colon, rectum, or bladder (depending on where the cancer has spread) along with the cervix, uterus, and vagina. This is called an exenteration and is rarely needed. Plastic surgery may be needed to make an artificial vagina after this operation.

Side effects: The side effects of surgery depend on the location of the tumor, the type of operation, and other factors. Although patients are often uncomfortable during the first few days after surgery, this pain can usually be controlled with medicine. The recovery period after an operation varies from patient to patient.

Radiation therapy

Radiation therapy is the use of high-energy x-rays to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external radiation therapy) or from putting materials that produce radiation (radioisotopes) through thin plastic tubes into the area where the cancer cells are found (internal radiation therapy).

Side effects: The most common side effects of radiation therapy are tiredness, skin reactions(such as a rash or redness) in the treated areas, and loss of appetite. Radiation treatment to the pelvic area may cause the vagina to narrow due to scar tissue. Early menopause and problems with urination are also possible. Radiation therapy may also cause a decrease in the number of white blood cells that help protect the body against infection. Most of these side effects can be treated or controlled and in most cases they are not permanent.

Chemotherapy

Chemotherapy is the use of drugs to kill cancer cells. Most anticancer drugs are injected into a vein (IV) or a muscle; some are given by mouth. Chemotherapy is a systemic treatment, meaning that the drugs flow through the bloodstream to nearly every part of the body to kill cancerous cells. It is generally given in cycles: a treatment period is followed by a recovery period, then another treatment period, and so on.

Side effects: Chemotherapy drugs generally target rapidly dividing cancer cells. However, other cells that also divide rapidly include blood cells, cells that line the digestive tract, and cells in hair follicles. Unfortunately, these healthy cells may also be impacted by the chemotherapy drugs, resulting in side effects such as infections, tiredness, temporary hair loss, mouth or vaginal sores, changes in the menstrual cycle, and infertility. Not all chemotherapy patients develop all of these symptoms, and they usually go away during the recovery period or after treatment stops. Medicines and other treatments are available to control or minimize many of these symptoms.

This page was last updated on: March 3, 2008.