Surgery
Surgery removes or destroys the cancerous tissue using a physical procedure or operation. To consider many of these treatments, it is necessary to consult with a surgeon specializing in the treatment of cervical cancer (a gynecologic oncologist). Within this category, the following procedures are commonly used:

For preinvasive disease:

• Cryosurgery, which destroys cancerous cells by freezing.
• Laser surgery, which destroys cancer with a narrow beam of intense light.
• Conization, in which a doctor uses a surgical knife or laser to remove a cone-shaped piece of tissue where the abnormality is found. Conization may be used to remove tissue for biopsy or to treat early-stage cancers.
• Loop electrosurgical excision procedure (LEEP) uses an electrical current passed through a thin wire hook that acts as a knife to remove tissue.

• In a hysterectomy, the uterus and cervix along with the cancer are removed. When the surgery is performed through the vagina, this is called a vaginal hysterectomy. When hysterectomy is performed through a cut an incision in the abdomen it is called total abdominal hysterectomy.
• Bilateral salpingo-oophorectomy refers to the removal of the tubes and ovaries as well.
• Radical hysterectomy is a hysterectomy in which the cervix, uterus and part of the vagina as well as the lymph nodes in the area are removed. Removal of lymph nodes is also called lymph node dissection.
• Exenteration is the removal of the uterus, the vagina, lower colon, rectum or bladder when cervical cancer has recurred in these organs following radiation therapy.

Radiation
Radiation treatment uses X-rays or other high-energy rays to kill cancer cells and therefore destroy tumors. If this course of treatment is chosen, patients will likely be referred to a radiation oncologist. In external beam therapy, a machine positioned outside of the body delivers the radiation. In brachytherapy, a radiation-emitting implant is placed in or near the tumor. The implant may be a capsule of radioactive material placed in the cervix and vagina near the tumor or inserted directly into the tumor through thin plastic tubes or needles.

Radiation may produce a sunburned look and feel at the treated area. However, this will gradually fade to a tanned look in six to 12 months after treatment. Side effects some patients experience during radiation treatment include tiredness, upset stomach, diarrhea, a narrowing of the vagina with scarred tissue that can make intercourse painful, premature menopause and problems with urination.

Chemotherapy
In chemotherapy, drugs are given to the patient to destroy cancer. They may be given through a vein or in pill form. The drugs travel throughout the body in the bloodstream and kill cancer cells. Drugs used to treat cervical cancer include ifosfamide, mitolactol and fluorouracil. For single-drug treatment, cisplatin has the best-documented response against cervical cancer cells, with 18 percent to 31 percent of patients responding to the drug. These drugs may be combined with other chemotherapy drugs.

Chemotherapy is also used in combination with radiation to treat cervical cancer. In response to recent findings of ongoing clinical trials, the National Cancer Institute announced in February 1999 that it strongly recommends physicians consider adding cisplatin to radiation therapy to treat invasive cervical cancer.

Unfortunately, chemotherapy is not specific. While killing cancer cells, these drugs also damage normal cells. Therefore, this treatment is associated with many side effects, including upset stomach, vomiting, loss or increase in appetite, hair loss, mouth sores, vaginal sores, increased susceptibility to infection, bleeding, anemia, tiredness, changes in the menstrual cycle, premature menopause and infertility.

The decision about what treatment will be used for cancer of the cervix depends on the stage of the disease, the size of the tumor and the patient's age, overall condition, and her desire to have children. Patients with the disease who are pregnant may decide to delay treatment until after the baby is delivered, depending on the stage of cancer and the balance between risk and benefit of treatment for the mother and the fetus.