Cervical Cancer Treatment Options in Nonpregnant and Pregnant Women

Procedures for preventing of cervical cancer have improved over the past years. In fact, the number of cases reported of certain types of cervical cancer have decreased over the years. Still there are many of women who are contracting this type of cancer each year. It is important that each woman has a knowledge of the treatments that are available to them as their doctor explains what procedure he feels would be best in their case. Women who have been diagnosed with cervical cancer have three basic treatment options. Current options to cure this cancer are surgery and radiation therapy and sometimes chemotherapy .

Surgery

cone biopsy to treat cervical cancer in early stage

Depending on the state of the disease and the extent of the tumor, the specialist will remove only malignant tissue, the entire cervix, uterus, preserving or not the ovaries and fallopian and regional lymph nodes.
The types of surgery that may be performed include:
Conization: this method is a cone biopsy. It is done if the cancer is micro-invasive, in squamous cell carcinoma in situ (stage 0). During this procedure, a bit of tissue in a cone shape is removed and viewed with a microscope. The goal is to see if the tissue contains cancer cells. So this procedure can be used as both a diagnostic and treatment of cervical cancer.
Radical trachelectomy: this type of surgery is employed to remove the cervix and dissecting the pelvic lymph nodes, but without touching the uterus. It usually applied when the cancer is in stage IA2 and in young women who wish to preserve fertility. This will depend on the size of the tumor. In these situations this procedure has achieved acceptance as an alternative to hysterectomy.
Hysterectomy: in this type of surgery, only the cervix and uterus is removed, and used when the cervical cancer is in the early stages, adenocarcinoma in situ, and also stage IA1 for women that do not want to preserve fertility. It can also be radical to treat cervical cancer if the cancer has progressed (stage IB1 and IIA1). This will involve the removal of also the top of the vagina, the pelvic lymph nodes and tissue around the cervix. The ovaries and fallopian tubes may or may not be removed during the surgery.
Pelvic exenteration: This procedure may remove the vagina, rectum, the lower colon, bladder and uterus if the cancer has spread to other organs after radiotherapy, if the cancer is recurrent.


Radiation therapy

A second option for treating cervical cancer is radiation therapy or radiotherapy. This procedure attempts to kill cancer by using high-energy X-rays. Radiation can be applied either externally or internally. When external radiation is used a machine aims the high-energy X-rays at the cancer from outside the body. Internal radiation uses needles or other devices to deliver radiation to the cancer in the cervix. Both methods of radiation can be used together to treat the disease. You may have side effects with such treatment depending on the dose and the part of the body where it is administered. The most common are red or dry skin, nausea, fatigue, vomiting, urinary discomfort, loss of appetite and diarrhea. These side effects usually disappear once treatment has ended.
It is recommended that during treatment you avoid intercourse. You will be able to resume after a few weeks elapsed after the end of the treatment provided. This method could be used alone, as a single treatment before surgery or in combination with chemotherapy (concurrent chemoradiation), and will be recommended depending on the stage of the cancer, usually in stage IB2 and IIA2.

Chemotherapy

A third option is chemotherapy. Chemotherapy destroys cancer cells by the use of drugs. Drugs can be administered in pill form or by needles. The medicine then travels through the body to kill any cancer cells. Chemotherapy and radiotherapy (concurrent chemoradiation) is usually used together to treat cervical cancer in stage IB2, IIA2, IIB, III and IVA.

Vomiting are the most common side effects of chemotherapy. You may also experience fatigue, nausea, diarrhea, loss of appetite, low white blood cells or hemoglobin, numbness or tingling in the hands and feet, headache, bleeding or bruising, hair loss and skin and nails darkening. These symptoms often disappear at the end of therapy and do not appear simultaneously.

Other possible effects on patients is that they can have early menopause and the inability to get pregnant.

Clinical trials

Also available to those diagnosed with cervical cancer are clinical trials. Clinical trials are being performed to research new and better medical treatment for cancer patients. Many patients have decided to take part in these research programs as they feel it is the best treatment option for them. The patient may have the privilege of playing a part in improving the treatment care for all with cervical cancer.

Cervical cancer treatment during pregnancy

The diagnosis of cancer is devastating for pregnant women and their families. In the treatment will be involved a medical team of specialists who can respond to issues such as termination against continuity of pregnancy, delay in definitive treatment, type of treatment that should be implemented during pregnancy and planning time and type of delivery.

Treatment for pregnant patients with invasive carcinoma of the cervix should be individualized based on the evaluation of maternal and fetal risk. To decide the treatment of cervical cancer during pregnancy, the medical team must take into account the stage of the cancer and the stage of pregnancy and the desire of pregnant continue the pregnancy.

The limited experience with cervical cancer diagnosed during pregnancy, makes any treatment that is proposed, apart from the established standard therapy for nonpregnant women, experimental.

Since it has not been shown that pregnancy has an adverse effect on cancer, when the diagnosis is established in the second half of pregnancy and depending on tumor stage, it is very likely that your doctor will tell you that you can continue with the pregnancy and the delivery will be by cesarean section. It is likely that, at the cesarean delivery, you will have a hysterectomy (removal of the uterus) and once you have recovered from surgery, chemotherapy treatments and radiation.

In cases where the cancer is detected in the first trimester of pregnancy and the tumor is classified as stage II, it is generally suggested to terminate pregnancy so that the treatment can start immediately. The radiation of the pelvis at this time will result in spontaneous abortion. Your doctor will see that a six – month delay in treatment is too much for a progressive cancer.

When you want to maintain pregnancy, the doctor will discuss with you the possible treatment options, the nature and risks. The doctor can perform a lymphadenectomy in which lymph nodes are surgically removed and studied to determine the exact stage of the cancer and the possible risk of continuing the pregnancy.

The neoadjuvant chemotherapy during pregnancy can be used to stabilize or reduce the size of cervical cancer.

The trachelectomy or removal by surgery of the cervix, is a procedure that has many risks and must be performed by an experienced surgeon. The use of these treatments depends on the stage of the cancer.

For cases of cervical cancer detected early (in situ) or cancer cases detected during the last trimester of pregnancy, it is likely that the doctor will defer treatment until the baby is born. In this case, your gynecologist and oncologist will need close monitoring. They will repeat Pap smears every two months during pregnancy. If you were to arise the suspicion of cancer spread, then it will have to be biopsied to allow accurate diagnosis and staging.

Labor can be vaginally when injuries are not very large, but usually your gynecologist will prefer cesarean section to prevent bleeding and infections.

Forecast

The chance of recovery or prognosis will depend on the following aspects:

– Age and general health of the pregnant woman.
– The stage of the cancer (if the whole cervix is affected or just a part, or the cancer has invaded lymph nodes or other parts of the body).
– The period of pregnancy in which the diagnosis was established. It is very likely that if diagnosed in the last quarter, has a grave prognosis and this is due mainly to the stage of the tumor and not the pregnancy itself.
– The type of cervical cancer.
– Tumor size.