Most cervical cancers are caught early with Pap smear screening tests, but approximately 8 percent of those in the United States have already metastasized by the time of diagnosis. Both metastatic and locally advanced cancers require specialized treatment. Reference 1 defined 11 stages of cervical cancer, depending on the size of the tumor, the degree of tissue invasion, and the extent of metastasis. These stages are labeled 0, IA1, IA2, IB1, IB2, IIA, IIB, IIIA, IIIB, IVA, and IVB.
For stage 0, surgery is simple and offers a complete cure. For more advanced cancers, radiation and chemotherapy may be used to shrink the tumor before surgery. Advanced surgical techniques include radical hysterectomy (removal of the uterus) and radical trachelectomy (removal of the cervix, leaving the body of the uterus intact). A study from the Memorial Sloan-Kettering Cancer Center in New York reported that these procedures have similar outcomes in terms of the emotional, sexual, and quality of life concerns of patients.
Radiation therapy is the mainstay of treatment for most advanced cervical cancers. Newer forms include intensity-modulated radiation therapy (IMRT) and 3D conformal proton therapy (3DCPT). These techniques are intended to optimize the delivery of radiation to the cancer with minimal damage to surrounding tissue, such as the pelvic bone marrow. A study at the University of California San Diego showed that the two techniques are comparable. IMRT was somewhat better at higher dose ranges, while 3DCPT showed some advantages at lower doses.
Platinum-based chemotherapy is the most common medical treatment, but many other chemotherapy options are available, including:
1. Epirubicin, mitomycin and 5-fluorouracil, and capecitabine, generally used in combination with radiation.
2. Vinorelbine, paclitaxel, pemetrexed, ifosfamide, irinotecan, topotecan, capecitabine, and S-1, generally used as single agents.
3. Combination chemotherapy including cisplatin.
4. Combination chemotherapy including carboplatin.
5. Topetecan and paclitaxel combination therapy.
6. Irinotecan and mitocycin-C combination therapy.
7. Agents targeting hypoxia: tirapazamine and sanazol.
8. Biologic agents: epidermal growth factor receptor inhibitors, angiogenesis inhibitors, and immunotherapy agents.
9. Magnesium valproate as an epigenetic agent.
References:
1. Movva S et al, “Novel chemotherapy approaches for cervical cancer”, Cancer 2009; 115: 3166-80.
2. Carter J et al, “A 2-year prospective study assessing the emotional, sexual, and quality of life concerns of women undergoing radical trachelectomy versus radical hysterectomy for treatment of early-stage cervical cancer”, Gynecol Oncol. 2010 Nov; 119(2): 358-65.
3. Powell ME, “Modern radiotherapy and cervical cancer”, Int J Gynecol Cancer. 2010 Oct; 20 (11 Suppl 2): S49-51.
4. Song WY et al, “Dosimetric comparison study between intensity modulated radiation therapy and three-dimensional conformal proton therapy for pelvic bone marrow sparing in the treatment of cervical cancer”, J Appl Clin Med Phys. 2010 Aug 15; 11(4): 3255.
Linda Fugate is a scientist and writer in Austin, Texas. She has a Ph.D. in Physics and an M.S. in Macromolecular Science and Engineering. Her background includes academic and industrial research in materials science. She currently writes song lyrics and health articles.