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Radiotherapy | Chemotherapy | Chemoradiation | Palliative treatment |
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 most common treatment for cervical cancer is surgery and/or a
combination of chemotherapy and radiotherapy (chemoradiation).
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.
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:
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.
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.
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.
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
13 11 20
for a free copy of
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.
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.
If you have a bilateral salpingo-oophorectomy
and have not been through menopause, the removal of your
ovaries will cause sudden menopause.
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.
"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.
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.
Avoid heavy lifting for at least
a month. The length of time
will depend on the type of
surgery you have.
Avoid driving for a few weeks.
Check with your car insurer
whether there are any exclusions
on your policy regarding major
surgery and driving.
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.
Drink plenty of water and eat lots
of fresh vegetables and fruit to
avoid becoming constipated.
Avoid sexual intercourse
for 4–6 weeks to give
the wound time to
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
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.
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.
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.
Radiation can affect bowel function, which can cause
diarrhoea. For suggestions on managing diarrhoea, see bowel problems.
Radiotherapy may make the skin in the
treatment area dry and itchy.
Burning when passing urine (cystitis)
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.
If your ovaries are still in place, radiotherapy will
cause them to stop working permanently, causing menopause.
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
13 11 20
for a copy of Understanding Radiotherapy.
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
has more information.
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
a week while you are
The side effects of
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 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.
- 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
- Sometimes the lymph nodes
in the pelvic region are
removed. This is called
- 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
- 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.