Cervical cancer: Options for prevention, treatment

Most cervical cancers, caused by the human papillomavirus (HPV), can be prevented or treated, especially with early diagnosis.

New options for cervical cancer prevention are vaccinations against HPV.  Vaccines protect against several strains of HPV. To be most effective, they should be administered before children and adolescents are sexually active.

If cervical cancer is not prevented, it can still often be treated successfully, said Dr. Elmer Lehman, a Marshfield Clinic Health System gynecologic oncologist who specializes in female cancers.

“We do see some very early cases that are actually cured through a procedure known as cone biopsy,” he said. “A cone-shaped piece of the cervix is removed for analysis and patients still have their full reproductive options.”

Screening Pap can provide early diagnosis

Most early detections are made as a consequence of a screening Pap test, he said.

With each new case, Lehman performs an exam and biopsy to reveal the extent and stage of the cancer. Stage 1 cancer is confined to the cervix. Staging goes up through Stage 4 cancer, which is well outside of the cervix. Treatment is individually designed for each patient but for some cases there is an option for hysterectomy to remove the uterus, or womb. But again, the patient sometimes has a choice.

In a total hysterectomy, appropriate for only a select few cases of very early cancers, the surgeon removes the cervix and uterus. Radical hysterectomy additionally removes tissue surrounding the cervix, part of the vagina, lymph nodes and, sometimes, tubes and ovaries. These operations can be performed through the abdomen or vagina, or laparoscopically through small incisions. Hysterectomy is only appropriate for certain early stages of cancer and only if other strict criteria are met.

Pregnancy after cervical cancer

Because it involves removing the womb, hysterectomy eliminates the possibility of getting pregnant.

“But for women who do hope to become pregnant, we rarely can offer a third option for those who qualify, called a trachelectomy which involves removing the cervix, a portion of the vagina and pelvic lymph nodes,” Lehman said. This procedure leaves the uterus and its blood supply in place. Again, this is only available in select cases.

“In most cases, the best treatment for cervical cancer can be recommended based on how early the cancer was found,” he said. “Most women are eager to accept effective therapy, even if it potentially means loss of the ability to have more children, or that they will enter menopause years earlier than it would arrive naturally.”

If you have questions or concerns about cervical cancer, talk with your doctor.