This information has been reviewed by:
Assoc. Prof. David Allen Chair, VCOG Committee,
Gynaecological Oncologist, Mercy Hospital For Women
Combined radiotherapy and chemotherapy
Taking part in a clinical trial
Many years of treating cancer patients and testing different treatments in clinical trials has helped doctors know what is likely to work for a particular type and stage of cancer. Your doctor will advise you on the best treatment for your cancer. This will depend on the results of your tests, where the cancer is and if it has spread, your age and general health, and what you want.
Treatments for cervical cancer include surgery, radiotherapy, chemotherapy or a combination of these treatments.
For most women, cervical cancer can be cured. However, treatment may make it more difficult, or impossible, for you to become pregnant. This may be a blow for many women, even if they already have a family. For women who have not yet had children, it can be very hard. Taking time over your decisions is even more important in this situation.
As discussed earlier, some very early cervical cancers may be treated with cone biopsy. However, great care is needed to ensure that all the cancer cells are removed, so the margins of the tissue removed are carefully examined. Most women who have a cone biopsy will not have any long-term side effects.
A hysterectomy is the removal of the uterus by surgery.
There are two kinds of hysterectomy. In a total hysterectomy, the uterus including the cervix is removed. In a radical hysterectomy, the uterus, cervix, support ligaments and top part of the vagina are removed. The ovaries are usually not removed in women who are still having periods. Lymph node dissection may also be done during a radical hysterectomy for cervical cancer.
For both types of hysterectomy, you will need a general anaesthetic. A radical hysterectomy is a longer operation and it may take you longer to recover.
When you wake up from the operation, you will find that you have several tubes in place. You will have an intravenous drip which will give you fluid and drugs. Sometimes you may have a drain tube in your pelvis for a little while. You will also have a catheter inserted into your bladder to drain away urine. As you improve after the operation, these tubes will gradually be removed.
As with all major operations, you will have some discomfort or pain. You can have painkillers to control this. They may be given through an intravenous drip or through an epidural tube into your spine. The epidural pain relief is similar to that given to women during childbirth. Let the doctor or nurse know if you start to feel uncomfortable-don't wait until the pain becomes severe.
A hysterectomy is a major operation. You may be in hospital for five days for a total hysterectomy. If you have a radical hysterectomy you will need to be in hospital for about five to seven days.
Your recovery time will depend on different factors. Don't expect to get back to your normal activities too quickly. For some women, it may take six weeks or even longer. During this time heavy work or lifting should be avoided. It may take some time before you feel completely well.
Before you go home from hospital, ask your doctor what you can do and what you should avoid for a while, for example, when you can start to have sex again.
There are many books about hysterectomy which may be helpful. Check your local library or bookshop.
Radiotherapy uses radiation to kill or injure cancer cells. The radiation can be targeted to cancer sites in your body. Treatment is carefully planned to do as little harm as possible to your normal body tissue.
Radiotherapy may be advised if you are not well enough for a major operation. It may also be advised if the cancer has spread into the tissues around the cervix, or if the tumour is very large, as this would be difficult to cure by surgery alone. Radiotherapy may also be used after surgery or combined with chemotherapy.
Radiotherapy can be given in two ways: from outside or inside the body. Usually both external and internal radiotherapy are used to treat cervical cancer.
If radiotherapy is advised, you will be treated by a doctor who specialises in radiotherapy treatment for women with cervical cancer. This doctor works closely with your gynaecological oncologist.
In external radiotherapy, rays from a large machine are directed at the part of the body needing treatment. For women with cervical cancer, this is the pelvic area.
You will probably have radiotherapy as an outpatient, five days a week for four to six weeks. The actual treatment takes two to three minutes each time. However the waiting and preparation time is longer. Like a normal x-ray, radiotherapy does not cause pain or discomfort as it is being given.
Currently, people have chemotherapy once a week with the external radiation.
In internal radiotherapy, a radioactive implant is placed inside your body as close to the cancer as possible.
You will need to be admitted to hospital for a few days. You will have a general anaesthetic. The implant will be inserted through your vagina. The implant is left in place for up to seventy-two hours. The dose of radiotherapy and the length of time the implant is left in place are very carefully measured.
You will be in a room of your own while the implant is in place. This is because the implant is radioactive. Some precautions will need to be taken by the hospital staff as well as by your family to protect themselves from unnecessary radiation. The nursing staff will explain these precautions to you and your family before the implant is inserted. Make sure that you and your family understand what you need to do.
Radiotherapy may cause a number of side effects that are temporary and can be controlled. These include tiredness, loss of appetite, diarrhoea, pain when passing urine and skin problems. The skin between your buttocks may feel sore, like the feeling you get from sunburn.
Special cream can relieve this burning feeling. If you have not been through menopause, radiotherapy will affect your ovaries and reduce their ability to produce normal hormones. This may cause infertility and symptoms of menopause. Vaginal spotting may also occur. It is unlikely to be a significant problem.
When having radiotherapy, allow plenty of time to rest. Remember to drink lots of water and have small but frequent meals. Ask the doctor or nurse how to manage any side effects.
This is the treatment of cancer with anti-cancer drugs. The aim is to destroy all cancer cells while doing the least possible damage to normal cells. The drugs work by stopping cancer cells from growing and reproducing themselves.
Chemotherapy is usually given to women with more advanced cancer or together with radiotherapy. You will probably have chemotherapy through a vein. You may need to stay in hospital overnight or you may be treated as a day patient. This depends on the drugs you are given and how you are feeling. You will probably have a number of chemotherapy treatments, usually six, every three to four weeks over several months. This depends on the disease and other treatments being used. You will have blood tests before your next treatment to make sure your body's normal cells have had time to recover.
The side effects of chemotherapy vary according to the drugs used. They may include feeling sick (nausea), vomiting, feeling off-colour and tired, and some thinning or loss of hair from your body and head. These side effects are temporary, and steps can often be taken to prevent or reduce them. Medications to prevent many of the side effects are available and effective.
Chemotherapy may also cause periods to stop, either temporarily or permanently, causing premature menopause.
A combination of radiotherapy and chemotherapy is being used increasingly to treat cervical cancer. Trials have found that women with invasive cervical cancer have better rates of survival when they receive chemotherapy that includes the drug cisplatin along with radiotherapy.
Combined radiotherapy and chemotherapy causes more severe side effects than radiotherapy alone. The side effects include leucopoenia, nausea and vomiting. These effects are temporary and can be relieved.
Cervical cancer can be effectively treated when it is found early. Most women with early cervical cancer will be cured.
For women whose cancer has progressed further, a cure is often still possible. For other women, treatment can keep the disease under control for long periods of time.
For information about your own prognosis, you should talk with your doctor, who knows your full medical history.
Even if your cancer is curable you may find that you often need to be reassured by your specialist. This is normal as you may feel that you can no longer trust your body. Over time you will find that you feel more confident.
Recovering from treatment is different for each woman. It depends on the type and stage of cervical cancer you have and also the amount of treatment you have needed.
You will need to have regular check-ups with your specialist. These may include blood tests and physical examinations. Talk with your doctor about how often these may be.
‘I'm very independent so I tried to do as much as I could myself. But I was so tired I had to ask for help.'
It may take some time for you to recover from the various types of treatment. You will find that there are physical changes as well as many emotional changes to cope with. It is important that you, your partner and family are prepared for this. You may also need to talk with your employer about how the treatment may affect your work.
Your doctor may suggest that you consider taking part in a clinical trial. Clinical trials are a vital part of the search to find better treatments for cancer. Doctors conduct clinical trials to test new or modified treatments and see if they are better than existing treatments. Many people all over the world have taken part in clinical trials that have improved cancer treatment. However, the decision to take part in a clinical trial is always yours.
If your doctor suggests that you take part in a clinical trial, make sure that you fully understand the reasons for the trial and what it means for you. Before deciding whether or not to join the trial, you may wish to ask your doctor:
If you decide to join a randomised clinical trial, you will be given either the best existing treatment or a promising new treatment. You will be allocated at random to receive one treatment or the other. In clinical trials, people's health and progress are carefully monitored.
If you do join a clinical trial, you have the right to withdraw at any time. Doing so will not affect your treatment for cancer.
It is always your decision to take part in a clinical trial. If you do not want to take part, your doctor will discuss the best current treatment choices with you.
Research is being done in Australia and elsewhere to investigate the human papilloma virus (HPV) and its role in developing cervical cancer, to understand the cancer's biology and develop better treatments.
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