Treatment for cervical cancer

Thursday 1 October, 2015

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On this page: Surgery | Radiotherapy | Chemotherapy | Chemoradiation | Palliative treatment | Key points


Your doctor will advise you on the best treatment for you. Treatment options will depend 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.

The most common treatment for cervical cancer is surgery and/or a combination of chemotherapy and radiotherapy (chemoradiation).

Surgery

Surgery is recommended for women who have small tumours that are confined to the cervix. The type of surgery you have will depend on how far within the cervix the cancer has spread.

Hysterectomy

A hysterectomy is when the uterus (womb) and other parts of the reproductive system are removed. There are two main types of hysterectomy, which are both done under a general anaesthetic:

Total hysterectomy

The uterus and cervix are removed. This can be done via keyhole surgery (laparoscopy) or by an open cut in the abdomen (laparotomy). Your surgeon will advise you on the best method for you.

Radical hysterectomy

The uterus, the cervix, the soft tissue around the cervix and about 2 cm of the upper vagina are removed. This surgery may cause nerve damage, which can affect bowel or bladder function. See managing side effects. You will spend up to a week in hospital after the hysterectomy, depending on the type of surgery you have.

Bilateral salpingo-oophorectomy

Depending on how far the cancer has spread, you may also need to have a bilateral salpingo-oophorectomy. This is when the ovaries and fallopian tubes are removed. They will be taken out at the same time as the hysterectomy. For some women, the ovaries will be left in place to prevent the onset of early menopause. Ask your doctor if this might be an option for you.Women who have a hysterectomy and/or bilateral salpingo- oophorectomy will become infertile, meaning they will no longer be able to have children naturally.

Trachelectomy

A trachelectomy is the removal of the cervix and some surrounding tissue. The uterus is left in place. This is not a common procedure, but it may be used in young women with early-stage cancer (e.g. a tumour smaller than 2 cm) who would like the option of being able to have children in the future. The side effects of a trachelectomy are similar to those of a hysterectomy (see side effects of surgery below), but you will not experience menopause – you will still have periods (menstruate) and be able to become pregnant.

Removing lymph nodes

During a hysterectomy, your doctor may decide to remove some lymph nodes in the pelvic and/or abdominal area to see if the cancer has spread beyond the cervix. This is called a lymph node dissection or lymphadenectomy. If cancer is found in the lymph nodes, your doctor may recommend you have additional treatment, such as radiotherapy.

A lymph node dissection may cause lymphoedema (see below). For ways to manage this condition, see managing side effects.

Your doctor will explain the side effects of your treatment to you. These can include infertility. If you would like to have children in the future, talk to your doctor before your treatment starts. For more information call 13 11 20 for a free copy of Fertility and Cancer or read more information on infertility.

Side effects of surgery

After surgery for cervical cancer, you may experience some of the following side effects. For more information on these side effects and ways to cope, see managing side effects.

Pain and discomfort

As with all major operations, you may be in pain after surgery. You will be given pain relief medicine through a drip (intravenously) or via an injection into the spine (epidural). If you still have pain, your doctor or nurse can change your medicine to one that is more effective.

Problems with bladder or bowel function

You may feel the sensation of not being able to empty your bladder completely, or emptying your bladder or bowel too slowly. These problems will improve with time. Some women experience accidental or involuntary leakage of urine after surgery for cervical cancer. This is called urinary incontinence.

Lymphoedema

If some of your lymph nodes are removed, your legs may swell because your lymphatic system is not working properly. This is called lymphoedema. Symptoms of lymphoedema may appear straightaway or years after surgery.

Menopause

If you have a bilateral salpingo-oophorectomy and have not been through menopause, the removal of your ovaries will cause sudden menopause.

Sexuality issues

The physical and emotional changes you experience may affect how you feel about sex.

Internal scar tissue (adhesions)

Tissues in the body may stick together, which can sometimes be painful. In some rare cases, adhesions to the bowel or bladder may need to be treated with further surgery.

Sarah's story

"When I was 26, I went to see my GP for a prescription and asked if I could have a Pap test as well. Some of my Pap test results had been abnormal in the past, and I was conscious of needing to have regular tests.

"A few days later, my GP called to tell me the results showed glandular abnormalities on my cervix. She referred me to a gynaecologist, who did a colposcopy. The colposcopy confirmed that there were abnormalities, so I was sent to hospital for a cone biopsy.

"The results of the cone biopsy showed that I had cervical adenocarcinoma, which is a rare type of cervical cancer. I knew that some treatments for cervical cancer can lead to infertility, and I was worried that I would end up not being able to have children. My oncologist recommended I have IVF to store some of my eggs in case I became infertile.

"About eight weeks after I had the Pap test, I was in hospital having surgery for cervical cancer. Because of my age and the fact I wanted the option to have children, I had a trachelectomy. This means that although my cervix was removed, my uterus wasn’t, and I’ll most likely be able to get pregnant naturally. The surgeon removed some lymph nodes from my pelvis as well.

"Recovering from surgery in hospital was difficult. I had to stay in bed for three or four days afterwards – I couldn’t even get up to go to the toilet. I was young and active, and not being able to do much was hard.

"I had a lot of support from family and friends, from when I was first diagnosed until after the surgery, and my doctors were fantastic. I haven’t needed any further treatment, and I’ve since had a normal Pap test result, which is a huge relief."

Tell your cancer story.  

After the operation and recovering at home

When you wake up from surgery, you will be in a recovery room near the operating theatre, then you will be taken back to your bed on the hospital ward.

Tubes and drips

You will have several tubes in place. You may have an intravenous (IV) drip to give you fluid and medication, 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, and then using an ultrasound scan to check how empty your bladder is. It is a quick, painless test that is done on the hospital ward.

Moving your legs

While you are in bed, your doctors, nurses and physiotherapist will show you how to move your legs to prevent deep vein thrombosis (DVT) and help drain any lymph fluid. You will be encouraged to get out of bed and walk around as soon as you can.

You will be able to go home when the medical team is satisfied with your recovery and the results of your bladder function tests. The illustrations below provide tips for recovering from surgery once you go home from hospital.

Taking care of yourself at home

Most women who have surgery for cervical cancer will feel better within six weeks, but recovery may take longer for some women. If you need home nursing care, ask hospital staff about services in your area. The following tips may help you during your recovery.

Rest

Take things easy for the first few weeks. Ask family or friends to help you with chores so you can rest as much as you need to.

Lifting

Avoid heavy lifting for at least a month. The length of time will depend on the type of surgery you have.

Driving

Avoid driving for a few weeks. Check with your car insurer whether there are any exclusions on your policy regarding major surgery and driving.

Exercise

Walk regularly if your doctors say it is okay to do so. Speak to your doctor if you would like to do more vigorous exercise.

Diet

Drink plenty of water and eat lots of fresh vegetables and fruit to avoid becoming constipated.

Sex

Avoid sexual intercourse for 4–6 weeks to give the wound time to heal properly.

Radiotherapy

Radiotherapy uses x-rays to kill cancer cells or injure them so they cannot multiply. The radiation is targeted at parts of the body with cancer, and treatment is carefully planned to do as little harm as possible to healthy body tissues.

Women with cervical cancer that has spread into the tissues or lymph nodes surrounding the cervix will usually have radiotherapy in combination with chemotherapy. This is called chemoradiation. Some women may have radiotherapy treatment after surgery.

Many women with cervical cancer have both external and internal radiotherapy.

External radiotherapy

In external radiotherapy, x-rays from a machine are directed at the cervix and other parts of the body that need treatment.

An initial planning session takes about 45 minutes. You will have a CT scan to work out where the x-ray beams should be directed.

You will probably have radiotherapy from Monday to Friday for 4–6 weeks as an outpatient. The actual treatment takes only a few minutes each time. You will lie on a metal table under the radiotherapy machine. Once the machine is turned on, you will be alone in the room, but you will still be able to talk to the radiation therapist through an intercom. The treatment itself is painless and will not make you radioactive.

Internal radiotherapy (brachytherapy)

Brachytherapy is when a radiation source is placed inside the body on or near the cancer, making the radiation less likely to affect the surrounding organs. The most common type of brachytherapy for cervical cancer is high-dose-rate brachytherapy.

You will usually have 3–4 sessions of brachytherapy in total over 2–4 weeks. Each treatment takes a few hours and you can usually go home the same day.

You will be given a general anaesthetic or sedation and an epidural. An implant will be inserted into your vagina and cervix. Gauze padding may be put into your vagina, and a stitch may be put into the lips of your vulva (labia) to keep the implant in place. A small tube will be inserted into your bladder to drain urine (catheter).

After you wake up, you will have a CT scan, x-ray, ultrasound or MRI scan to check the location of the tumour and to work out the best dose of brachytherapy, During this test, a small ‘marker’ tube may be placed inside your rectum to help make the pictures clearer.

The radiation source will then be placed into the implant for 15–30 minutes. You may feel anxious during this time, but talking on the phone, watching TV, reading or listening to music can help you pass the time. Nurses or other staff may come into the room during treatment, but while they are in the room, the treatment will be stopped. Once they leave the room, it will start again.

When the treatment is finished, the implant will be removed and you will be able to go home.

If you’ve had surgery to remove your cervix and uterus, an applicator will be placed inside your vagina to deliver radiotherapy. You will not need to have an anaesthetic, sedation or gauze padding.

Once treatment is over and the brachytherapy implant is removed, you aren’t radioactive and you can safely interact with other people.  

Side effects of radiotherapy

Side effects vary depending on the dose of the radiotherapy and the length of the treatment. Most side effects occur during treatment or soon after it has finished. However, some women experience long-term side effects.

Tiredness

During radiotherapy, 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 towards the end.

Loss of appetite

You may lose your appetite during the course of radiotherapy. If you don’t feel like eating, you can replace some meals with nutritious high-kilojoule drinks available from the chemist. Talking to a dietitian can also be helpful. 

Hair loss

If radiotherapy is aimed at your cervix, you may lose your pubic hair. This hair may grow back after the treatment ends, but it will usually be thinner. Radiotherapy will not cause you to lose hair from your head.

Diarrhoea

Radiation can affect bowel function, which can cause diarrhoea. For suggestions on managing diarrhoea, see bowel problems.

Skin problems

Radiotherapy may make the skin in the treatment area dry and itchy. 

Burning when passing urine (cystitis)

Radiation passes through the bladder to reach the treatment area, which can cause cystitis. You may need to have a urine test to rule out infection, so talk to your doctor about your symptoms. Drinking water, cranberry juice and Ural® (available from chemists) can help relieve symptoms of cystitis. You may also be given pain relief.

Menopause

If your ovaries are still in place, radiotherapy will cause them to stop working permanently, causing menopause.

Vaginal stenosis

Radiotherapy may cause internal scar tissue to form, which sometimes shortens and narrows the vagina. This is called vaginal stenosis and can be prevented or reduced with a vaginal dilator (see sexuality issues).  

For more information about radiotherapy and its side effects, call Cancer Council 13 11 20 for a copy of Understanding Radiotherapy.

Chemotherapy

Chemotherapy is the use of drugs to kill or slow the growth of cancer cells. The aim is to destroy cancer cells while causing the least possible damage to healthy cells. However, some healthy cells in the body, such as hair and bone marrow cells, may be affected.

The drugs are usually given through a vein (intravenously). You may need to stay overnight in hospital, or you may be treated as an outpatient. The number of chemotherapy sessions you have will depend on the type of cervical cancer and any other treatment you may be having. If you have chemotherapy without radiotherapy, you will probably have treatment up to six times, and these will be 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, and your general health and fitness. 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 also reduce the number of blood cells in your body. Depending on the type of cells affected, you may feel very tired and be more prone to infections, such as colds. You will have regular blood tests during treatment to check your blood count.

Most side effects are temporary, and your treatment team can help you to prevent or reduce them. Cancer Council’s booklet Understanding Chemotherapy has more information.

Chemoradiation

Chemoradiation is a combination of chemotherapy and radiotherapy. It is the most common treatment for advanced cervical cancer.

If you are treated with chemoradiation, you will usually receive low-dose chemotherapy once a week while you are having radiotherapy.

The side effects of chemoradiation include nausea, vomiting and a lowered number of white blood cells. These side effects are more severe than the side effects of treatment with radiotherapy or chemotherapy alone.

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

Palliative treatment

Palliative treatment aims to reduce symptoms of cancer without trying to cure the disease. It can be given at any stage of advanced cancer to improve quality of life. It is not just for people who are about to die and does not mean you have given up hope. Rather, 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 pain and help manage other physical and emotional symptoms. Treatment may include radiotherapy, chemotherapy or other medication.

For more information, call 13 11 20 or read Understanding Palliative Care or Living with Advanced Cancer.

Key points

  • Surgery is a common treatment for cervical cancer. The type of surgery you have will depend on how far the cancer has spread.
  • A hysterectomy is the surgical removal of the cervix and uterus. Some women also need a bilateral salpingo- oophorectomy, which is an operation to remove the ovaries and fallopian tubes.
  • A trachelectomy removes only the cervix. This is not a common procedure and is used more often for young women with early-stage cervical cancer.
  • Sometimes the lymph nodes in the pelvic region are removed. This is called a lymphadenectomy.
  • After surgery, you will need to rest as much as possible while you recover. This may take many weeks.
  • Radiotherapy uses x-rays to kill or damage cancer cells. You may have external or internal radiotherapy (brachytherapy), or both.
  • Chemotherapy is the use of drugs to kill or damage cancer cells. Chemotherapy is usually given intravenously every 3–4 weeks, or weekly if combined with radiotherapy.
  • Chemoradiation is a combination of chemotherapy and radiotherapy. It is usually given to treat advanced cervical cancer.
  • Treatment for cervical cancer can cause temporary or permanent side effects. The side effects you experience will depend on the treatment you have. Your medical team can help you manage these.
  • Palliative treatment can treat symptoms and side effects at any stage of advanced cancer.

Reviewed by: Dr Archana Rao, Gynaecological Oncologist, Royal Hospital for Women, NSW; Danielle Carpenter, Gynaecological Cancer Nurse Consultant, Gynaecology Unit, The Royal Women’s Hospital, VIC; Carmen Heathcote, 13 11 20 Consultant, Cancer Council Queensland, QLD; A/Prof Michael Jackson, Director, Radiation Oncology, Prince of Wales Hospital, NSW; Haley McNamara, Social Worker, Cancer Care Services, Metro North Hospital and Health Service, QLD; Isabelle Rousseau, Consumer.
Updated: 01 Oct, 2015