Treatment

Treatments

There are different types of treatment for patients with cervical cancer, depending on the stage of the cancer, whether you are a candidate for surgery, and your childbearing status. At Siteman, each cancer has a wide range of treatments that can be used alone or in combination to give the best outcome for your specific cancer, including standard therapies and novel therapies only available in clinical trials. That’s why careful diagnosis is so important. As part of a research medical center, physicians at the Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine in St. Louis have access to a wide range of clinical trials to test new therapies as they emerge. Many of our doctors are principle investigators in these trials, which cover medical, surgical, and radiation therapies. Discuss with your physician how your cancer might benefit from clinical trials.

The standard treatments for cervical cancer include surgery, radiation therapy, chemotherapy and targeted therapy. Clinical trials are testing many other approaches, some of which are becoming standard of care.

Surgery

Conization: This procedure removes a cone-shaped piece of tissue from the cervix and cervical canal. This procedure may be used for treatment of carcinoma in situ and stage 1 cervical cancer. It can be done with a scalpel, cutting it out. Another option is a loop electrosurgical excision procedure (LEEP), a surgical procedure that uses electrical current passed through a thin wire loop as a knife to remove abnormal tissue or cancer. A laser may also be used to remove the abnormal tissue.

Total hysterectomy: The surgeon removes the uterus and the cervix. It may be done through the vagina, through an abdominal incision, or laparoscopically through several small incisions. Often the ovaries don’t have to be removed, preserving their function.

Radical hysterectomy: The surgeon removes the uterus, cervix, upper vagina, and parametrium, along with regional lymph nodes. Often the ovaries don’t have to be removed, preserving their function.

Radical trachelectomy: Surgery to remove the cervix, nearby tissue and lymph nodes, and the upper part of the vagina. This procedure may be used to treat women with early-stage cervical cancer who want to have children. After the cervix is removed, the uterus is attached to the remaining part of the vagina, and a special stitch is created to act as the cervix and the opening to the uterus. This is a highly specialized procedure only offered at certain centers, such as Siteman.

Chemotherapy

Chemotherapy uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). The way the chemotherapy is given depends on the type and stage of the cancer being treated. There are a number of drugs approved to treat cervical cancer. New chemotherapies are constantly being evaluated and tested.

Radiation Therapy

Radiation oncology has active trials for minimizing the duration and amount of radiation a patient receives to reduce long-term side effects. No one should be over or undertreated. Siteman is a leader in using shorter radiation durations than the national average with the same outcomes.

Patients also can take part in studies with the Radiation Therapy Oncology Group, a group dedicated to radiation therapy trials, and receive new cancer therapies offered through clinical studies initiated by Siteman researchers and physicians.

MR-guided adaptive radiation therapy:  Siteman cancer center is the only center in the world performing MR-guided adaptive radiation therapy. By using an MRI to guide the radiation therapy; Siteman radiation oncologists can adjust, or adapt, the radiation to the patient every day.

Stereotactic body radiation therapy uses special equipment to position a patient and deliver radiation directly to the tumors. The total dose of radiation is divided into smaller doses given over several days. This type of radiation therapy helps prevent damage to normal tissue. This type of radiation therapy is being studied in clinical trials.

Brachytherapy This type of localized radiation allows a high-dose concentration of radiation immediately surrounding the radioactive source, with rapid fall-off of radiation exposer to adjacent tissues. In gynecologic cancers, the radiation source can be put inside an existing body cavity (intracavitary) or directly into tissue (interstitial). In cervical cancer, the radiation source is applied with an intrauterine applicator or a vaginal ring.

Siteman Cancer Center has the largest Brachytherapy Center in the United States and sees more than 1,200 patients for gynecologic cancer as well as thousands more for other types of cancer.

Radiation oncologists here are the only ones in the country to offer Image-Guided Adaptive Brachytherapy (IGABT) and have set the protocols and standards of care for this highly specialized and target-specific treatment that allows for adapting both the dose and parameters of radiation beams. The team also is the only one in the region specializing in combined brachytherapy and Intensity-Modulated Radiation Therapy (IMRT).

Vaccines and Immune Therapy

Vaccines are currently being tested in trials for the treatment of cervical cancer to allow your immune system to fight the cancer without the harsh side effects of traditional chemotherapy.

Targeted Therapy

Targeted therapy uses drugs or other substances to identify and attack specific cancer cells without harming normal cells. One type of targeted therapy is monoclonal antibody therapy, which uses antibodies made in the laboratory that can identify substances on cancer cells or normal substances that may help cancer cells grow. The antibodies attach to the substances and kill the cancer cells, block their growth, or keep them from spreading. They may be used alone or to carry drugs, toxins, or radioactive material directly to cancer cells.

One monoclonal antibody, Bevacizumab, binds to a protein called vascular endothelial growth factor (VEGF) and may prevent the growth of new blood vessels that tumors need to grow. Bevacizumab is used to treat cervical cancer that has metastasized and recurrent cervical cancer.

Targeted treatments are enhanced by the Washington University Genomics and Pathology Service (GPS), which offers genomic testing and next generation sequencing that can identify optimal patient treatment strategies for your specific cancer type and subtype.

Post treatment monitoring: Physical exams and PET scans are being used at Siteman to monitor patients post-treatment to detect any recurrence. If recurrence should happen, they have aggressive surgical techniques may help cure the cancer.

Different combinations of therapies may be used depending on the stage of the cancer and the health of the patient. New combinations of therapies are always being tested in clinical trials and are available at Siteman Cancer Center before other places may have access to them.