Best Treatments for Cervical Cancer

Radiation therapy, surgery, chemotherapy and various combinations of these methods are used to treat cervical cancer (CC)¹. Recently, other methods have begun to be used in Russia – targeted and immunotherapy.

Treatment is carried out according to standards depending on the stage and prevalence of the disease, the age of the woman and her desire to preserve reproductive function.¹ (possibility to become pregnant and bear a child). For each case, you can choose an effective method of treating cervical cancer or a combination of both.

Treatment of a patient with cervical cancer can only begin after a comprehensive examination. The therapeutic program must be coordinated at a consultation consisting of a surgeon, radiotherapist, chemotherapist and, if necessary, doctors of related specialties: diagnosticians, anesthesiologists, and therapists.  

Causes of cervical cancer

• Age from 40 to 49 years – women in this age group get sick most often.
• The presence in the body of the human papillomavirus (HPV), primarily viruses 16 and 18 types.
• Early onset of sexual activity.
• Frequent change of sexual partners.
• Injuries of the cervix during childbirth, abortion, surgical interventions.

Symptoms of cervical cancer

At the initial stage, cervical cancer does not manifest itself in any way. If the disease progresses, a woman may experience symptoms such as:

• pain and spotting during intercourse;
• intermenstrual bleeding;
• unreasonable pain in the small pelvis, which can radiate to the lower back, thigh and perineum;
• weight loss without diet
• anemia;
• swelling of the legs;
• constipation and difficulty urinating.

Stages of cervical cancer

1. Radiation therapy for cervical cancer

Radiation therapy (RT) is the destruction of cancer cells with the help of ionizing radiation. Radiation therapy for cervical cancer is used alone or in combination with chemotherapy, and sometimes with surgery. Most often, radiation therapy is combined with the introduction of platinum preparations, which enhance the effect of radiation.². The combination of radiotherapy with chemotherapy is called chemoradiotherapy or CRT.

Starting from stage IB2-IVA of the tumor process, the main method of treatment is combined chemoradiotherapy according to a radical program.². Before it is performed, young patients under 45 years of age have the opportunity to perform a transposition in order to preserve ovarian function. Transposition is a surgical operation in which the ovaries are moved from the pelvis to the abdominal cavity and thus removed from the radiation zone.

There are two types of radiation therapy:

• Remote – the source of ionizing radiation is located at a distance from the patient.
• Brachytherapy for cervical cancer – a radioactive source is located inside the tumor and destroys it. The source is introduced directly into the tissues of the body by installing intrastats: special needles or catheters that are removed after the completion of the course of treatment.

Under the influence of ionizing radiation, changes occur in the tumor – from dystrophy to its replacement with fibrous tissue. The effectiveness of irradiation depends on the radiosensitivity of the tissue from which the tumor originated. Squamous cell carcinoma of the cervix is ​​radiosensitive, that is, it completely disappears after a course of radiation therapy.

Radiation therapy sessions are usually given daily. Total treatment time with CRT or RT should not exceed 7-8 weeks². In this case, it is impossible to interrupt the course of therapy².

To date, the combination of remote radiation therapy with chemotherapy and subsequent brachytherapy is a generally accepted method of treating cervical cancer (when a tumor larger than 4 cm spreads to the vagina, body of the uterus, parametrium, metastasizes to regional lymph nodes). Thanks to the treatment, tumor cells are completely destroyed both in the primary focus and in areas where metastases have reached.

Treatment is planned and carried out under the control of three-dimensional visualization: according to CT / MRI – images and PET / CT data)². This allows you to bring the maximum dose to the target without affecting the surrounding healthy organs and tissues.

Modern radiation therapy, carried out according to international standards, allows women with locally advanced cervical cancer to be completely cured.

2. Chemotherapy for cervical cancer

Chemotherapy helps slow down the progression of the disease and alleviate its course. For this purpose, antitumor drugs are used that cause the death of cancer cells, or stop their growth and reproduction.

The drugs are taken in tablets or administered intravenously. As a rule, the patient is prescribed several courses of treatment with a break of 21 days. The most commonly prescribed drugs are Cisplatin, Ifosfamide, Fluorouracil.³.

If “chemistry” is carried out according to a radical program, the drug Cisplatin is used. The drug is administered once a week at the stage of remote irradiation and does not cause hair loss.

Different types of chemotherapy can be used for cervical cancer:

• Neoadjuvant is performed before surgery to remove the tumor. The goal is to reduce the size of the tumor and reduce the risk of recurrence.³.
• Adjuvant (prophylactic) is performed after surgery to prevent re-growth of the tumor and the appearance of metastases³. Often combined with chemotherapy, which reduces the dose of radiation and reduces the toxic load on the body.

Anticancer drugs are rarely prescribed for stage 1 and 2 cervical cancer. In this case, the main method of treatment is surgery, supplemented by a course of radiation therapy. Stages 3 and 4 of the disease require a combined approach that includes surgery, chemotherapy and radiation.

Chemotherapy for cervical cancer can be an independent method of treatment if the patient is not indicated for surgery and radiation therapy³.

3. Immunotherapy for cervical cancer

Immunotherapy is a new treatment for cervical cancer. The principle of action is based on the ability of the human immune system to recognize and destroy cancer cells. Immune drugs do not act directly on the tumor, but activate the body’s defenses⁴. With immunotherapy, healthy cells are practically not affected or suffer much less than with other types of treatment.⁴. However, tumors have learned to adapt to new conditions and elude the immune response.⁴. This is the main problem of immunotherapy.

Currently, immunotherapy is prescribed if the disease continues to progress during or after chemotherapy.

4. Targeted therapy for cervical cancer

Like immunotherapy, it refers to new methods of treating cervical cancer. Targeted therapy uses targeted drugs that destroy abnormal cells and do not damage healthy ones. Drugs work in different ways:

• interrupt the growth and division of atypical cells and stop the development of the tumor;
• stop the blood supply to the malignant neoplasm;
• bind to cancer cell receptors and destroy them.

Targeted therapy is used to treat primary tumors and for tumors that have stopped responding to chemotherapy. In case of recurrence or metastasis, the patient may be prescribed the targeted drug bevacizumab in combination with traditional cytostatics.⁵.

5. Surgery for cervical cancer

Surgery is the leading treatment for cervical cancer. The amount of surgical intervention depends on how far the tumor has spread, the age of the patient and the presence of concomitant diseases.¹.

After surgery, adjuvant (postoperative) radiation or chemoradiotherapy may be prescribed. Treatment is prescribed only after a study of the histology obtained during the operation, and an assessment of risk factors – for example, the risk of recurrence.

6. Cervical conization

With dysplasia, conization of the cervix (or a cone-shaped biopsy with diagnostic curettage of the cervical canal) may be prescribed.¹). This is a partial removal of the cervix, when pathological areas are removed and healthy tissue is left. The advantage of the method is that the woman retains the ability to bear children.

7. Extirpation of the uterus

Extirpation or hysterectomy is an operation to remove the uterus along with the appendages (ovaries and fallopian tubes)¹. Extirpation is recommended for patients with tumors ranging in size from 2 to 4 cm¹. According to indications, an extended extirpation according to Verheim is performed, in which, together with the uterus and appendages, the upper third of the vagina, regional lymph nodes and nearby tissues are removed.

Popular questions and answers

Cancer is surrounded by many myths and fears. Our experts – candidate of medical sciences, oncologist Anastasia Dubinina, epidemiologist Nikolai Dubinin and director of the medical support service Yulia Tarasova answered some popular questions to dispel common misconceptions about cervical cancer.

Sources of:

1. Cervical cancer. Clinical guidelines 2020. “Association of Oncologists of Russia”, “Russian Society of Clinical Oncology”, “Russian Society of Specialists in the Prevention and Treatment of Tumors of the Reproductive System. https://disk.yandex.ru/i/3loOiCU7Z8bHXQ
2. Practical guidelines for drug treatment of cervical cancer. Khokhlova S.V., Kolomiets L.A., Kravets O.A., Morkhov K.Yu., Nechushkina V.M., Tyulandina A.S., Urmancheeva A.F. 2021 version. https://rosoncoweb.ru/standards/RUSSCO/2021/2021-13.pdf
3. Modern approaches to the treatment of cervical cancer. K.Yu Morkhov, V.V. Kuznetsov, A.I. Lebedev, V.M. Nechushkina, T.I. Zakharova, S.A. Tyulyandin https://umedp.ru/articles/sovremennye_podkhody_k_lecheniyu_raka_sheyki_matki.html
4. Immunotherapy of malignant neoplasms. August 28.08.2015, XNUMX https://cyberleninka.ru/article/n/immunoterapiya-zlokachestvennyh-novoobrazovaniy-obzor/viewer
5. Possibilities of drug therapy in metastatic cervical cancer. E.A. Ulrich, T.Yu. Semiglazova, D.I. Khalimbekova, O.A. Smirnova, D.G. Ulrich, A.F. Urmancheev. Magazine “Farmateka” No. 12 for 2018. https://pharmateca.ru/ru/archive/article/36851