Cervical Cancer Treatments: Surgery, Chemotherapy, and More

What is cervical cancer?

Cervical cancer is a form of cancer that develops in the cells of the cervix, connecting the uterus and the vagina. Often linked to persistent HPV infections, this type of cancer has various treatment options that depend on the stage and specific characteristics of the disease. Therefore, early detection through regular screenings can significantly improve treatment outcomes. 

Despite an advanced healthcare system, cervical cancer remains a significant health issue in Singapore. According to the Singapore Cancer Registry, it is one of the top ten cancers affecting women in the country.

Concerned about cervical cancer? Request an appointment with our specialists at Thomson Medical for personalised guidance.

Treatments for cervical cancer

Cervical cancer treatment varies based on the stage of the disease and may include several key approaches for your consideration: 

1. Surgery:

   • For early-stage cervical cancer, surgery often involves removing the cervix (trachelectomy) or the uterus (hysterectomy). Fertility-preservation options, such as cervical conisation or trachelectomy, may be also available.

2. Radiation therapy:

   • Radiation therapy is frequently combined with chemotherapy for advanced cases of cervical cancer. The radiation targets cancer cells in the cervix and nearby areas to help control the disease.

3. Chemotherapy:

   • Often used in advanced or metastatic stages, chemotherapy uses drugs to destroy cancer cells throughout the body.

4. Targeted therapy:

   • Designed to focus on specific cancer cell characteristics, targeted therapy minimises harm to healthy cells.

5. Immunotherapy:

   • This treatment enhances the immune system’s ability to recognise and fight cancer cells.

For advanced stages (FIGO IB2 and above), the standard treatment generally involves a combination of chemoradiotherapy (CCRT) and brachytherapy. Special techniques, such as frozen section assessments and sentinel node detection, help guide staging and treatment choices.

For high-risk patients, adjuvant chemoradiotherapy or radiotherapy is recommended post-surgery, particularly for those with positive lymph nodes, parametrial involvement, or large tumours. Neoadjuvant chemotherapy may also be used to reduce tumour size before surgery, increasing treatment flexibility.

Discussing these options with our gynaecologists is essential in helping us tailor your treatment to your needs. Regular screenings and early detection remain critical to achieving the best outcomes.

Choosing the appropriate treatment option for cervical cancer

Deciding on the most suitable treatment plan for cervical cancer is a multi-step process that ensures each patient's unique needs and circumstances are carefully considered. Here are  several important steps:

1. Staging the cancer

   • Understanding how far the cancer has progressed is essential for selecting the right treatment. 

   • Staging is conducted using diagnostic tools such as Pap smears, biopsies, and imaging scans (e.g., MRI, CT, and PET scans). These tests help determine if the cancer is confined to the cervix or has spread to surrounding areas, informing us on the intensity and combination of treatments required. More details on the cancer screening can be found here.

2. Identifying cancer type

   • Cervical cancer mainly appears as squamous cell carcinoma or adenocarcinoma, each responding differently to treatment, making accurate identification essential:

     1. Adenocarcinoma: Starts in the glandular cells lining organs like the cervix. Its unique cellular makeup may require a distinct treatment approach compared to squamous cell carcinoma.

     2. Squamous cell carcinoma: Begins in the flat squamous cells that line the cervix’s surface and is the most common type. It may need different treatment due to its specific cellular structure.

3. Assessing patient health

   • A patient’s overall health, age, and any existing medical conditions can impact treatment choices, helping to avoid complications.

4. Setting your treatment goals

   • Clearly defining the goals of treatment is a key step in decision-making. 

   • If the cancer is in an early stage, the aim may be curative, focusing on complete removal of cancer cells. 

   • In more advanced stages, goals may shift to controlling the disease, alleviating symptoms, or extending quality of life, often involving a palliative approach to enhance comfort.

5. Reviewing treatment options

   • Surgery, which may include procedures like trachelectomy or hysterectomy, is often suitable for early-stage cancers, with fertility-sparing options available.

   • Radiation therapy, especially when combined with chemotherapy, is commonly used for advanced cases. Chemotherapy, targeted therapy, and immunotherapy are also considered, with discussions around possible side effects to help patients make informed choices.

6. Incorporating patient preferences

   • A truly personalised treatment plan respects the patient’s personal values, lifestyle, and preferences. Some patients may prioritise fertility preservation, while others may wish to avoid certain side effects. Understanding these preferences helps the medical team create a treatment plan that aligns with the patient’s life goals and comfort levels.

7. Exploring clinical trials

   • Clinical trials offer access to cutting-edge treatments, which can be a valuable option for eligible patients.

8. Consulting a multidisciplinary team

   • A collaborative team of specialists, including oncologists, surgeons, and radiologists, ensures a comprehensive treatment plan based on expert input. 

Through careful consideration of these factors and a thorough discussion with a healthcare team, patients and their families can make well-informed, confident decisions regarding cervical cancer treatment. Consider consulting with us today to discuss a personalised treatment plan that is tailored to your needs.

Potential complications of cervical cancer treatment

Cervical cancer treatment can include surgery, radiation therapy, chemotherapy, or a combination of these approaches. While effective, these treatments may lead to complications, which vary depending on the specific type of treatment. Below are some of the common complications associated with cervical cancer treatments:

Surgical complications

• Bleeding: 

  • Surgeries such as hysterectomy may lead to significant blood loss.

• Infection: 

  • As with any surgery, there is a risk of postoperative infections.

• Bladder and bowel dysfunction: 

  • Nerve damage during surgery can affect bladder control and bowel function.

• Lymphatic issues: 

  • Removal of lymph nodes may cause lymphedema, or swelling in the legs due to fluid buildup.

• Sexual dysfunction: 

  • Surgery may impact sexual function, causing reduced sensation, vaginal dryness, or other changes.

Radiation therapy complications

• Fatigue: 

  • Radiation often causes significant fatigue, which can impact daily life.

• Skin irritation: 

  • Radiation may cause skin irritation or burns in the treated area.

• Vaginal stenosis: 

  • Radiation can lead to scarring in the vaginal area, causing narrowing that may make sexual intercourse painful.

• Bladder and bowel Issues: 

  • Radiation may damage nearby organs, leading to bladder inflammation, diarrhoea, or long-term incontinence.

• Premature menopause: 

  • Radiation can lead to early menopause by affecting ovarian function in premenopausal women.

• Bone weakening: 

  • Radiation to the pelvic area can weaken bones, increasing the risk of fractures over time.

Chemotherapy complications

• Nausea and vomiting: 

  • Many chemotherapy drugs cause nausea and vomiting as common side effects.

• Immune suppression: 

  • Chemotherapy weakens the immune system, increasing vulnerability to infections.

• Hair loss: 

  • Hair loss is a known side effect of certain chemotherapy medications.

• Peripheral neuropathy: 

  • Nerve damage from chemotherapy can cause numbness, tingling, or pain in the hands and feet.

• Kidney damage: 

  • Some chemotherapy drugs may impact kidney health, leading to potential complications.

Fertility and reproductive health

• Infertility: 

  • Certain treatments, such as pelvic radiation and hysterectomy, may impact fertility. 

  • Chemotherapy may also affect fertility for some women, making it essential to discuss fertility preservation options with your doctor if this is a concern.

Emotional and psychological effects

• Living with these health challenges can feel overwhelming at times, and it's perfectly normal to experience a range of emotions—from anxiety about the future to moments of sadness or uncertainty. Many people worry about changes in relationships, intimacy, or their ability to have children. Remember, these feelings are a natural part of the journey, and you're not alone in experiencing them. Reach out to your support system, including loved ones, friends, or healthcare professionals, for guidance and reassurance as you navigate this path.

Long-term health risks

• Chronic pain: 

  • Some patients experience ongoing pelvic pain after treatment.

• Secondary cancers: 

  • Radiation therapy may slightly increase the risk of developing other types of cancer, such as bladder or rectal cancer, later in life.

Cervical cancer treatments are personalised to each patient, so not everyone will experience these complications, and the severity of side effects can vary. Regular follow-ups with a healthcare professional can help manage and mitigate potential side effects for a smoother recovery journey.At Thomson Medical, we are committed to providing comprehensive care for cervical cancer patients, focusing on effective treatment and managing potential side effects to enhance overall well-being. For personalised guidance and support on this special journey, request an appointment with us today.

FAQ

Can I still have children after cervical cancer treatment?

The ability to have children after treatment depends on the type and extent of treatment received. Early-stage cervical cancer can sometimes be treated with fertility-sparing procedures, such as a trachelectomy, which preserves the uterus. However, more advanced stages or treatments like hysterectomy and radiation therapy may impact fertility. If preserving fertility is a priority, consider discussing options like egg or embryo freezing with your doctor before beginning treatment.

How effective is cervical cancer treatment?

The effectiveness of cervical cancer treatment varies depending on the cancer stage and how early it is detected. Early-stage cervical cancer generally has a high cure rate, especially with surgery or a combination of therapies. For locally advanced cases, chemoradiation is often effective. Treatment for advanced or metastatic cervical cancer focuses on controlling the disease and extending life, though it may not be curative.

Can cervical cancer come back after treatment?

Yes, cervical cancer can recur, with recurrence being more likely within the first few years post-treatment. This is why regular follow-up care is essential. If the cancer does return, additional treatments such as surgery, chemotherapy, or radiation may be recommended.

Is there any way to prevent cervical cancer from recurring?

While recurrence cannot be completely prevented, adhering to your treatment plan and attending regular follow-up appointments can help detect any recurrence early. Maintaining a healthy lifestyle, including a balanced diet, regular exercise, and avoiding smoking, may also support recovery and long-term health.

The information provided is intended for general guidance only and should not be considered medical advice. For personalised recommendations and tailored advice, please consult a specialist at Thomson Medical. Request an appointment with Thomson Medical today.