The stage of cervical cancer is crucial when deciding on treatment, as it indicates how much the cancer has spread. Alongside the stage, several other factors also play a role in determining the best course of action. These include the specific location of the cancer within the cervix, whether it is squamous cell carcinoma or adenocarcinoma (different types of cervical cancer), your age and overall health condition, and whether preserving fertility is a priority for you.
Each of these factors influences which treatment options are most suitable. It’s essential to discuss these aspects thoroughly with your healthcare provider to develop a treatment plan that meets your medical needs and personal preferences.
What is Cervical Cancer?
Cervical cancer is a type of cancer that develops in the cells of the cervix, which is the lower part of the uterus (womb) that connects to the vagina. It typically starts when normal cells in the cervix undergo changes and begin to grow uncontrollably, forming a mass or tumor.
Stages of Cervical Cancer
Cervical cancer is staged to determine the extent of its spread in the body, which guides treatment decisions. Here are the stages of cervical cancer according to the International Federation of Gynecology and Obstetrics (FIGO) staging system:
Stage 0: Carcinoma in situ, where abnormal cells are found only on the surface of the cervix.
Stage I: Cancer is confined to the cervix.
IA: Cancer is microscopic and confined to the cervix.
- IA1: Cancer invasion depth is ≤3 mm.
- IA2: Cancer invasion depth is >3 mm but ≤5 mm.
IB: Visible cervical cancer.
- IB1: Tumor size ≤2 cm.
- IB2: Tumor size >2 cm but ≤4 cm.
- IB3: Tumor size >4 cm.
Stage II: Cancer has spread beyond the cervix but not to the pelvic wall or lower third of the vagina.
IIA: Cancer has spread to the upper two-thirds of the vagina.
- IIA1: Tumor size ≤4 cm.
- IIA2: Tumor size >4 cm.
IIB: Cancer has spread to the tissue around the uterus.
Stage III: Cancer has spread to the lower third of the vagina and/or the pelvic wall and/or causes kidney problems and/or involves lymph nodes.
- IIIA: Cancer has spread to the lower third of the vagina but not to the pelvic wall.
- IIIB: Cancer has spread to the pelvic wall or causes kidney problems.
- IIIC: Cancer has spread to pelvic or para-aortic lymph nodes.
Stage IV: Cancer has spread beyond the pelvic area or to the bladder or rectum, or has metastasized to other
organs.
- IVA: Cancer has spread to nearby pelvic organs such as the bladder or rectum.
- IVB: Cancer has metastasized to distant organs such as the liver, lungs, bones, or distant lymph nodes.
Recurrent Cervical Cancer: Cancer that has returned after treatment, either in the cervix or as metastatic tumors in other parts of the body.
Understanding these stages helps doctors determine the appropriate treatment plan. For more detailed information on each stage, consult reliable medical sources such as the American Cancer Society or the National Cancer Institute.
Options of Cervical Cancer Treatment by Stage
Different cervical cancer treatment stages require different lines of treatment. Let’s understand in detail here.
Stage IA1 Cervical Cancer Treatment Options
Treatment options for Stage IA1 cervical cancer depend on whether fertility preservation is desired and whether cancer has invaded blood or lymph vessels. Each approach aims to remove or destroy cancer cells while preserving reproductive options whenever possible.
For Women Who Want to Maintain Fertility:
- Cone Biopsy: This is the preferred procedure if you want to have children after treatment. If the biopsy edges (margins) are clear of cancer cells (negative margins), you may just need close monitoring without further treatment unless the cancer returns.
- Positive Margins: If cancer cells are found at the edges of the cone biopsy, suggesting some cancer may be left behind, options include a repeat cone biopsy or a radical trachelectomy (removing the cervix but preserving the uterus).
If Cancer Has Invaded Blood or Lymph Vessels:
- Cone Biopsy with Lymph Node Removal: This may be done if the cone biopsy has negative margins (no cancer cells at edges), combined with removal of pelvic lymph nodes.
- Radical Trachelectomy with Lymph Node Removal: Another option involves removing the cervix and some surrounding tissue, along with pelvic lymph nodes.
For Women Who Do Not Want to Maintain Fertility:
- Simple Hysterectomy: This may be considered if the biopsy shows no invasion of blood or lymph vessels and has clear margins.
- Positive Margins: If cancer cells are present at the biopsy edges, options include a repeat cone biopsy or a radical hysterectomy (removal of the uterus and cervix), often with pelvic lymph node removal.
If Cancer Has Invaded Blood or Lymph Vessels:
- Radical Hysterectomy with Lymph Node Removal: This is recommended if cancer has spread to blood or lymph vessels.
- Radiation Therapy: External beam radiation followed by brachytherapy (internal radiation) might be considered if surgery isn’t an option.
Additional Considerations:
- Combined Therapy: If lymph nodes show cancer involvement or if there are positive margins after surgery, radiation (external beam with chemotherapy) is typically recommended. Brachytherapy may follow this combined treatment.
Stage IA2 Cervical Cancer Treatment Options
Treatment options for Stage IA2 cervical cancer depend on whether fertility preservation is desired and the extent of cancer spread. Each treatment aims to effectively remove or destroy cancer cells while considering the patient’s preferences and overall health.
For Women Who Want to Maintain Fertility:
- Cone Biopsy with Pelvic Lymph Node Removal: This procedure may be recommended if you wish to preserve fertility. It involves removing a cone-shaped piece of tissue from the cervix along with pelvic lymph nodes.
- Radical Trachelectomy with Pelvic Lymph Node Removal: Another option is a more extensive surgery where the cervix is removed along with surrounding tissue (trachelectomy) and pelvic lymph nodes.
For Women Who Do Not Want to Maintain Fertility:
- External Beam Radiation Therapy (EBRT) with Brachytherapy: This treatment involves external radiation to the pelvis followed by brachytherapy (internal radiation).
- Radical Hysterectomy with Pelvic Lymph Node Removal: This surgery removes the uterus and cervix, often along with pelvic lymph nodes.
Additional Considerations:
- Radiation Therapy: If no cancer cells are found in the lymph nodes, radiation therapy might still be considered, especially if the tumor is large or has invaded nearby blood vessels or connective tissues.
- Combined Therapy: If cancer has spread to nearby tissues (parametria) or lymph nodes, or if surgery leaves positive margins, radiation therapy combined with chemotherapy (EBRT) is usually recommended. Brachytherapy may also be part of this combined treatment.
Stages IB and IIA Cervical Cancer Treatment Options
Treatment for Stages IB and IIA cervical cancer depends on fertility preservation desires, cancer spread, and overall health. Surgical options aim to remove cancerous tissues, while radiation and chemotherapy may be used alone or together depending on the extent of cancer and individual health considerations.
For Women Who Want to Maintain Fertility:
Radical Trachelectomy with Pelvic Lymph Node Dissection: This surgery removes the cervix and nearby lymph nodes. Sometimes, lymph nodes from the para-aortic area (near the aorta) may also be removed.
For Women Who Do Not Want to Maintain Fertility:
- Radical Hysterectomy with Pelvic Lymph Node Removal: This surgical procedure removes the uterus and cervix, along with pelvic lymph nodes. In some cases, lymph nodes from the para-aortic area may also be removed.
- Radiation Therapy: If no cancer is found in the lymph nodes, radiation therapy may be considered. This includes external beam radiation therapy (EBRT) if the tumor is large or has spread into blood vessels, lymph nodes, or surrounding tissue (stroma).
- Combined Therapy: If cancer has spread to nearby tissues (parametria), lymph nodes, or if surgical margins are positive, a combination of EBRT and chemotherapy is usually recommended. Brachytherapy (internal radiation) may also follow this combined treatment.
Alternative Treatment:
- Radiation Therapy (EBRT and Brachytherapy): For women who are not suitable for surgery or prefer non-surgical options, radiation therapy using both external beam radiation and brachytherapy may be considered.
- Chemotherapy (Chemo): Chemo can be given concurrently with radiation therapy (concurrent chemoradiation) to enhance treatment effectiveness.
Stage IIA1 Cervical Cancer Treatment Options
Radical Hysterectomy with Lymph Node Dissection and Sampling:
- Procedure: This surgery involves removing the uterus and cervix, along with pelvic lymph nodes. Additionally, lymph nodes from the para-aortic area may be sampled to check for cancer cells.
- Follow-up Treatment: If cancer cells are found in the lymph nodes removed or in the margins of the removed tissue (positive margins), radiation therapy is often recommended.
Radiation Therapy:
- Description: This treatment combines external beam radiation therapy (EBRT) and brachytherapy (internal radiation).
- Chemotherapy: Concurrently with radiation, chemotherapy may include drugs like cisplatin, carboplatin, or a combination of cisplatin plus fluorouracil.
Additional Considerations:
- Treatment Plan: The choice between surgery followed by radiation or radiation with chemotherapy depends on the extent of cancer spread and individual health factors.
- Goal: The goal is to eliminate cancer cells and prevent recurrence while preserving overall health and well-being.
Stages IB3 and IIA2 Cervical Cancer Treatment Options
Chemoradiation:
- Description: This treatment combines chemotherapy and radiation therapy to target cancer cells.
- Chemotherapy Options: Cisplatin, carboplatin, or a combination of cisplatin plus fluorouracil may be used.
- Radiation Therapy: Includes both external beam radiation and brachytherapy (internal radiation).
Radical Hysterectomy with Lymph Node Dissection and Sampling:
- Procedure: Involves surgical removal of the uterus and cervix, along with pelvic lymph nodes. Para-aortic lymph nodes may also be sampled.
- Follow-up Treatment: If cancer cells are found in the removed lymph nodes or in the margins of the tissue removed (positive margins), additional therapy such as radiation with chemotherapy (concurrent chemoradiation) may be recommended.
Chemoradiation Followed by Hysterectomy:
- Sequence: This treatment plan involves first administering chemoradiation, followed by a hysterectomy procedure.
- Purpose: The goal is to effectively treat the cancer by combining these treatments to reduce the risk of recurrence.
Considerations:
- Individualized Approach: Treatment decisions are tailored based on the specific characteristics of the cancer and the patient’s overall health.
- Treatment Goals: Aim to eliminate cancer cells while preserving important reproductive and overall health functions.
Stages IIB, III, IVA Cervical Cancer Treatment Options
For stages IIB, III, and IVA of cervical cancer, treatment typically involves a combination of chemotherapy and radiation therapy known as chemoradiation. Chemotherapy options include drugs like cisplatin, carboplatin, or combinations such as cisplatin plus fluorouracil. Radiation therapy consists of both external beam radiation, which targets the cancer from outside the body, and brachytherapy, where radioactive sources are placed inside the body near the tumor.
In advanced cases, particularly in stage III or IV cervical cancer, pembrolizumab may also be included alongside chemoradiation. Pembrolizumab is an immunotherapy drug that works by enhancing the body’s immune response against cancer cells.
The goal of these treatments is to effectively destroy cancerous cells, reduce the size of tumors, and prevent the cancer from spreading further. This combined approach helps improve survival rates and quality of life for patients with cervical cancer.
Stage IVB Cervical Cancer Treatment Option
Stage IVB cervical cancer indicates that the cancer has spread beyond the pelvic area to other parts of the body. At this advanced stage, curing the cancer is typically not possible. Treatment aims to manage symptoms, slow down the cancer’s growth, and improve quality of life.
The main treatment options for Stage IVB cervical cancer include radiation therapy, sometimes combined with chemotherapy. Radiation therapy can help shrink tumors and alleviate symptoms. Chemotherapy usually includes a platinum-based drug like cisplatin or carboplatin, often combined with other drugs such as paclitaxel, gemcitabine, or topotecan. These combinations are designed to target and destroy cancer cells throughout the body.
In addition to standard chemotherapy, targeted therapies like bevacizumab (Avastin), immunotherapy with pembrolizumab (Keytruda), or the targeted drug tisotumab vedotin-tftv (Tivdak) may also be considered. Clinical trials are ongoing to explore new combinations of chemotherapy drugs and experimental treatments to further improve outcomes for patients with Stage IVB cervical cancer.
Cervical cancer in Pregnant Women
Cervical cancer in pregnant women is rare but can happen, especially in early stages like stage I. Doctors decide on treatment based on factors such as tumor size, if nearby lymph nodes are affected, how far along the pregnancy is, and the type of cancer.
For very early cancers, like stage IA, it’s usually safe to finish the pregnancy and start treatment after giving birth. Treatments could include surgery to remove the cancerous tissue, like a hysterectomy, radical trachelectomy, or cone biopsy.
If the cancer is stage IB or higher, the decision to continue the pregnancy depends on the situation. Treatment might involve a radical hysterectomy, radiation, or sometimes chemotherapy during the second or third trimester to shrink the tumor.
If continuing the pregnancy, the baby is usually delivered by cesarean section when it can survive outside the womb. More advanced cancers may need immediate treatment to ensure the best outcomes for both the mother and baby.
Also Read: Immunotherapy for Stage 4 Cervical Cancer
Conclusion
Understanding the stages of cervical cancer is crucial for tailoring effective treatment plans. From early-stage options like cone biopsy or radical hysterectomy to advanced chemoradiation therapies for Stage IVB, each approach aims to maximize outcomes while considering fertility preservation and individual health factors. Treatment decisions are nuanced, involving multidisciplinary discussions to address the specific characteristics of the cancer and the patient’s preferences. Ongoing research and clinical trials continue to expand treatment possibilities, promising improved outcomes and better quality of life for those affected by cervical cancer.
Also Read: Cervical Cancer Treatment Cost In India
