Cervix

Question 1

Stage I cervix cancer

Answer 1

Confined to cervix with varying depth of invasion.

Surgery: main treatment for stage I, type of surgery depends on age, stage and pregnancy wishes.

• Cone-biopsy is used for staging and can be offered as treatment for stage IA1 cervical cancers, if removed and no tumour is around edges.
• Trachelectomy: removes the cervix with the upper part of the vagina, some of the structures and tissues around the cervix and lymph nodes in the pelvis. Used for tumours <2cm (IA2 and IB1) or those wanting to become pregnant.
• Hysterectomy: removes the uterus and the cervix. Also may remove the lymph nodes.

Radiation therapy:

• Can be used after surgery or as the main treatment
• External beam can be used alone or with intracavitary brachytherapy

Chemoradiation:
- can be offered after surgery for stage IB1 but is often the main treatment for stage IB2 or higher cervical cancers.

Question 2

Stage II cervical cancer

Answer 2

Tumour invades beyond uterus but not the pelvic wall or lower third of the vagina.

Chemoradiation: main treatment for stage II.

• Chemotherapy is given during the same period as radiation to make radiation more effective.
• Can be given after surgery.

Surgery: may be offered for stage II.
- Hysterectomy: removes the uterus and the cervix. Also may remove the lymph nodes.

Radiation therapy:
- Typically external beam and brachytherapy are both given

Question 3

Stage III cervical cancer

Answer 3

Tumour extends to the pelvic wall or involves lower one-third of vagina.

Chemoradiation: main treatment for stage III.

• Chemotherapy is given during the same period as radiation to make radiation more effective.
• Can be given after surgery.
• Typically external beam and brachytherapy are both given

Radiation: can be given alone as main treatment

Question 4

Stage IV cervical cancer

Answer 4

Tumour invades mucosa of bladder or rectum, or extends beyond the true pelvis.

Chemoradiation: main treatment for stage III.

• Chemotherapy is given during the same period as radiation to make radiation more effective.
• Can be given after surgery.
• Typically external beam and brachytherapy are both given
• Can also be offered to help relieve pain and symptoms of advanced disease.

Radiation:
- For stage IVB can be used to palliate and offer relief of symptoms.