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The treatment of cervical cancer depends upon the stage of the disease, the woman's age and overall condition, her desire to bear children in the future, and in the advanced stages of the disease, her goals of care (aggressive treatment versus focus on comfort).

Ablative Modalities

Ablative modalities are procedures that destroy the affected tissue and are usually recommended only for women in whom invasive cervical cancer has been ruled our through a combination of colposcopy and cytology. These methods are not known to cause any complications with sex, becoming pregnant, or giving birth.

Ablative modalities for cervical cancer include:

• Cryotherapy - this is a method of destroying abnormal cells by freezing. The procedure can be performed in the doctor's office under a local anesthetic. Some cramping may be felt during the procedure. A light vaginal discharge may be present for a few days following the procedure. Some women will require a second treatment to ensure that all abnormal tissue has been destroyed.

• Electrocautery - this method burns off abnormal cells using an electric current; this procedure may cause more discomfort than newer procedures so is less frequently used now than in the past. It is, however, an effective method for treatment of CIN 1 and CIN 2.

• Laser Vaporization - this is a method of destroying abnormal cells with a laser.

• Cold Coagulation - unlike its name suggests, this is a method of destroying abnormal cells with a heated probe.

• Diathermy/Electrofulguration - this method uses an electric current to cut away the area of abnormal cells.

Excisional Modalities

These procedures remove the affected tissue by surgical excision:

• Loop Electrocautery Excision Procedure (LEEP) This procedure entails the removal of suspicious cervical tissue with a sharp wire loop and the site is cauterized (burned) to eliminate any remaining abnormal tissue.

• Conization - In this procedure, a small scalpel or laser is used to remove a cone-shaped section of the cervix. This procedure requires general anesthesia and usually is performed as outpatient surgery in the hospital.

Chemotherapy

Chemotherapy uses toxic drugs to destroy cancer cells. Chemotherapy is administered intravenously, through injection, or in pill form. Platinum-based drugs (Cisplatin/Platinol) and fluorouracil (Adrucil; Efudex) are the most commonly used drugs for cervical cancer and are often used in combination.

Side effects of chemotherapy may include:

• Nausea and vomiting
• Hair loss
• Diarrhea
• Leukopenia - low white blood cell count which can increase susceptibility to infection
• Anemia - low red blood cell count which can cause fatigue

Neoadjuvant chemotherapy is the use of chemotherapy prior to radiation or surgery to reduce the size of the tumor which needs to be irradiated or removed. Chemotherapy administered prior to surgery may shrink inoperable tumors (such as later Stage II and Stage III tumors) sufficiently so as to make them operable, as well as treat any disease that has spread (metastasized).

As tumors increase in size, they can exceed their blood supply which leads to inadequate oxygen supply to the cells. To maximize the effectiveness of radiation therapy and chemotherapy, it is important for the area to be treated to have adequate blood and oxygen supply. This can also be affected by issues such as anemia. Therefore, interventions such as medications to stimulate the bone marrow to make red blood cells or blood transfusions may be used to increase red blood cell (hemoglobin) levels.

Radiation Therapy