Cervical Cancer Treatment Options

Surgery is an option for women with Stage I or II cervical cancer. The surgeon removes tissue that may contain cancer cells:

• Radical trachelectomy: The surgeon removes the cervix, part of the vagina, and the lymph nodes in the pelvis. This option is for a small number of women with small tumors who want to try to get pregnant later on.
• Total hysterectomy: The surgeon removes the cervix and uterus.
• Radical hysterectomy: The surgeon removes the cervix, some tissue around the cervix, the uterus, and part of the vagina.

With either total or radical hysterectomy, the surgeon may remove other tissues:

• Fallopian tubes and ovaries: The surgeon may remove both fallopian tubes and ovaries. This surgery is called a salpingo-oophorectomy.
• Lymph nodes: The surgeon may remove the lymph nodes near the tumor to see if they contain cancer. If cancer cells have reached the lymph nodes, it means the disease may have spread to other parts of the body.

Radiation therapy (also called radiotherapy) is an option for women with any stage of cervical cancer. Women with early-stage cervical cancer may choose radiation therapy instead of surgery. It also may be used after surgery to destroy any cancer cells that remain in the area. Women with cancer that extends beyond the cervix may have radiation therapy and chemotherapy

Radiation therapy uses high-energy rays to kill cancer cells. It affects cells only in the treated area.

Types of Radiation Therapy Used to Treat Cervical Cancer

Doctors use two types of radiation therapy to treat cervical cancer. Some women receive both types:

1. External radiation therapy: A large machine directs radiation at your pelvis or other tissues where the cancer has spread. The treatment usually is given in a hospital or clinic. You may receive external radiation 5 days a week for several weeks. Each treatment takes only a few minutes.
2. Internal radiation therapy: A thin tube is placed inside the vagina. A radioactive substance is loaded into the tube. You may need to stay in the hospital while the radioactive source is in place (up to 3 days). Or the treatment session may last a few minutes, and you can go home afterward. Once the radioactive substance is removed, no radioactivity is left in your body. Internal radiation may be repeated two or more times over several weeks.

Chemotherapy is a category of drugs given intravenously (through a vein) to kill cancer cells throughout the body. The most commonly used chemotherapy for cervical cancer is cisplatin. It can be combined with other chemotherapy drugs and/or with a monoclonal antibody drug that restricts the development of blood vessels that allow tumors to grow.

Chemotherapy is usually combined with radiation therapy. This is called chemoradiation. 

Immunotherapy is a type of cancer treatment that uses our body's immune system to recognize, target, control, and eliminate certain types of cancer cells. Immunotherapy drugs help the immune system:

• Find and attack cancer cells while leaving healthy cells intact
• Adapt to changes in the cancer, re-evaluate, and launch a new attack
• “Remember” the cancer cells, target and kill them if cancer recurs
• Boost immune cells to maximize their cancer-fighting ability

Pembrolizumab is a checkpoint inhibitor immunotherapy that blocks the PD-1 protein on cervical cancer cells. By doing this, the body can distinguish cancer cells from healthy cells. The immune system is then able to attack the cancer cells. Other PD-1 protein inhibitors that could be used for cervical cancer include cemiplimab and nivolumab.

Gynecologic oncologists might recommend immunotherapy for advanced-stage cervical cancer, recurrent cervical cancer, or patients with resistance to chemotherapy.

Targeted therapies are medicines specifically targeting proteins on cervical cancer cells to help stop their growth or spread. The goal of these drugs is to destroy cancer cells or slow down their growth. Targeted drug therapies have different side effects compared to chemotherapy, and some are administered in pill form. They are used most often for stage IV or recurrent cervical cancer.

There are several types of targeted therapy, each with its own goal. 

Antibody-Drug Conjugates (ADCs)

ADCs combine a monoclonal antibody with a chemotherapy drug. The antibody finds and attaches to a protein on the cancer cell, delivering the chemo directly to it.

Fam-trastuzumab deruxtecan, T-DXd 

This ADC targets the HER2 protein and is used to treat HER2-positive cervical cancer that has come back after the first treatment. It's given through an IV every three weeks.

Common side effects of this drug include low blood cell counts, nausea, vomiting, diarrhea, fatigue, hair loss, decreased appetite, low potassium, liver changes, and cough. A severe but less common side effect is heart muscle weakness.

Tisotumab vedotin-tftv 

This ADC targets the TF protein on cancer cells and delivers the chemo drug directly to them. It is used for late-stage cervical cancer that has returned after initial treatment. It's given through an IV every three weeks.

Patients may experience fatigue, nausea, vomiting, hair loss, bleeding, diarrhea, rash, nerve damage, kidney issues, or low blood cell counts. Serious but less common side effects include vision loss or vision changes, so regular eye exams are recommended.

RET Inhibitors

In some cases of cervical cancers, tumor cells have a change in the RET gene, leading to abnormal protein that helps the cancer grow.

Selpercatinib is a RET inhibitor used for advanced cervical cancer with this gene change. These are capsules you take twice a day.

Common side effects include diarrhea, constipation, dry mouth, high blood pressure, fatigue, swelling, skin rash, muscle and joint pain, and low blood cell counts. Serious side effects include liver or lung damage, allergic reactions, heart rhythm changes, easy bleeding, and wound healing issues.

NTRK Inhibitors

A few cervical cancers have changes in the NTRK genes, leading to abnormal TRK proteins that cause cancer growth.

Larotrectinib and entrectinib are NTRK inhibitors that target these proteins. They are taken as pills once or twice a day.

Patients may experience abnormal liver tests, low blood cell counts, muscle and joint pain, fatigue, diarrhea or constipation, nausea, vomiting, and stomach pain. Serious side effects can include mental changes, liver damage, heart rhythm issues, vision changes, and potential harm to a fetus.

If you or a loved one received a diagnosis of cervical cancer or another type of gynecologic cancer, request an appointment with one of our gynecologic oncologists at Compass Oncology. We offer second opinions on diagnosis and treatment as well as the latest treatment options including clinical trials.