Cervical cancer is one of the most common malignant gynecologic tumors worldwide, and its main cause is persistent infection with high-risk human papillomavirus (HPV), especially HPV types 16 and 18. Other risk factors include early sexual activity, multiple sexual partners, smoking, long-term chronic cervicitis, low immune function, and family history. In recent years, the incidence of cervical cancer has shown a younger trend, but with the popularization of cervical cancer screening (TCT/HPV) and HPV vaccination, early detection and cure rates have increased significantly. The treatment of cervical cancer follows the principle of individualized comprehensive treatment, mainly based on clinical stage, patient age, physical condition, fertility requirements and pathological type, and commonly used methods include surgery, radiotherapy, chemotherapy, targeted therapy and immunotherapy.
Surgical Treatment
Surgery is the preferred treatment for early-stage cervical cancer (Stage ⅠA to ⅡA), aiming to completely remove the lesion and reduce the risk of recurrence. Common surgical procedures include conization of the cervix, extensive hysterectomy plus pelvic lymphadenectomy, and radical trachelectomy.
Cervical conization is suitable for microinvasive cervical cancer or high-grade precancerous lesions, and can preserve the uterus and fertility function for young patients. Extensive hysterectomy is the standard surgery for early invasive cervical cancer, removing the uterus, cervical tissue, part of the vagina and surrounding parametrial tissues, as well as pelvic lymph nodes. Dr. Emily Clark, a gynecologic oncologist, notes that fertility-sparing radical trachelectomy is available for selected young patients with early cervical cancer who wish to have children, with comparable oncological outcomes to standard surgery.
Radiotherapy
Radiotherapy is suitable for locally advanced cervical cancer (Stage ⅡB to ⅣA), recurrent cervical cancer, or patients who cannot tolerate surgery. It is divided into external beam radiotherapy and intracavitary brachytherapy, and the combination of the two is the standard radiotherapy regimen for cervical cancer. Radiotherapy can kill local tumor cells, shrink lesions, control bleeding and pain symptoms, and improve survival. For some early-stage patients who are not suitable for surgery, radical radiotherapy can also achieve a curative effect similar to surgery.
Chemotherapy
Chemotherapy is mostly used as a adjuvant treatment, concurrent radiosensitization, or palliative treatment for advanced and metastatic cervical cancer. Commonly used chemotherapeutic agents include platinum-based drugs (cisplatin, carboplatin), paclitaxel, gemcitabine, etc. Concurrent chemoradiotherapy (chemotherapy combined with radiotherapy) is the first-line treatment for locally advanced cervical cancer, which can significantly improve local control rate and overall survival. For recurrent or metastatic cervical cancer, systemic chemotherapy is the main means to relieve symptoms and prolong survival.
Targeted Therapy and Immunotherapy
In recent years, targeted therapy and immunotherapy have brought new options for recurrent and metastatic cervical cancer. Anti-angiogenic targeted drugs (such as bevacizumab) can inhibit tumor neovascularization and slow down tumor progression. Immunotherapy drugs represented by PD-1/PD-L1 inhibitors have shown good efficacy in patients with recurrent or metastatic cervical cancer, especially those with positive PD-L1 expression or high microsatellite instability. These precision treatments have higher specificity and lower side effects than traditional chemotherapy.
Follow-up and Prevention
After treatment, regular follow-up is essential to detect recurrence early. In the first two years, reexamination is recommended every 3 months; in the next 3 years, every 6 months; and annually thereafter. In addition to standardized treatment, HPV vaccination, regular cervical cancer screening, and healthy living habits can effectively prevent the occurrence and development of cervical cancer.