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Treatment for cervical cancer
The most common treatment for cervical cancer is surgery and/or a combination of radiation therapy and chemotherapy (chemoradiation). When cervical cancer has spread beyond the cervix, targeted therapy may also be used.
Your medical team will recommend treatment based on the results of your tests; the location of the cancer and whether it has spread; your age and general health; and whether you would like to have children in the future.
If becoming a parent is important to you, talk to your doctor before starting treatment and ask for a referral to a fertility specialist.
For some women, surgery may be the only treatment needed. Surgery is usually recommended for women who have a tumour that is in the cervix only. The type of surgery you have will depend on how far within the cervix the cancer has spread. Your surgeon will talk to you about the most appropriate surgery for you, as well as the risks and any possible complications (in both the short and long term).
The main type of surgery is called a hysterectomy, which is done under general anaesthetic. A hysterectomy is an operation to remove the uterus (womb) and cervix. The surgeon may also remove other organs of the reproductive system or the lymph glands on the side wall of the pelvis.
How the surgery is done
The surgery will be performed under a general anaesthetic. The hysterectomy can be done in two different ways.
Open surgery (laparotomy) – The surgery is performed through the abdomen. A cut is usually made from the pubic area to the bellybutton. Sometimes the cut is made along the pubic line instead. The uterus and other organs are then removed. Research has shown that open surgery is the better option for most cervical cancers.
Keyhole surgery (laparoscopy or robotic surgery) – These methods use thin cameras and instruments that are inserted through small cuts into the abdomen. The uterus and other organs are removed through the vagina. Laparoscopic surgery may be used for small, early-stage tumours.
Treatment of lymph nodes
Cancer cells can spread from the cervix to the lymph nodes in the pelvis. You may have one of the following procedures:
Sentinel lymph node biopsy – This test helps to identify the lymph node that the cancer is most likely to spread to first (the sentinel lymph node). While you are under anaesthetic, your doctor will inject a dye into the cervix. The dye will flow to the sentinel lymph node, and the surgeon will remove it for testing. If it contains cancer cells, the remaining nodes in the area may be removed in a procedure called a lymphadenectomy. Alternatively, your doctors may decide you need other treatments such as chemoradiation. A sentinel lymph node biopsy can help the doctor avoid removing more lymph nodes than necessary and minimise side effects such as lymphoedema. This procedure may be used for some women with early cervical cancer and is only available in some treatment centres. Research into its role in treating cervical cancer is ongoing.
Lymphadenectomy (lymph node dissection) – The surgeon will remove an area of lymph nodes from the pelvic and/or abdominal areas to see if the cancer has spread beyond the cervix. If cancer is found in the lymph nodes, your doctor may recommend you have additional treatment, such as radiation therapy.
What to expect after surgery
When you wake up from surgery, you will be in a recovery room near the operating theatre. Once you are fully conscious, you will be taken to your bed on the hospital ward.
Tubes and drips – You may have an intravenous (IV) drip to give you fluid and medicine, a tube in your abdomen to drain fluid from the operation site, and a small plastic tube (catheter) in your bladder to drain urine. These tubes will be removed before you go home.
After the catheter is removed from your bladder, the nurses will perform a test to check that your bladder is emptying properly. This is done by measuring the amount of urine you pass each time you go to the toilet, then using an ultrasound scan to check that your bladder is empty. It is a quick, painless test that is done on the hospital ward.
Pain and discomfort – After a major operation it is common to feel some pain. You will be given pain medicine as a tablet, through a drip (intravenously) or through a catheter inserted in the spaces in the spine (epidural). If you still have pain, let your doctor or nurse know so they can change your medicine to one that provides more relief.
Moving your legs – While you are in bed, you may have to wear compression stockings or “calf compressors” around your lower legs. These help the blood in your legs circulate and prevent blood clots forming in the deep veins of the legs or pelvis (deep vein thrombosis). You will be encouraged to walk around as soon as you can.
Recovery – You will spend 3–5 days in hospital after a hysterectomy. The recovery time depends on the type of surgery and your fitness. You will be able to go home when the medical team is satisfied with your recovery and the results of your bladder function tests.
Side effects of surgery
After surgery for cervical cancer, you may experience some of the following side effects.
Problems with bladder or bowel function – If some of the nerves to the bladder were removed during the hysterectomy, you may feel that you’re not able to empty your bladder completely, or that you’re emptying your bladder or bowel too slowly. These problems improve with time. Some women experience accidental leakage of urine after surgery. This is called urinary incontinence.
Lymphoedema – Sometimes the removal of lymph nodes in the pelvis can stop or slow the natural flow of lymphatic fluid. This may cause lymphoedema, which is excess fluid in the legs. Symptoms of lymphoedema may appear immediately or years after surgery.
Menopause – If your ovaries are removed and you have not been through menopause, removal will cause sudden menopause. After menopause you will not be able to become pregnant.
Impact on sexuality – The physical and emotional changes you experience after surgery may affect how you feel about sex, but surgery doesn’t change the ability to have sex or feel pleasure.
Internal scar tissue (adhesions) – Tissues in the pelvis may stick together. Sometimes adhesions to the bowel or bladder may cause abdominal pain or discomfort. Rarely, adhesions may need to be treated with surgery.
Taking care of yourself at home
Your recovery time after a hysterectomy will depend on the type of surgery you had, your age and general health. Most women say they feel better within six weeks
Rest – Take things easy for the first few weeks and only do what is comfortable. Ask family or friends to help you with chores so you can rest as much as you need to.
Work – Depending on the nature of your work, you will probably need 6 weeks leave from work.
Diet – Drink plenty of water and eat lots of fresh vegetables and fruit to avoid becoming constipated.
Exercise – Walk regularly if your doctors say it is okay to do so. Gentle exercise can help speed up recovery. Speak to your doctor about when it is suitable to start more vigorous exercise.
Sex – You’ll need to avoid sexual intercourse for at least 6 weeks to give the vaginal wound time to heal properly.
Bathing – Take showers instead of baths and avoid swimming for 4–6 weeks after surgery.
Lifting – Avoid heavy lifting for about a month, although this will depend on the type of surgery you had.
Also called radiotherapy, radiation therapy uses x-rays to kill or damage cancer cells. The radiation is targeted at the parts of the body with cancer or areas the cancer cells might have spread to. Treatment is carefully planned to do as little harm as possible to healthy tissues.
You may have radiation therapy on its own as the main treatment for cervical cancer, or you may have it after surgery to help get rid of any remaining cancer cells. Women with cervical cancer that has spread to the tissues or lymph nodes surrounding the cervix will usually have radiation therapy in combination with chemotherapy (chemoradiation) to reduce the chance of the cancer coming back.
Chemoradiation – When radiation therapy is combined with chemotherapy, it is known as chemoradiation. The chemotherapy drugs make the cancer cells more sensitive to radiation therapy.
If you have chemoradiation, you will usually receive chemotherapy once a week a few hours before the radiation therapy appointment.
Side effects of chemoradiation include fatigue; diarrhoea; needing to pass urine more often or in a hurry; cystitis; dry and itchy skin in the treatment area; nausea; and low blood counts. Low numbers of bloods cells may cause anaemia, infections or bleeding problems. Talk to your treatment team about ways to manage the side effects of chemoradiation.
There are two main ways of delivering radiation therapy: externally or internally. Most women who have radiation therapy for cervical cancer will have both types.
External beam radiation therapy
In external beam radiation therapy, a machine precisely directs radiation beams from outside the body to the cervix, lymph nodes and other organs that need treatment. The initial planning session will include a CT scan to work out where to direct the radiation beams, and may take up to 45 minutes. The actual treatment takes only a few minutes each time.
You will probably have external radiation therapy as daily treatments, Monday to Friday, over 4–6 weeks as an outpatient. You will lie on a table under the radiation therapy machine. Before the machine is turned on, the radiation therapist will leave the room, but they will be able to talk to you through an intercom and they will watch you on a screen while you have treatment. The treatment itself is painless.
Internal radiation therapy
Internal radiation therapy is known as brachytherapy. It is a way of delivering radiation therapy from inside your body directly to the tumour, while reducing the amount of radiation delivered to nearby organs such as the bowel and bladder. The main type of internal radiation therapy used for cervical cancer is high-dose-rate (HDR) brachytherapy. With HDR, bigger doses are given in a few treatments.
During treatment – You will probably have 3–4 sessions over 2–4 weeks. You will be given a general or spinal anaesthetic at each brachytherapy session.
Applicators are used to deliver the radiation source to the cancer. They are available in different sizes and your radiation oncologist will examine you to choose a suitable applicator for your situation. The applicator is placed into the cervix under the guidance of an ultrasound to make sure it is in the right place.
To hold the applicator in place, you may have gauze padding put into your vagina, and a stitch or two in the area between the vulva and the anus (perineum). You will also have a small tube (catheter) inserted to empty your bladder of urine during treatment.
You will have a CT or MRI scan to check the position of the applicator. This scan helps your doctor deliver the brachytherapy to the correct area. Once your doctor has completed the treatment plan, the radiation source will be placed into the applicator for 10–20 minutes. If you have a general anaesthetic, this will happen while you are asleep.
If you’ve had surgery to remove the cervix and uterus (hysterectomy), your doctor may want to deliver some extra radiation to the top of the vagina. An applicator will be placed into your vagina. You will not need to have a general anaesthetic or gauze padding.
After treatment – The applicator is taken out after the radiation dose is delivered. If several sessions are needed, the applicator will be reinserted each time.
Side effects of radiation therapy
The side effects you experience will vary depending on the dose of radiation and the length of the treatment. Many will be short-term side effects that occur during treatment or within a few weeks of finishing. Side effects can take several weeks to get better, though some may continue longer. Some side effects from radiation therapy may not show up until many months or years after treatment. These are called late effects.
Short-term side effects
Fatigue – Your body uses a lot of energy dealing with the effects of radiation on healthy cells. Tiredness usually builds up slowly during the course of the treatment, particularly near the end. It may last for some time after treatment ends.
Bladder and bowel problems – You may pass urine more often or with more urgency, or with a burning sensation. Try to drink plenty of water to make your urine less concentrated. Bowel motions may be more frequent, urgent or loose (diarrhoea), or you may pass more wind than normal. Less commonly, there may be some blood in the stools. Your treatment team will prescribe medicines to reduce these side effects.
Skin redness, soreness and swelling – Radiation therapy may make the skin in the treatment area dry and itchy. Occasionally, your skin may look red and peel, like sunburn. The treatment team will recommend creams to use to make you more comfortable.
Hair loss – If radiation therapy is aimed at your pelvic area, you may lose your pubic hair. This hair may grow back after the treatment ends, but it will usually be thinner. The radiation therapy will not cause you to lose hair from your head or other parts of your body.
Vaginal discharge – Radiation therapy may cause or increase vaginal discharge. Let your treatment team know if it smells bad or has blood in it. Do not wash inside the vagina with douches as this may cause infection.
Long term or late effects
Lymphoedema – Radiation can scar the lymph nodes and vessels and stop them draining lymph fluid properly from the legs. This may lead to swelling of the legs. This can occur months or years after radiation therapy.
Bladder and bowel problems – Bladder and bowel changes can also be late effects, appearing months or years after radiation therapy finishes. You may pass urine more often or need to go in a hurry. The movement of waste through the large bowel can become faster, meaning you need to go to the toilet more urgently and more often. It is important to let your doctor know if you have any bleeding or if you have pain in the abdomen and cannot open your bowels.
Narrowing of the vagina – The vagina may become drier, shorter and narrower (vaginal stenosis), which may make sex and follow-up pelvic examinations uncomfortable or difficult. Your treatment team will suggest strategies to prevent this.
Menopause – If your ovaries have not been removed, radiation therapy can stop the ovaries producing hormones, which leads to early menopause. Your periods will stop, you will no longer be able to become pregnant and you may have menopausal symptoms.
Pelvic fracture – In rare cases, radiation therapy to the pelvic area can weaken the bones and cause a fracture. Pelvic fractures are the most common. This may not occur for 2–4 years after treatment.
Chemotherapy uses drugs to kill cancer cells or slow their growth while causing the least possible damage to healthy cells. Chemotherapy may be given if the cervical cancer is advanced or returns after treatment, and may be combined with radiation therapy.
The drugs are usually given through a vein (intravenously) and most women have treatment as an outpatient. The number of chemotherapy sessions you have depends on the type of cervical cancer and any other treatments you may be having. If you have chemotherapy without radiation therapy, you are likely to have six sessions, scheduled every 3–4 weeks over several months.
Side effects of chemotherapy
The side effects of chemotherapy vary according to the drugs given, how often you have treatment, your general health and fitness, and whether you have chemotherapy alone, or as part of chemoradiation. You may experience nausea or vomiting, feel tired, or lose some hair from your body or head. Chemotherapy can also cause temporary or permanent menopause.
Chemotherapy may reduce the number of blood cells in your body. Depending on the type of blood cells affected, you may feel very tired and be more prone to infections. If your temperature rises to 38°C or above, seek urgent medical attention. You will have regular blood tests during treatment to monitor the levels of blood cells.
Most side effects are temporary, and your treatment team can help you to prevent or reduce them.
Targeted therapy drugs affect specific molecules within cells to block cell growth. They are used to treat some women with cervical cancer that has spread to other parts of the body or has come back and cannot be treated by surgery or radiation therapy.
Cancers develop their own blood vessels to help them grow. This process is called angiogenesis. Some targeted therapy drugs known as angiogenesis inhibitors are designed to stop this process.
Bevacizumab is an angiogenesis inhibitor that can be used to treat advanced cervical cancer. It is given with chemotherapy every three weeks through a drip into a vein (infusion). The total number of infusions you receive will depend on how you respond to treatment.
Side effects of targeted therapy
The most common side effects experienced by women taking bevacizumab include high blood pressure, feeling tired and loss of appetite. Less common side effects include bleeding and wound healing problems.
Palliative treatment helps to improve people’s quality of life by managing the symptoms of cancer without trying to cure the disease.
Many people think that palliative treatment is for people at the end of their life, but it may be beneficial for people at any stage of advanced cervical cancer. It is about living as long as possible in the most satisfying way you can.
As well as slowing the spread of cancer, palliative treatment can relieve any pain and help manage other symptoms. Treatment may include radiation therapy, chemotherapy, targeted therapy or other medicines such as hormone treatment.
Palliative treatment is one aspect of palliative care, in which a team of health professionals aim to meet your physical, emotional, practical and spiritual needs. The team also provides support to families and carers.
This information is reviewed by
This information was last reviewed in September 2019 by the following expert content reviewers: A/Prof Penny Blomfield, Gynaecological Oncologist, Hobart Women’s Specialists, and Chair, Australian Society of Gynaecological Oncologists, TAS; Karina Campbell, Consumer; Carmen Heathcote, 13 11 20 Consultant, Cancer Council Queensland; Dr Pearly Khaw, Consultant Radiation Oncologist, Peter MacCallum Cancer Centre, VIC; A/Prof Jim Nicklin, Director, Gynaecological Oncology, Royal Brisbane and Women’s Hospital, and Associate Professor Gynaecologic Oncology, The University of Queensland; Prof Martin K Oehler, Director, Gynaecological Oncology, Royal Adelaide Hospital, SA; Dr Megan Smith, Program Manager – Cervix, Cancer Council NSW; Pauline Tanner, Cancer Nurse Coordinator – Gynaecology, WA Cancer & Palliative Care Network, WA; Tamara Wraith, Senior Clinician, Physiotherapy Department, The Royal Women’s Hospital, VIC.