Nurses Must Stay Up-to-Date With Treatments and Clinical Trials for Patients With Cervical Cancer
January is cervical cancer awareness month. This third article in a series highlights current cervical cancer treatment options.
Oncology nurses and social workers working with patients with cervical cancer must have the most current information regarding available cancer treatment modalities and actively enrolling clinical trials. After a patient receives a diagnosis of cervical cancer, the patient along with her gynecologist can select from a whole host of treatment options. The first step in this journey is to find a board-certified gynecologist oncologist, or GYO. Treatment options are then determined by the stage the cancer at diagnosis.
Surgical Treatment Options
Surgery, such as a TAHBSO (total abdominal hysterectomy and bilateral salpingoophorectomy) wherein the cervix is also removed, is an option available to patients. The following surgical procedures may also be used: cold knife conization, sentinel lymph node biopsy, total hysterectomy and radical trachelectomy, and a total pelvic exenteration.2
Cold knife conization
This is invasive surgery done in a hospital setting wherein tissue that is in a cone shape is excised from the cervix and cervical canal.2 If circumstances are correct, the whole cancer can be removed at this time.This procedure is performed under general anesthesia.
Sentinel lymph node biopsy
The sentinel lymph node, or the first lymph node to receive drainage from the primary tumor, is the target here. If cancer is going to spread from the original site, it will usually travel here first.
To determine where the sentinel lymph node is located, the patient is injected with a radioactive material and/or a blue dye. This material then travels to the lymph nodes and the first lymph node identified is excised. This is then reviewed by the pathology department to find the cervical malignancy. A lymph node dissection will be done if there are more affected lymph nodes found.The entire cancer can then be removed at this time.2
A hysterectomy is a surgical procedure to remove the uterus. In the case of cervical cancer, the cervix, and oftentimes surrounding structures, are removed. There are multiple types of hysterectomy may be used to treat cervical cancer.2
- Total Hysterectomy
- A total hysterectomy removes both the uterus and the cervix. A total vaginal hysterectomy means that there are no incisions on the abdomen and the structures are removed through the vagina. A total abdominal hysterectomy means that these structures were removed through a large incision in the abdomen. A series of small incisions on the abdomen is called a total laparoscopic hysterectomy.
- Radical Hysterectomy
- A radical hysterectomy involves the removal of the uterus, cervix, part of the vagina, and an array of ligament and tissues around these organs. In this procedure, the ovaries, fallopian tubes, or nearby lymph nodes may also be removed.
- Modified Radical Hysterectomy
- In a modified radical hysterectomy, the uterus, the cervix, the upper part of the vagina, as well as the ligaments and tissues that closely surround these organs, are removed. In this procedure, the ovaries, fallopian tubes, or nearby lymph nodes may also be removed.
Also called a radical cervicectomy, in a radical trachelectomy the cervix, surrounding tissue, and the part of the upper vagina are excised. In addition, lymph nodes can be removed. The rest of the vagina and uterus are then repaired. If pregnancy is a consideration, a cerclage band or stitch is placed in the uterus to prevent a miscarriage.2
In a bilateral salpingo-oophorectomy, both the ovaries and the fallopian tubes are removed. This is performed when the cancer has already spread to these organs.
Total Pelvic Exenteration
During this procedure, which is very extensive, the lower colon, rectum, and bladder are removed. The vagina, ovaries, cervix, and adjacent lymph nodes are also excised. A colostomy and a urostomy are then created to remove stool and urine. In addition, plastic surgery may also be needed to create an artificial vagina.
Systemic Treatment Options
Beyond surgery, systemic treatments such as chemotherapy and radiation, targeted therapy, and immunotherapy may be considered depending on the stage of the cervical malignancy.1
In general, radiation therapy is a modality that uses either external radiation or internal radiation to kill cancer. Brachytherapy is another term for internal radiation. Fortunately, radiation therapy is used for ongoing treatment as a curative or palliative treatment. If it is palliative, it can be used to help a woman suffering from cervical cancer survive its’ ravages.2
Chemotherapy is given to deter cancer cells from multiplying in the cervix.
There are several types of chemotherapy that are used in the treatment of cervical cancer.Some of the chemotherapies are the following: cisplatin, carboplatin, gemcitabine, isofasfamide, irinotecan, paclitaxel, topotecan, and vinorelbine.
Targeted Therapy and Immunotherapy
Enzymes and proteins promoting the growth of cervical cancer are stopped with targeted therapy treatments. Bevacizumab (Avastin) and tisotumab vedotin (Tivdak) are given as targeted therapies.
Immunotherapy is given to boost a woman’s immune system to fight cervical cancer. An example of a drug given for this purpose is pembrolizumab (Keytruda) if the patient has the biomarker PD-L1.
The National Cancer Institute (NCI) has a listing of available clinical trials for cervical cancer patients. Women can participate in clinical trials to find more progressive treatment options and also as a way of helping to further refine standard treatment options. ClinicalTrials.gov website that will give the patient information about ongoing trials outside of NCI. The NCI’s Cancer Information Service is also available to the public wherein clinical trials can be located through either phone, or the web in English and Spanish.