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General: Patients should tell their healthcare providers if they are taking any drugs (prescription or over–the–counter), herbs or supplements. Complementary or alternative therapies should not replace conventional treatments that have proven to effectively treat cervical cancer. Pre–cancer and carcinoma in situ : A cold knife cone biopsy (surgical scalpel or laser is used to remove the abnormal tissue), loop electrosurgical excision procedure (cone biopsy that is performed with a wire that is heated by an electrical current), cryosurgery (freezing the cells with a metal probe), cauterization or diathermy (burning off the cancerous cells) and laser surgery (burning off the cancerous cells with a laser beam) have been used to treat cancer that is confined to the surface of the cervix (Stage 0) or other early–stage cervical cancers in women who may want to become pregnant. They can be used in combination with other treatments. These procedures may cause bleeding or cramping. All of these treatments require close follow–up to detect any recurrence of the cancer. Hysterectomy: A simple hysterectomy (surgical removal of the uterus) is used to treat some stages 0 and IA cervical cancers. In most cases, only the uterus is removed. However, sometimes the fallopian tubes and ovaries are removed as well. The tissues adjacent the uterus, including the vagina, remain intact. The uterus may be removed either through the abdomen or the vagina. Women who undergo a simple hysterectomy can no longer become pregnant. A radical hysterectomy has been used to treat stages IA2, IB and IIA cervical cancers, especially in young women. During the procedure, the uterus and adjacent tissues, including the ovaries, the upper region of the vagina near the cervix and the pelvic lymph nodes, are surgically removed. Most radical hysterectomies involve abdominal surgery. However, it can be performed vaginally, in combination with a laparoscopic pelvic lymph node dissection (surgical removal of tissues). During a laparoscopy, a tube is inserted through a surgical incision and the lymph nodes are removed. After a hysterectomy is performed, the tissue is examined to determine whether the cancer has spread and requires additional treatment. Women who have had hysterectomies cannot become pregnant. Women who have had their fallopian tubes and ovaries removed will no longer experience menstruation, and they typically experience a decreased sex drive. This is because the ovaries produce the female hormones (estrogen and progesterone), which are responsible for menstruation and libido. Pelvic exenteration (extensive surgery): Patients who experience recurrent cervical cancer that does not respond to other treatments may undergo pelvic exenteration (extensive surgery). This procedure includes a radical hysterectomy, in addition to the removal of the bladder, rectum, part of the colon and/or the entire vagina. These operations require the creation of new opening for the urine and feces. A new vagina may be created surgically. In many cases the external genitals, including the clitoris, remain intact. Recovery from a pelvic exenteration may take anywhere from six months to two years. This treatment is successful with 40–50% of recurrent cervical cancers that are confined to the pelvis. If the recurrent cancer has spread to other organs, radiation or chemotherapy may be used to destroy cancer cells by preventing them from growing and multiplying. Radiation therapy: Radiation therapy is often is used for treating stages IB, IIA and IIB cervical cancers, or in combination with surgery. The therapy involves the use of high–dosage X–rays or other high–energy waves to kill cancer cells. There are several different types of radiation therapy. External–beam radiation therapy uses rays that focus on the pelvic area from a source outside the body. Implant or internal radiation therapy involves a pellet of radioactive material that is placed internally, near the tumor. Alternatively, thin needles may be used to insert the radioactive material directly into the tumor. Not all patients respond to radiation therapy. In addition, cervical cancer returns in about one–third of all women who are treated for advanced cervical cancer, usually within two years after therapy. Common side effects of radiation therapy include skin reaction in the area of treatment, fatigue, upset stomach, loose bowels, premature menopause in young women, problems with urination and vaginal stenosis (narrowing of the vagina due to build–up of scar tissue), which may cause painful sexual intercourse. Chemotherapy: Chemotherapy involves the use of one or more drugs that kill cancer cells. Cervical cancer patients receive chemotherapy when the cancer has spread beyond the cervix. The treatment is usually used after surgery or radiation treatment. Stages IIB, III, IV and recurrent cervical cancers are usually treated with a combination of external and internal radiation, as well as chemotherapy. Commonly used chemotherapy drugs for cervical cancer include cisplatin (Platinol ®–AQ), ifosfamide (Ifex ®) and fluorouracil (Adrucil ®). These may be injected or taken orally. The National Cancer Institute recommends that chemotherapy with cisplatin (Platinol ®–AQ) be considered for all women who receive radiation therapy for cervical cancer. Chemotherapy side effects depend on the type of drug, dose and length of treatment. Common symptoms include nausea and vomiting, fatigue, changes in appetite, hair loss, mouth or vaginal sores, infections, menstrual cycle changes, premature menopause, infertility and anemia (low red blood cell count). With the exception of menopause and infertility, most of the side effects are temporary and resolve once the treatment is completed.
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