s at the margin of the area removed, followup and more treatment may be needed.
Cone biopsy. A cone-shaped piece of tissue removed from the cervix. This is done with surgery, laser or the LEEP/LLETZ procedure. The cone of tissue removed is examined under the microscope by a pathologist. If the margins (outer edges) of the cone are “positive”—that is, if they contain cancerous or precancerous cells—some cancer (or precancer) may have been left behind, so follow-up is needed.
Hysterectomy. Surgery to remove the uterus in early-stage cervical cancer. This procedure can be done using a laparoscope (a thin tube with a camera at the end) or a robotic surgical technique and requires only a few small incisions instead of a larger cut in the abdomen.
Radical hysterectomy. Surgery for cancer that has spread beyond the cervix. The surgeon removes the uterus along with nearby tissues.
Trachelectomy. A type of surgery that removes the cervix and the upper part of the vagina, but not the uterus. It allows women with cervical cancer that has begun to spread to be treated while preserving their ability to have children. After a trachelectomy, a woman can become pregnant and deliver a healthy baby by cesarean section.
Women with early cervical cancer may be treated with radiation or surgery. Radiation also may be used after surgery to remove any cancer cells that remain in the area. Women with cancer that has spread beyond the cervix may receive radiation and chemotherapy. Several technologies have made radiation safer and more effective in women with cervical cancer:
External beam radiation therapy (EBRT) aims x-rays at the cervical cancer from outside the body. When radiation is used as the main treatment for cervical cancer, EBRT usually is combined with chemotherapy for advanced cervical cancer.
Brachytherapy involves placing a source of radiation in or near the cancer. For most women with cervical cancer, the radiation source is placed in a device inserted into the vagina and the cervix. This treatment is used in addition to EBRT. Low-dose brachytherapy is completed in just a few days in the hospital. High-dose brachytherapy is done outside the hospital over several treatments (often at least a week apart).
Chemotherapy and Targeted Treatments
Most women with cervical cancer are treated with surgery. However, some women may need to receive chemotherapy before or after surgery. They also may receive chemoradiation treatment, which is a combination of chemotherapy and radiation. In addition to chemotherapy, doctors may prescribe targeted treatments, which focus on specific cell mechanisms thought to be important for the growth and survival of tumor cells. Unlike chemotherapy, targeted treatments are designed to spare healthy tissues and may cause less severe side effects than chemotherapy.
Chemotherapy and targeted treatments for cervical cancer include the following medications:
Bevacizumab (Avastin). In 2014, this targeted treatment became the first drug approved for late-stage cervical cancer since 2006. Bevacizumab helps prevent the growth of new blood vessels that tumors need to grow. Because it more than tripled the rate of response to a cervical cancer drug, a result learned from clinical trials, the U.S. Food and Drug Administration fast-tracked approval of bevacizumab for this type of cervical cancer. Bevacizumab usually is combined with other drugs that target the cancer itself.
Cisplatin. This drug usually is combined with radiation for advanced-stage cervical cancer, alone or with fluorouracil. Cisplatin also may be used to treat cervical cancer that comes back (recurrent) or has spread outside of the pelvis. Cisplatin may be combined with other medications such as fluorouracil plus cetuximab (Erbitux) or docetaxel (Taxotere and others) plus paclitaxel (Taxol and others).
Carboplatin. Carboplatin usually is given intravenously (IV) through a blood vein. It is used in advanced-stage or recurrent cervical cancer.
Topotecan (Hycamtin and others). This medication usually is reserved for treating cervical cancer that no longer 