 If unusual cells are found, the doctor may order HPV testing. If that test shows the presence of high-risk strains of HPV, the doctor will perform a colposcopy to look more closely at the cervix.
A colposcopy also may be done if the cells in the cervix appear to be abnormal (cervical neoplasia). The colposcope combines a bright light with a magnifying lens to make it easier to see the tissue. If there are abnormal cells in the cervix, the doctor will take a tissue sample (biopsy). Most of the time, this type of biopsy is performed in the doctor’s office, usually under local anesthesia.
When found early, cervical cancer can be treated effectively. Precancerous cells usually can be removed without harming healthy cells. If the abnormal cells have become cancerous, the most common treatments are surgery, radiation and chemotherapy.
Radiation alone or surgery to remove part or all of the cervix may be used for a small tumor or early-stage cervical cancer. A combination of chemotherapy and radiation often is used for large tumors or more advanced cervical cancers. Choosing the best treatment also takes into account a woman’s desire to have children. Some treatments can preserve fertility for future successful pregnancies.
A gynecologic oncologist—a doctor specializing in cancers of the female reproductive system, including the cervix, uterus (womb) and ovaries—should head the health care team for the best possible outcome.
Several types of surgery may be used to treat cervical cancer or remove precancerous cells from the cervix:
Cryosurgery. Used to treat precancer of the cervix. Liquid nitrogen is used to freeze the abnormal cells and destroy them.
Laser surgery. Also used to treat precancer of the cervix. A focused laser beam is used to remove abnormal cells. This can be done in a doctor’s office under local anesthesia.
LEEP (loop electrocautery excision procedure)/LLETZ (large loop excision of the transformation zone). Used to remove an abnormal area on the cervix seen during colposcopy. If there are abnormal cells 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