• Cervical Cancer

    Dana-Farber/Brigham and Women's Cancer Care

    How We Treat Cervical Cancer

    At the Gynecologic Cancer Treatment Center at Dana-Farber/Brigham and Women's Cancer Center (DF/BWCC), our gynecologic experts make your cervical cancer their priority. You can feel confident in the treatment at DF/BWCC, as our specialists focus exclusively on gynecologic cancers. If you need surgery, you will see a surgeon who specializes in gynecologic procedures. If your treatment includes chemotherapy, you will work with a medical oncologist who treats only gynecologic patients. If you require radiation therapy, you will work with a radiation oncologist who specializes in gynecology, in a lab dedicated solely to gynecology patients.

    For referring physicians

    Because the patient's primary care physician or community specialist is an integral part of the patient's care team, we are committed to collaborating with you in the care of your patient.

    If you are a referring physician and have a patient with cervical cancer, we look forward to working with you.

    Find out more about how to refer a patient to DF/BWCC.

    Personalized medicine, multidisciplinary approach

    Our multidisciplinary team includes experienced surgical oncologists, medical oncologists, radiation oncologists, radiologists, pathologists, researchers, nurses, physician assistants, and social workers who treat, counsel, and care for each patient with dedication and compassion.

    Beginning with your first appointment, our nurses will walk you through the entire treatment process, making sure you know what to expect and where to find helpful resources, such as counseling, nutrition advice, or palliative care.

    Each patient can request to work with, or may be referred to, a social worker to provide extra support and guidance. Your medical team will meet regularly to review your health and treatment options and ensure you receive the best possible care. We create a unique, personalized plan for every patient, and we consider all aspects of your health history and future when making our recommendations.

    Cervical cancer treatment by stage

    Depending on how much the cancer has grown, you may have one treatment or a combination of treatments. Treatment depends on:

    • The stage of the disease
    • Your age
    • Your desire to preserve fertility
    • Your overall health

    More than 90 percent of early-stage cancers are treated successfully with surgical procedures and do not require any further treatment.

    If you are a young woman with early-stage cervical cancer (stage I) and would still like to have children, there are surgical options that can preserve your fertility without compromising treatment or survival. If you're a young woman with advanced stage cervical cancer, we will carefully review your treatment and surgery options to ensure good pregnancy outcomes. Our dedicated fertility and reproductive specialists can discuss all fertility concerns, as well as options for you to consider, such as embryo (egg) freezing or embryo harvesting.

    • If you are diagnosed with cervical dysplasia or precancerous cells are found (carcinoma in situ, or stage 0 cervical cancer), surgery is generally the only treatment necessary to remove precancerous areas on the cervix. A biopsy to remove areas on your cervix will be performed, either by using the loop electrosurgical excision procedure (LEEP) or the cold-knife cone biopsy procedure. A minor fertility-sparing surgery may be the only treatment necessary to remove precancerous areas on the cervix, or a simple hysterectomy is often suggested if you are no longer interested in having children. In certain young women with moderate dysplasia, close observation may be another option.
    • If you are diagnosed with Stage I (Stage IA or IB) cervical cancer, your treatment may include surgeries and therapies beyond a biopsy to remove the cancerous cells. Radiation may also be suggested. However, surgery is generally recommended for younger patients, and radiation is generally recommended for older patients. In some cases, or when fertility is not a concern, surgery to remove the uterus and cervix (hysterectomy or radical hysterectomy) may be the preferred course of treatment.
    • If you are diagnosed with Stage II (Stage IIA or IIB) cervical cancer, radiation therapy (external and internal radiation) and chemotherapy are generally the first suggested lines of treatment. In stage II cases, your doctor will generally review clinical trials as an option to supplement treatment. In rare stage II cases, removal of the uterus, cervix, and adjacent lymph nodes may be performed.
    • If you are diagnosed with Stage III cervical cancer, your doctor will start a customized treatment plan of radiation (external and internal radiation) combined with chemotherapy. In advanced stage III cases, surgery to remove the uterus and/or cervix is not necessary, as the cancer has spread throughout the pelvis and, in some cases, to the ureter. Instead, your doctor may recommend a clinical trial as a supplemental treatment option.
    • If you are diagnosed with Stage IV (Stage IVA or IVB) cervical cancer, your treatment plan will be tailored to your specific needs. Extensive radiation therapy (external and internal radiation) is generally administered and combined with chemotherapy to control the spread of the cancer, relieve any symptoms, and improve your quality of life. In advanced cases like these, your doctor will encourage you to participate in a clinical trial of new anticancer drugs or drug combinations. Surgery is only a palliative care option at this stage of the disease.

    Surgery

    Our surgical team is recognized internationally as one of the best for the treatment of gynecologic cancers, and consistently ranks as one of the top in the country for surgical care. We perform over 1,500 gynecologic surgeries each year; as a result, our patients can be reassured that they will receive the highest level of surgical care from one of the most experienced teams available.

    Ross Berkowitz, MD  

    Gynecological oncologists at Dana-Farber/Brigham and Women's Cancer Center use the most advanced technology available to perform surgery with exacting precision. Our skilled surgeons regularly perform leading-edge, minimally-invasive surgeries, such as:

    • Laparoscopy: A procedure performed through small incisions in the abdomen, rendering more extensive surgeries unnecessary
    • Robot-assisted hysterectomy: The benefits of robot-assisted radical hysterectomy are multiple; the procedure provides a safer, less invasive approach to the hysterectomy procedure and offers patients better outcomes, shorter hospital stays, faster recoveries, and enhanced safety. This procedure, which Dana-Farber/Brigham and Women's Cancer Center was the first New England hospital to offer, allows our experts to carefully perform complex robotic surgeries in place of more invasive procedures.

    Surgery not only helps determine the stage of your cervical cancer, but may be sufficient treatment if you have early-stage cervical cancer. Surgery options for cervical cancer may include:

    • Taking a small sample of your cervix or cervical tissue (biopsy) to examine for cancerous cells under a microscope
    • Removing the uterus and the cervix (hysterectomy) and/or parts of the vagina (radical hysterectomy)
    • Surgery to remove the lower colon, rectum, bladder, cervix, vagina, ovaries, and nearby lymph nodes (pelvic exenteration). Pelvic exenteration is usually reserved for extremely advanced or recurrent cases of cervical cancer.

    Surgery takes place in the operating suites at Brigham and Women's Hospital, whose gynecology program is widely recognized as one of the best in the United States. Post-surgical care and other inpatient care are provided at Brigham and Women's Hospital by the DF/BWCC team.

    hysterectomyHysterectomy. The uterus is surgically removed with or without other organs or tissues. In a total hysterectomy, the uterus and cervix are removed. In a total hysterectomy with salpingo-oophorectomy, (a) the uterus plus one (unilateral) ovary and fallopian tube are removed; or (b) the uterus plus both (bilateral) ovaries and fallopian tubes are removed. In a radical hysterectomy, the uterus, cervix, both ovaries, both fallopian tubes, and nearby tissue are removed. These procedures are done using a low transverse incision or a vertical incision. 

    Read our post-operative guidelines for gynecologic surgery.

    Find out more about your hospital stay at Brigham and Women's Hospital.

    Chemotherapy

    Medical oncologists are medical doctors who study and treat cancers. Medical oncologists at DF/BWCC offer the most effective therapies possible, while helping you maintain your quality of life during treatment. Chemotherapy is provided at Dana-Farber's Yawkey Center for Cancer Care, one of the most advanced outpatient centers in the country — designed by patients, for patients.

    Chemotherapy for cervical cancer may be used at any stage of the disease when surgery alone will not remove the cancer. Chemotherapy drugs are usually administered in conjunction with radiation, and before or after surgery to eliminate cancer cells or keep them from returning. On occasion, chemotherapy drugs will be given as supplemental treatment to radiation therapy. Some early-stage cancer patients may also receive radiation-sensitizing chemotherapy drugs, which help the radiation therapy work more effectively.

    Throughout your treatment, your medical oncologist will work closely with your team of nurses, nutritionists, and social workers to minimize the toxicities and side effects of chemotherapy, maintain your quality of life, and optimize your results. We encourage you to be actively involved in the decision-making process when it comes to choices about chemotherapy treatment.

    Radiation therapy

    Radiation therapy is a non-invasive cancer treatment that uses high-energy X-rays or other types of radiation to eliminate cancer cells and stop cancer growth. Radiation therapy for cervical cancer is given by our experienced team of radiation oncologists. As pioneers in the field, our team regularly sets the standards for treatment and safety nationwide. Our experts administer radiation in a dedicated radiation suite built specifically for gynecologic patients. This suite features state-of-the-art equipment and the latest imaging techniques to treat your cervical cancer.

    Radiation therapy is used for cervical cancer cases beyond stage I, and high doses of radiation cure most cases. Additionally, patients with recurring cervical cancer, or advanced cancer that hasn't responded to other treatments, can be treated with new radiation technologies at DF/BWCC, and with more success.

    Radiation treatment for cervical cancer could include these therapies:

    • In brachytherapy, interstitial brachytherapy, or tandem and ovoid brachytherapy, radioactive material is directly implanted in or near the tumor via a tiny needle, wire, or other device. Our radiation oncologists at DF/BWCC are among a limited few in the nation to deliver this type of radiation with image-guided techniques. Occasionally, cylinder brachytherapy, a type of radiation therapy delivered to the vagina, will be performed on patients after surgery.
    • DF/BWCC is one of the few treatment centers in the U.S. to offer image-guided brachytherapy using real-time 3D imaging as an alternative to surgery or non-image-guided radiation for some patients with cervical cancers. This technique offers many benefits, including the preservation of healthy tissue, prevention of unnecessary hysterectomies, and better eradication outcomes.
    • 3D imaging radiation therapy called intensity-modulated radiation therapy (IMRT) uses computer images to find and target the cancerous tumor. Radiation is externally delivered and aimed at the tumor, firing thin radiation beams from different angles. This reduces the damage to the surrounding healthy tissue.
    • Radiation oncologists at DF/BWCC are currently pioneering therapies using gel spacers with great success. Radiation therapy is delivered to a targeted location in the cervix while using a gel spacer, a small, removable sponge-like material injected with gel, strategically placed inside the body to block radiation from nearby healthy tissue or surrounding organs.

    Revolutionary imaging therapies

    For cases of cervical cancer that require complex imaging treatment, you will be cared for in an innovative operating and research environment developed specifically at Brigham and Women's Hospital (BWH) in 2011. Called the Advanced Multimodality Image Guided Operating (AMIGO) Suite, our team of surgeons, interventional radiologists, imaging physicists, computer scientists, biomedical engineers, nurses, and technologists uses the latest imaging tools to develop and deliver the safest, state-of-the-art therapies. The AMIGO suite is unique, as it combines PET/CT, MRI, and OR technologies in one operating room. BWH is one of the few hospitals in the United States to operate an AMIGO suite.

    Clinical trials

    DF/BWCC offers one of the largest and most active clinical trial programs available, including clinical trials for women with cervical cancer. The clinical trials conducted at Dana-Farber have had a profound impact on the type of care administered worldwide.

    For some women with advanced or recurrent cases of cervical cancer, taking part in a clinical trial is the best treatment option. There are also less aggressive clinical trial options for women with early-stage cervical cancer. If you qualify for a clinical trial, your doctor will carefully discuss all options and the best time to begin a trial (before, during, or after cancer treatment).

    Clinical trials are part of the cancer research process; they are regulated research studies to determine if new cancer treatments are effective, or better than a current plan. Not only can trials lead to new discoveries and improve cancer care, but they can also have significant anti-cancer benefits.

    Clinical trials may include biologic therapies, or treatments that use the patient's immune system to fight the cancer (immunotherapy or biotherapy). Trials also include targeted therapy, or therapies using drugs to identify and attack the specific cervical cancer cells without harming healthy cells.

    Find out more about clinical trials at DF/BWCC. Detailed information about clinical trials is available from the NCI Web site. For all nationally run clinical trials, please visit ClinicalTrials.gov.

    Questions to ask your doctor about clinical trials

    If your doctor suggests a clinical trial as part of your cancer treatment, you may have questions before you get started. Review some commonly asked questions about clinical trials and discuss them with your doctor.

    Next: Our Cervical Cancer Specialists 

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