Treatment for cervical cancer

For some people, surgery may be the only treatment needed. Surgery is usually recommended  when the tumour 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 may also remove some lymph nodes during surgery.

Types of surgery

Depending on how far the cancer has spread and your age, you may have one or more of the procedures pictured below. Click on each image to enlarge.

How the surgery is done

Your surgeon will talk to you about the most suitable surgery for you, as well as the risks and any possible complications (in both the short and long term).

The surgery will be performed under a general anaesthetic. Research has shown that outcomes for cervical cancer surgery are better with open surgery (laparotomy). This means that 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 bikini line instead. The uterus and other organs are then removed through the cut.

Keyhole surgery (laparoscopy or robotic surgery) is not commonly recommended to treat cervical cancer.

Surgery to remove lymph nodes

You may have one of the following procedures to check if the cancer has spread from the cervix to lymph nodes in the pelvis.

Sentinel lymph node biopsy – This procedure may be used for some women with early cervical cancer and is only available in some treatment centres. It 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 surgeon 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 surgeon may remove the remaining nodes in the area 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 surgeon avoid removing more lymph nodes than necessary and minimise side effects such as lymphoedema.

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 doctors 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 (wee). These tubes will be removed before you go home.

After the catheter is removed from your bladder, the nurses will check that your bladder is  emptying properly. This is called a bladder scan. It is done by measuring the amount of urine you pass each time you go to the toilet, then using an ultrasound scan of your lower belly to check that your bladder is empty. It is a quick, painless scan 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 (orally), 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.

Blood clot prevention – You will usually have injections of a blood thinner to reduce the risk of blood clots. While you are in bed, you may have to wear compression stockings on your lower legs. These stockings 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 usually spend 2–3 days in hospital after surgery. The recovery time depends on the type of surgery, your fitness and whether you have any complications. You will be able to go home when the treatment 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 have some side effects.

Problems with how the bladder works – 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 too slowly. These problems improve with time. You may find that you leak some urine after surgery. This is called urinary incontinence.

Constipation – The pain medicines used during and after surgery can cause constipation (difficulty having bowel movements). Your treatment team may suggest medicines to help prevent or relieve constipation. Once your surgeon says you can get out of bed, walking around can also help.

Lymphoedema – Sometimes removing lymph nodes in the pelvic area can stop or slow the natural flow of lymphatic fluid. This may cause lymphoedema, which is a build-up of fluid in the soft tissues under the skin.

Menopause – If your ovaries are removed and you have not been through menopause, removal will cause sudden menopause. After menopause, you will stop having periods and you will not be able to become pregnant.

Impact on sexuality – The physical and emotional changes you have after surgery may affect how you feel about sex, but surgery doesn’t change the ability to 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. In most cases, you will feel better within six weeks.

Rest up – Take things easy for the first few weeks after the surgery and only do what is  comfortable. Ask family or friends to help you with household chores so you can rest as much as you need to.

Work – Depending on the type of work you do, you will probably need up to 4–6 weeks leave from your job.

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 you can start more vigorous exercise or go swimming.

Sex – You’ll need to avoid sexual intercourse for at least 6 weeks to give the vaginal wound time to heal properly.

Lifting – Avoid heavy lifting for about a month, although this will depend on the type of surgery  you had.

Download our booklet ‘Understanding Surgery’

Also known as radiotherapy, radiation therapy uses a controlled dose of radiation to kill or  damage cancer cells. The radiation is usually in the form of x-ray beams. It 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:

• in combination with chemotherapy as the main treatment for cervical cancer (chemoradiation)
• after surgery to help get rid of any remaining cancer cells and reduce the chance of the cancer coming back (adjuvant therapy).

There are two main ways of delivering radiation therapy: externally or internally. It’s common to have both types to treat cervical cancer.

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 (irritation of the bladder); dry and itchy skin in the treatment area; and nausea.

Chemoradiation can also affect the blood, increasing the risk of anaemia (due to low levels of red blood cells), infections (due to low levels of white blood cells) and bleeding problems (due to lower number of platelets).

Talk to your treatment team about ways to manage the side effects of chemoradiation.

External beam radiation therapy

In external beam radiation therapy (EBRT), a machine precisely directs radiation beams from outside the body to the cervix, lymph nodes and other organs that need treatment. You will have a planning session, including a CT scan, to work out where to direct the radiation beams. This may take up to 45 minutes. The actual treatment takes only a few minutes each time and is painless.

You will probably have EBRT as daily treatments, Monday to Friday, over 4–6 weeks as an  outpatient. You will lie on a table under the radiation therapy machine. The radiation therapist will leave the room before turning the machine on. They will be able to talk to you through an intercom and watch you on a screen while you have treatment.

Internal radiation therapy

Also known as brachytherapy, this delivers radiation therapy directly to the tumour from inside your body, while reducing the amount of radiation delivered to nearby organs such as the bowel and bladder. Brachytherapy is usually given after the course of EBRT is finished.

The main type of internal radiation therapy used for cervical cancer is high-dose-rate (HDR) brachytherapy. With HDR brachytherapy, you only need a few treatments to receive the prescribed dose of radiation. You will usually have HDR brachytherapy as a day patient.

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 suitable applicators for your situation. Applicators are placed into the cervix under ultrasound guidance to make sure they are in the right place. To hold the applicators 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 applicators. 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 applicators for 10–20 minutes.

After treatment – The applicators are taken out after the radiation dose is delivered. As several sessions are needed, the applicators may need to be put in each time. Occasionally, you may stay in hospital with the applicators in place (no radiation inside), so that the radiation sessions can be given closer together. After brachytherapy, you may feel uncomfortable in the vaginal region or have a small amount of bleeding. Pain medicines can help if needed.

Radiation therapy after surgery (adjuvant therapy)

If you’ve had a hysterectomy, your doctor may recommend you also have radiation therapy. Usually, about 4–6 weeks after surgery, you will have EBRT in combination with chemotherapy. Occasionally, some women will have brachytherapy to deliver radiation to the top of the vagina.

Short-term side effects of radiation therapy

The side effects you have 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.

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 changes – You may pass urine more often or with more urgency, or feel a burning sensation. Try to drink plenty of water to dilute your urine. Bowel movements 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 faeces (poo or 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 of radiation therapy

The side effects you have 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. Some side effects may continue for longer. Other side effects from radiation therapy may not show up until many months or years after treatment. These are called late effects.

Lymphoedema – Radiation can scar the lymph nodes and vessels and stop them draining lymph fluid properly. This may lead to swelling of the legs or genital area. This can occur months or years after radiation therapy.

Bladder and bowel changes – 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. Let your doctor know if you have any bleeding or 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, such as using vaginal dilators.

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 – Rarely, radiation therapy to the pelvic area can weaken bones and cause a  fracture. Pelvic fractures are the most common. This may not happen until 2–4 years after treatment. The risk is higher after menopause and if you have osteoporosis (thin, weakened bones).

Download our booklet ‘Understanding Radiation Therapy’

Chemotherapy uses drugs to kill cancer cells or slow their growth while causing the least possible damage to healthy cells. Chemotherapy may be given:

• in combination with radiation therapy as the main treatment for cervical cancer (chemoradiation)
• on its own or combined with targeted therapy if the cancer has already spread beyond the pelvis  at the time of diagnosis or comes back after treatment.

The drugs are usually given through a vein (intravenously) and during day visits to a hospital or clinic 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 up to six sessions, every 3–4 weeks, though it may  continue for longer.

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 or chemoradiation. You may have 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 likely to get infections. If your temperature rises
to 38°C or above, go to the nearest hospital emergency department immediately. You will have regular blood tests during treatment to monitor the levels of blood cells.

Most side effects of chemotherapy are temporary, and your treatment team can help you to prevent or reduce them.

Download our booklet ‘Understanding Chemotherapy’

Targeted therapy is a drug treatment that attacks specific features of cancer cells to stop the cancer growing and spreading. It is used to treat 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 the drug.

Side effects of targeted therapy

The most common side effects of taking bevacizumab include high blood pressure, feeling tired  and loss of appetite. Less common side effects include bleeding, blood clots and problems with wound healing. Rarely, bevacizumab has the potential to cause other more serious side effects, such as damage to the bowel (perforation) or a passage opening up between the vagina and another part of the body (fistula). Your doctor will discuss these possible side effects with you.

Download our fact sheet ‘Understanding Targeted Therapy’

Palliative treatment helps to improve people’s quality of life by managing the symptoms of cancer without trying to cure the disease. It is best thought of as supportive care.

Many people think that palliative treatment is only for people at the end of their life, but it may help at any stage of advanced cervical cancer. It is about living for 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 therapy.

Palliative treatment is one aspect of palliative care, in which a team of health professionals aim to meet your physical, emotional, practical, cultural, social and spiritual needs. The team also provides support to families and carers.

Download our booklet ‘Understanding Palliative Care’

Download our booklet ‘Living with Advanced Cancer’