Treatments

The treatment of cervical cancer is primarily based on surgery, which can be more extensive or less extensive depending on the stage of the tumor. It can be supplemented by Curietherapy, radiotherapy (or even radio-chemotherapy), and immunotherapy.

Cervical cancer surgery

The surgery mainly concerns patients with an early-stage cervical cancer.

For a locally advanced cervical cancer, the treatment consists of radiotherapy with concomitant chemotherapy. The treatment is therefore not surgical, but lymph node surgical staging may nevertheless be indicated in order to specify the radiotherapy fields. At the end of treatment, surgery may be proposed as an exception if a residual tumor is detected.

For cancers at very early stages, the surgery consists in removing a small conical-shaped fragment of the cervix - i.e. conization.

For slightly more advanced cancers, the surgeon removes the uterus with the cervix. Thus, a total hysterectomy is performed. It is sometimes necessary to perform a colpo-hysterectomy with annexectomy; this involves removing 1 to 2 cm of the upper part of the vagina, as well as the ovaries, along with the uterus. A more extensive hysterectomy is sometimes recommended, that is to say that the surgeon must remove all the tissues that surround the cervix in which the vessels of the cervix and uterus are located. This anatomical area is called the parameter. The type of intervention is discussed in a multidisciplinary consultation meeting.

As part of the management of early-stage cervical cancers, it is also often necessary to perform an excision (removal) of lymph nodes that drain the cervix in order to identify the stage of the pathology and adapt any adjuvant treatments. At Institut Curie, removal of the lymph node closest to the tumor, called the sentinel node, is the preferred approach, when possible. This technique avoids removing the entire lymph node chain if it is not invaded by cancer cells.

If there is a desire for pregnancy and if cancer management allows for it, surgery may constitute a more conservative approach. The surgeon then performs a trachelectomy (by removing the cervix only), which can be more extensive if they also remove adjacent tissues (the parameters).

Radiotherapy and Curietherapy for cervical cancer

When cervical cancer affects neighboring structures (vagina, stomach, bladder, rectum) or lymph nodes, it is classified as locally advanced cervical cancer. In this case, radiotherapy treatment is indicated. This treatment is curative since cervical cancer is radiosensitive in most cases. Radiotherapy is then combined with concomitant chemotherapy.

Following radiochemotherapy, treatment is completed with uterovaginal Curietherapy. Curietherapy involves introducing a radioactive source, often iridium, directly into contact with the tumor, using a vaginal applicator. The precision of Curietherapy makes it possible to release very high and very targeted doses of irradiation. This technique helps limit the exposure of tissues and organs near the cervix to the rays, thus preserving healthy areas as much as possible and helping maintain the quality of life of patients. Curietherapy can sometimes also be used before or after surgery in the earlier stages.

Radiochemotherapy for cervical cancer

In the context of locally advanced cervical cancer, chemoradiotherapy concomitantly combines radiotherapy with chemotherapy. It aims to make each treatment more effective. Indeed, chemotherapy makes cancer cells more sensitive to radiation, and radiotherapy targets the cancerous tumor by preserving adjacent healthy tissues. Radiation chemotherapy is often supplemented by Curietherapy, and an additional dose of irradiation is applied directly to the tumor of the cervix. Institut Curie has expertise in these quality therapeutic solutions.

The drug used as part of chemotherapy is cisplatin, which is administered during the entire time of radiotherapy, or even during Curietherapy as well.

Immunotherapy for Cervical Cancer

Immunotherapy can be used for the treatment of metastatic cervical cancers. However, its use at earlier stages of the disease is being currently studied; Institut Curie is conducting clinical trials to determine the most suitable place for immunotherapy in the treatment of cervical cancer.