Cervical Cancer

Cervical cancer is the fourth most common cancer in women worldwide, but when detected early, it is highly curable. Radiation therapy may be utilized in early stage to locally advanced cancer. The treatment typically includes external beam radiotherapy with concurrent cisplatin‑based chemotherapy, followed by brachytherapy. Radiation therapy may also be utilized after surgery for select patients with high risk factors.

Cervical Cancer Symptoms

• Abnormal vaginal bleeding
• Unusual vaginal discharge
• Pelvic pain or pain during intercourse
• Advanced symptoms: leg swelling, difficulty urinating, or low back pain

Causes / Risk Factors

• Persistent infection with high‑risk human papillomavirus (HPV) types (most commonly HPV‑16 and HPV‑18) – the primary cause
• Smoking
• Immunosuppression
• Long‑term use of oral contraceptives (>5 years)
• Multiple full‑term pregnancies
• Early age at first intercourse or multiple sexual partners
• Low socioeconomic status (reduced screening access)
• Family history of cervical cancer

Treatment for Early‑Stage Cervical Cancer

For very early cancers, a simple conization (cone biopsy) may be curative. For stage IA2, IB1, and select IIA tumors, radical trachelectomy combined with pelvic lymphadenectomy for fertility preservation is recommended. After surgery, if there are risk factors such as deep stromal invasion, lymphovascular space invasion, or large tumor size, adjuvant radiation therapy is recommended to reduce the risk of pelvic recurrence. Adjuvant chemotherapy is added if there are positive margins, parametrial extension or positive nodes.

Treatment for Locally Advanced Cervical Cancer

For locally advanced cervical cancer, radiation therapy is an important part of treatment and is often given together with chemotherapy. Radiation uses high-energy beams to destroy cancer cells in the cervix and nearby areas where the cancer may have spread. Treatment typically includes external beam radiation, given over several weeks, along with a type of internal radiation called brachytherapy. Brachytherapy means “short‑distance therapy.” A doctor places a thin applicator into the vagina and cervical canal for 5‑20 minutes. This is called intracavitary brachytherapy typically using a tandem and ring device. A tiny radioactive source delivers a very high dose directly to the tumor while the bladder and rectum receive a minimal dose. This precise delivery is what makes brachytherapy so effective.

Interstitial brachytherapy is an internal radiation treatment that delivers a high dose of radiation directly to the cervical cancer and nearby tissues in very advanced cases. For this treatment, small needles or tubes are carefully placed through the vaginal tissues into or around the tumor, allowing radiation to be focused precisely where it is needed while limiting radiation to nearby healthy organs such as the bladder and rectum. It may be recommended when the tumor’s location or size makes standard brachytherapy alone less suitable.

Both forms of brachytherapy are performed by physicians within ROC.

Fertility Preservation and Ovarian Protection

For premenopausal women who want to preserve fertility, there are a few options:

• Ovarian transposition—Before starting radiation, a minimally invasive laparoscopic procedure moves the ovaries out of the pelvis (usually upward and laterally) to shield them from scattered radiation. This preserves ovarian hormone function and egg reserve in about 60‑80% of patients.
• Ovarian shielding during IMRT – When transposition is not possible, radiation therapy is designed to potentially block the ovaries.
• We also work closely with reproductive endocrinologists to discuss egg or embryo cryopreservation before treatment for those who wish to pursue future pregnancy.

Side Effects and Supportive Care

Temporary (during and shortly after treatment):

• Diarrhea, fatigue, vaginal dryness, and frequent urination – most resolve within 4‑8 weeks.
• Vaginal moisturizers and dilators are prescribed to prevent stenosis.
  Long‑term (less than 5% risk with modern planning):
• Rectovaginal fistula – extremely rare.
• Bladder or rectal bleeding (telangiectasias)—manageable with local treatments.

Call 847-698-0600 ext. 112 to schedule a consultation at our centers. Our radiation oncologists work closely with gynecologic surgeons and reproductive specialists to help you achieve the best possible outcome.