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Cervical cancer


Treatment for cervical cancer


The treatment recommended by your doctors will depend on the stage of the cancer, your age, general health and whether you would like to have children in the future. You may have more than one treatment, and treatments may be given in different orders and combinations.

  • Early or localised cancer (stage 1) – usually treated with surgery to remove the cancer. May have chemoradiation after surgery.
  • Locally advanced cancer (stage 2 or 3) – usually treated with two types of radiation therapy (chemoradiation followed by brachytherapy). Surgery may or may not be used.
  • Advanced cancer (stage 4) – may have radiation therapy, chemotherapy, targeted therapy, chemoradiation and/or surgery. 

If becoming a parent is important to you, talk to your doctor before starting treatment and ask for a referral to a fertility specialist. 

Surgery

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.

After surgery for cervical cancer, you may have some side effects including problems with how the bladder works, constipation, lymphoedema, early menopause, internal scar tissue (adhesions) and an impact on sexuality.

Types of surgery

Depending on how far the cancer has spread and your age, you may have one or more of the following procedures:

  • Cone biopsy removes a cone-shaped piece of tissue around the cancer, including a margin of healthy tissue. A cone biopsy is used to treat very early cervical cancers, particularly for young women who would like to have children.
  • Trachelectomy removes part or all of the cervix, along with the upper part of the vagina. The uterus, fallopian tubes and ovaries are left in place. This is not a common procedure, but it may be used in young women with early-stage cancer who would like to have children.
  • Total hysterectomy – removes the uterus and cervix. This surgery can be used for early cervical cancers. The fallopian tubes are also commonly removed. Some premenopausal women are able to keep their ovaries.
  • Radical hysterectomy – removes the uterus, cervix, and soft tissue around the cervix and top of the vagina. This is the standard operation for most cervical cancers treated with surgery. The fallopian tubes are also commonly removed. Some premenopausal women are able to keep their ovaries.
  • Bilateral salpingectomy – removes both fallopian tubes. This procedure is commonly recommended for women having a hysterectomy.
  • Bilateral salpingo-oophorectomy removes both fallopian tubes and ovaries. This is considered for women having a hysterectomy when your doctor is concerned that the cancer may have spread to the ovaries, or for women approaching menopause (between the ages of 45 and 55) or who have been through menopause.

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. It helps to identify the lymph node that the cancer is most likely to spread to first (the sentinel lymph node), which is then removed for testing. If it contains cancer cells, the surgeon may remove the remaining nodes in the area or recommend other treatments.

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.

What to expect after surgery

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 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 a major operation, it is common to feel some pain and you will be given medicine for relief. You will usually have injections of a blood thinner and may have to wear compression stockings on your legs to reduce the risk of blood clots. 

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. You’ll need to avoid sexual intercourse to give the vaginal wound time to heal properly and you may need to stop working during this time. You should take things easy after surgery, try gentle exercise and avoid heavy lifting.

 

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, and nausea. Chemoradiation can also affect the blood, increasing the risk of anaemia, infections and bleeding problems.

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

Radiation therapy

Radiation therapy uses a controlled dose of radiation to kill or damage cancer cells. 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 and neither will make you radioactive. It is safe for you to be with both adults and children after your treatment sessions.

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.

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. 

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 and have 3–4 sessions over 2–4 weeks.

Applicators are placed into the cervix and used to deliver the radiation source to the cancer. 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.

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

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.

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, and may include fatigue, bladder and bowel changes, skin redness, soreness and swelling, pubic hair loss and vaginal discharge. Side effects can take several weeks to get better. 

Some side effects may continue for longer or may not show up until many months or years after treatment. These are called late effects and may include lymphoedema, bladder and bowel changes, narrowing of the vagina, menopause and rarely, pelvic fracture. 

 

Chemotherapy

Chemotherapy uses drugs to kill cancer cells or slow their growth while causing the least possible damage to healthy cells. It 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) 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.

You may experience nausea, fatigue, hair loss, increased risk of infections, or temporary or permanent menopause. Most side effects of chemotherapy are temporary, and your treatment team can help you to prevent or reduce them. 

Targeted therapy

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. The total number of infusions you receive will depend on how you respond to the drug.

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 can cause damage to the bowel or a passage opening up between the vagina and another part of the body (fistula). Your doctor will discuss possible side effects with you.

Some drugs are being tested in clinical trials for people with cervical cancer that has come back or not responded to treatment. Ask your doctor about recent developments in drugs for cervical cancer and whether a clinical trial may be an option for you.

Learn more about clinical trials

Palliative treatment 

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 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. It 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.

Understanding Cervical Cancer

Download our Understanding Cervical Cancer booklet to learn more

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Expert content reviewers:

Dr Pearly Khaw, Lead Radiation Oncologist, Gynae-Tumour Stream, Peter MacCallum Cancer Centre, VIC; Dr Deborah Neesham, Gynaecological Oncologist, The Royal Women’s Hospital and Frances Perry House, VIC; Kate Barber, 13 11 20 Consultant, VIC; Dr Alison Davis, Medical Oncologist, Canberra Hospital, ACT; Krystle Drewitt, Consumer; Shannon Philp, Nurse Practitioner, Gynaecological Oncology, Chris O’Brien Lifehouse and The University of Sydney Susan Wakil School of Nursing and Midwifery, NSW; Dr Robyn Sayer, Gynaecological Oncologist Cancer Surgeon, Chris O’Brien Lifehouse, NSW; Megan Smith, Senior Research Fellow, Cancer Council NSW; Melissa Whalen, Consumer. 

Page last updated:

The information on this webpage was adapted from Understanding Cervical Cancer - A guide for people with cancer, their families and friends (2021 edition). This webpage was last updated in October 2021.

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