Cervical Cancer Treatment

At Penn Medicine's Abramson Cancer Center, we offer a comprehensive cancer program that provides women more options for treating cervical cancer. Specialists at the Jordan Center for Gynecologic Cancers are dedicated to identifying cervical cancer, eliminating it, and preventing it from recurring.

Learn about managing treatment side effects.

Chemotherapy and Biologic Therapies for Cervical Cancer

Penn Medicine specializes in a team approach to cancer treatment with interdisciplinary care and innovative approaches that use chemotherapy to target tumors prior to and after surgery.

Chemotherapy

Chemotherapy uses drugs to kill cancer cells. It is delivered through the bloodstream, targeting cancer cells throughout the body. Chemotherapy is considered a "systemic" therapy, meaning that it travels throughout the body, unlike surgery or radiation, which are "local" therapies. Chemotherapy is usually delivered intravenously through a catheter, or orally by pill.

Hormone Therapy

Our medical oncologists sometimes use hormone therapy to stop cancer cells from multiplying. Hormone therapy keeps cancer cells from getting the materials they need to grow and divide. Hormones are chemicals produced by glands in the body. They circulate in the bloodstream and can affect the way some cancers grow. Hormones include:

  • Estrogen
  • Progesterone
  • Testosterone

Immunotherapy

Cancer specialists at Penn Medicine are pioneers in using a patient's own immune systems to fight cancer. Immunotherapy involves triggering the immune system to fight the cancer or to lessen the side effects that may be caused by some cancer treatments.

Immunotherapy is designed to repair, stimulate, or enhance the immune system's responses to cancer. The immune system fights viruses and bacteria to prevent disease, but it also plays a role in preventing cancer from developing or spreading. The goal of immunotherapy is to enhance the body's natural defense and its ability to recognize and fight cancer.

At Penn, medical oncologists help the immune system function better by introducing substances that occur naturally in the body. The therapy may stimulate the immune system to make more of the substance, or the therapy may be a man-made version of that natural substance itself. Other types of therapies use cells from the patient's body, which are then altered in a laboratory and given back to the patient.

Immunotherapy is less invasive and less toxic because it uses the body's immune system to fight cancer cells. It works by:

  • Targeting specific cancer cells, avoiding damage to normal cells
  • Making cancer cells easy for the immune system to recognize
  • Possibly preventing or slowing tumor growth
  • Potentially preventing the spread of cancer cells
  • Using the immune system better to more effectively attack cancer cells

Vaccine Therapy

Cancer vaccines teach the immune system to attack and destroy cancer cells. Oncologists at Penn Medicine are recognized around the world for the research and development of cancer vaccine therapies.

When foreign cells, such as viruses, enter the body the immune system responds to the invasion and clears the intruders. But cancer cells are not recognized as foreign. In fact, the immune system thinks cancer cells are normal cells and does not mount an immune response. Cancer vaccines "tell" the immune system to recognize and attack the cancer cells.

There are two types of cancer vaccines:

  • Preventive
  • Treatment

Preventive cancer vaccines work just like vaccines used to prevent measles or polio. Harmless versions of the disease, which stimulate an immune response, are introduced to the body. When the immune system encounters these vaccines it responds, eliminating the cells from the body, and develops a memory of them. This vaccine-induced memory enables the immune system to act quickly if it encounters the same substance in the future. The HPV vaccine that protects against the virus that can cause cervical cancer is an example of a preventive.

Cancer treatment vaccines treat cancers that have already occurred. They are intended to delay or stop cancer cell growth, shrink tumors, prevent cancer from coming back or eliminate cancer cells that are not killed by other forms of treatment. Some cancer vaccines are made with the cells from the patient"s own tumor, then reintroduced to stop or delay the cancer.

Clinical Trials for Cervical Cancer

Today, more and more people are surviving cancer. Clinical trials benefit patients with access to breakthrough therapies and treatments. These new advances in cancer treatment are occurring every day at Penn Medicine, giving patients hope that even greater discoveries lie ahead. Through clinical trials:

  • Diagnosing cancer has become more precise.
  • Radiation and surgical techniques have advanced.
  • Medications are more successful.
  • Combinations of medical, surgical and radiation therapy are improving treatment effectiveness and enhancing outcomes.
  • Strategies to address the late effects of cancer and its treatment are improving quality of life.

Radiation Therapy for Cervical Cancer

Radiation therapy is very effective in treating cervical cancer. Radiation therapy, also referred to as radiotherapy, uses high energy X-rays to kill cancer cells. Surgery and radiation have been shown to be equally effective treatments for early stage cervical cancer, but radiation therapy is the preferred treatment for advanced-stage cervical cancer.

Radiation treats all of the cancer cells in the radiation field; thus lymph nodes can be treated as well as the primary tumor during the course of the same treatment.

Brachytherapy

Brachytherapy involves the placement of radioactive sources directly in and adjacent to the cervix allowing high doses of radiation therapy to be delivered directly to cancer cells with less exposure to surrounding normal organs.

Penn Radiation Oncology has instituted a program to treat patients with HDR interstitial (multicatheter) brachytherapy. It is the only center in the Philadelphia area to offer this treatment. Combined with MR imaging, brachytherapy allows improved dose conformality.

Conformal Radiation Therapy

Conformal radiation therapy shapes the radiation treatment beam to the shape of the tumor. Known as conformal radiation therapy, this technology gives doctors more control when treating cervical cancer.

In conformal radiation, a special computer uses CT imaging scans to create 3-D maps of the location of the cancer in the body. The system permits delivery of radiation from several directions and the beams are shaped, or conformed, to match the shape of the cancer. Conformal radiation therapy limits radiation exposure to nearby healthy tissue as well as the tissue in the beam's path.

Image-Guided Radiation Therapy (IGRT)

Image-guided radiation therapy (IGRT) uses frequent imaging during a course of radiation therapy to improve the precision and accuracy of the delivery the radiation treatment. In IGRT, the linear accelerators (machines that deliver radiation) are equipped with imaging technology that take pictures of the tumor immediately before or even during the time radiation is delivered.

Specialized computer software compares these images of the tumor to the images taken during the simulation to establish the treatment plan. Necessary adjustments can then be made to the patient's position and/or the radiation beams to more precisely target radiation at the cancer and avoid the healthy surrounding tissue.

Intensity-Modulated Radiation Therapy (IMRT)

Intensity-modulated radiation therapy (IMRT) is a type of high-precision radiotherapy using computer-controlled linear accelerators to deliver precise radiation doses to tumors or specific areas within the tumors.

Using 3-D computed tomography (CT) images of the patient in conjunction with computerized dose calculations, IMRT allows the radiation dose to conform more precisely to the three-dimensional shape of the tumor by controlling, or modulating, the intensity of the radiation beam in multiple small volumes. The therapy allows higher radiation doses to be focused on regions within the tumor while minimizing the dose to surrounding normal critical structures.

Proton Therapy

Proton therapy is external beam radiotherapy in which protons are directed at a tumor. The radiation dose that is given through protons is very precise, and limits the exposure of normal tissues. This allows the radiation dose delivered to the tumor to be increased beyond conventional radiation. The result is a better chance for curing cancer with fewer harmful side effects.

Currently, Penn researchers are learning how proton therapy can be used for women with positive para-aortic lymph nodes from cervical cancer.

Surgery for Cervical Cancer

Pre-cancer (dysplasia) or very small lesions can be treated with minor surgery that may even be performed within the gynecologic practice. Larger tumors or cancer that has spread may require a more extensive surgery, such as a hysterectomy or radical hysterectomy, and additional treatment options including radiation and chemotherapy.

Penn gynecological oncologists work with patients to develop individual treatment plans and can often preserve reproductive options for women who wish to still have children. Our gynecologic surgeons are skilled in open surgery and are experts in using advanced minimally invasive laparoscopic and robotic-assisted surgical techniques. Alongside this innovative technology, our physicians, nurses and support staff give patients compassionate, exemplary and individualized surgical care.

Our gynecologic specialists continue their efforts to devise and enhance new and even better options for complex gynecologic surgery through the Penn Center for Advanced Gynecologic Surgery.

Conization (Cone Biopsy)

Penn Medicine physicians use conization, including cold-knife cone and loop electrosurgical procedure (LEEP), to diagnose and treat cervical cancer and precancerous lesions of the cervix.

During the procedure, a piece of tissue is removed from the cervix using either a scalpel (cold-knife cone biopsy) or a thin wire heated with electricity (loop electrosurgical procedure or LEEP). Conization is rarely used as the sole treatment for cervical cancer unless a woman wants to preserve her ability to have children and the amount of cancer present in the cervix is very small. The tissue removed during conization is checked under a microscope. If the outer edges of the tissue, called margins, still show precancerous changes, additional treatment may be needed to make sure that all of the abnormal cells are removed.

Hysterectomy

At Penn Medicine, minimally invasive techniques such as laparoscopic robotic-assisted surgery have become the standard of care for treating certain gynecologic cancers. For some types of cervical cancer, surgeons remove the body of the uterus and the cervix in a procedure known as a hysterectomy.

Hysterectomy may be performed as an open procedure, known as an abdominal hysterectomy, in which the uterus is removed through an incision in the abdomen. If lymph node sampling is needed, this can be done through the same incision as the abdominal hysterectomy.

Removing the uterus through the vagina is called vaginal hysterectomy. This procedure is minimally-invasive, sometimes with the assistance of a laparoscope, which is a thin camera inserted into the abdomen to facilitate the procedure and allow for abdominal and pelvic lymph node biopsies if necessary.

Our surgeons consider medical history, stage of cancer and current health condition to determine the type of surgery needed. Dependent upon the extent of the cancer, surgeons may also perform biopsies in other areas of the abdomen.

Simple Hysterectomy

A simple hysterectomy removes only the uterus and cervix. Removing the ovaries and fallopian tubes is not always necessary for adequate treatment of cervical cancer.

Radical Hysterectomy

When surgeons perform a radical hysterectomy, the entire uterus, as well as the tissues next to the uterus (parametrium and uterosacral ligaments), and the upper part (about an inch) of the vagina (near the cervix) are removed.

Usually performed abdominally, radical hysterectomy can also be performed vaginally, laparoscopically, or robotically. Most patients undergoing a radical hysterectomy also have a lymph node dissection, in which lymph nodes are removed either through the abdominal incision or by laparoscopic or robotic lymph node sampling.

Laser Surgery

Penn gynecologists may use laser surgery to treat pre-invasive forms of cervical cancer, known as cervical dysplasia. Laser surgery focuses a high-energy light beam on abnormal cervical cells and vaporizes them.

Pelvic Exenteration

Pelvic exenteration is a radical cervical cancer surgery that removes all organs from the pelvic region. It is not commonly performed, but may be used to in special cases to treat cervical cancer that has recurred. A variety of structures or organs adjacent to the cervix may be removed during the procedure, including the:

  • Parametria and uterosacral ligaments
  • Vagina
  • Fallopian tubes and ovaries
  • Bladder and rectum

During the operation, stomas are created to allow urine and stool to collect in special bags. Some patients may have a type of reconstruction that allow a continent stoma (one that does not require a bag) for urine. If the vagina is removed, an artificial vagina can be created through reconstructive surgery. Plastic surgeon use grafts of muscle and skin to reconstruct the vagina.

Other Treatments for Cervical Cancer

In addition to standard treatments and clinical trials, you may wish to add additional therapies and treatments such as massage therapy, acupuncture and art therapy. These therapies do not have curative intent, and are designed to complement standard treatments, not take their place.

Integrative Oncology Services

At Penn, our integrative oncology services can supplement traditional cancer treatments such as chemotherapy, surgery and radiation therapy. While conventional medicine plays a critical role in eradicating cancer, integrative medicine and wellness programs offer you ways to enhance the quality of your life, minimize or reduce the side effects of cancer and cancer treatment, and promote healing and recovery.

Our cancer specialists are knowledgeable and supportive of complementary cancer treatments. Our cancer team works with you and your family to integrate these supportive programs into the overall care plan, while ensuring your health and safety.

The Abramson Cancer Center's range of integrative supportive services is designed to help you cope with the cancer experience and improve your overall sense of well-being.

Services include:

Joan Karnell Supportive Services at Pennsylvania Hospital offers an extensive variety of supportive care programs for patients and families, from diagnosis through survivorship. These programs are available at no cost to the patients treated at Pennsylvania Hospital, and some are open to patients treated elsewhere. These services include social work counseling, nutrition counseling, psychological counseling and spiritual counseling.

The Cancer Appetite and Rehabilitation Clinic focuses on patients with loss of appetite and weight.

The Supportive Oncology Clinic helps to manage cancer related symptoms. Integrative support programs include:

Palliative Care

Palliative care provides medical and non-medical interventions to ease the symptoms of cancer and its treatment. Palliative care includes physical, emotional and spiritual care that can enhance the quality of life for cancer patients. Palliative care can be used to complement traditional cancer therapies, or can be used when curative therapies are no longer an option to treat symptoms and improve quality of life.

Palliative care is an approach to patient care that can be integrated with curative therapies at any point from diagnosis to survivorship or end of life care. Palliative care services include palliative chemotherapy, radiation therapy and surgery as well as psychological counseling, art therapy and support groups for patients and families.

Penn Home Care and Hospice Services

Penn Medicine offers a full range of “at home” health care services, including specialized therapies and medications, for patients with cancer and cancer-related conditions.