Cervical cancer


Treatment for cervical cancer

The most common treatment for cervical cancer is surgery and/or a combination of chemotherapy and radiotherapy (chemoradiotherapy). When cervical cancer has spread beyond the cervix, targeted therapy may also be used.

Your medical team will recommend treatment based on:

  • the results of your tests
  • the location of the cancer and whether it has spread
  • your age and general health
  • whether you would like to have children in the future.
  • 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

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

The main type of surgery is called a hysterectomy. A hysterectomy is an operation to remove the uterus (womb) and sometimes other organs of the reproductive system. There are different types of hysterectomy, which are done under a general anaesthetic. See below.

A hysterectomy may also involve removing both ovaries and fallopian tubes (a bilateral salpingo-oophorectomy) and some pelvic lymph nodes.

Types of hysterectomies

How the surgery is done

The hysterectomy can be done in two different ways. Your surgeon will talk to you about the most suitable method of surgery.

Open surgery (laparotomy)

This may involve an up and down (vertical) or crossways (transverse) cut on your tummy. Open surgery usually means a longer hospital stay and slower recovery.

Keyhole surgery (laparoscopy)

This technique is becoming more common. This involves 3–4 small cuts in your abdomen, and usually means a shorter hospital stay and faster recovery.

Bilateral salpingo-oophorectomy

Depending on how far the cancer has spread, and your age, you may also have the ovaries and fallopian tubes removed. This is called a bilateral salpingo-oophorectomy. With your consent, 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.

Trachelectomy

A trachelectomy involves removing part 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 cancer smaller than 2 cm) who would like the option of being able to have children in the future.

Removing lymph nodes

During a hysterectomy, your doctor may decide to remove some of the lymph nodes in the pelvic and/or abdominal area to see if the cancer has spread beyond the cervix. This is called a lymphadenectomy or lymph node dissection.

Before a lymphadenectomy, some women with early cervical cancer may have a sentinel lymph node biopsy. This test helps identify the lymph node most likely to be the first to have cancer spread to it. You will have an anaesthetic and an injection of radioactive dye near the site of the cancer. They dye will flow to this node, and the surgeon will remove it and determine whether it's necessary to remove more lymph nodes. A sentinel lymph node biopsy can help the surgeon avoid removing all of the pelvic lymph nodes, which reduces the risk of lymphoedema. If cancer is found in the lymph nodes, your doctor may recommend you have additional treatment, such as radiotherapy.

What to expect after surgery

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 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. These tubes will be removed before you go home.

After the catheter is removed, 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, then using an ultrasound scan to check that your bladder is empty. It is a quick, painless test 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 relief medicine through a drip (intravenously) or via a catheter inserted in the spaces in the spine (epidural) or as a tablet. If you still have pain, your doctor or nurse can change your medicine to one that is more effective.

Moving your legs

While you are in bed, you may have to wear "calf compressors" around your lower legs. These act like a constant massage to help the blood in your legs circulate and prevent deep vein thrombosis (DVT). You will be encouraged to get out of bed and walk around as soon as you can.

Recovery time

You will spend up to a week in hospital after a hysterectomy, depending on the type of surgery you have. The recovery time depends on the type of surgery and your fitness. You will be able to go home when the medical team is satisfied with your recovery and the results of your bladder function tests. See tips for recovering from surgery once you get home from hospital.

Anne's story

"After the operation, I had radiation therapy daily for six weeks. The treatment made me feel very tired and also affected my bowels and bladder.

"But for me, the hardest part of cancer and treatment is the ongoing emotional side of it. The physicality of having treatment is one thing, but the emotional roller-coaster was the worst part.

"My doctors have told me to be vigilant about everything abnormal, such as any vaginal bleeding or pain. Even many years later, there is a lot of uncertainty.

"Sometimes I panic when I feel unwell and rush to my doctor for reassurance. Mostly now, it feels like it was a bad dream, and I focus on living my life to the full."

Tell your cancer story.

Side effects of surgery

After surgery for cervical cancer, you may experience some of the following side effects. For more information about the side effects listed below, see managing side effects.

Problems with bladder or bowel function

Because some of the nerves to the bladder are removed, you may feel the sensation of not being able to empty your bladder completely, or emptying your bladder or bowel too slowly. These problems improve with time. Some women experience accidental leakage of urine after surgery. This is called urinary incontinence.

Lymphoedema

If you have a lymphadenectomy, you may develop lymphoedema, which is excess tissue fluid in the legs or pubic area. 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.

This will affect your fertility.

Impact on sexuality

The physical and emotional changes you experience after surgery may affect how you feel about sex, but surgery doesn't change the ability to have sex or feel pleasure during sexual intercourse.

Internal scar tissue (adhesions)

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

What to expect when you get home

Most women say they feel better within six weeks of surgery, but recovery may take longer.

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 carrying heavy shopping bags, doing laundry or vacuuming for at least a month. The length of time will depend on the type of surgery you have.

Exercise

Walk regularly if your doctors say it is okay to do so. Speak to your doctor about when it is suitable to start more vigorous exercise.

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.

Sex

If you've had open surgery, you'll need to avoid sexual intercourse for at least 4–6 weeks to give the vaginal wound time to heal properly.

Diet

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

Radiotherapy

Radiotherapy, also called radiation therapy, uses radiation such as 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.

Most women who have radiotherapy for cervical cancer will have both external and internal radiotherapy.

Women with cervical cancer that has spread to the tissues or lymph nodes surrounding the cervix will usually have chemoradiotherapy to reduce the chance of the cancer coming back. See below.

Chemoradiotherapy

Chemoradiotherapy means having radiotherapy and chemotherapy together. The chemotherapy drugs can make the cancer cells more sensitive to radiotherapy.

If you are treated with chemoradiotherapy, you will usually receive lowdose chemotherapy once a week a few hours before the radiotherapy appointment.

The side effects of treatment include fatigue, diarrhoea, needing to pass urine more often or in a hurry, cystitis, dry and itchy skin in the treatment area, nausea, and a lowered number of white blood cells, which means you have an increased risk of infection. Talk to your treatment team about ways to manage the side effects of chemoradiotherapy.

External radiotherapy

In external radiotherapy, a machine produces radiation (such as x-rays) and directs it to the cervix, lymph nodes and other organs that need treatment. The initial planning session will include a CT scan to work out where to direct the radiation beams. This may take up to 45 minutes, but the actual treatment takes only a few minutes each time.

You will probably have external radiotherapy as daily treatments, Monday to Friday, over 4–6 weeks as an outpatient. You will lie on a table under the radiotherapy machine. Before the machine is turned on, the radiation therapist will leave the room, but they will be able to talk to you through an intercom and they will watch you on a screen while you have treatment. The treatment itself is painless and will not make you radioactive.

Internal radiotherapy

Internal radiotherapy is known as brachytherapy. For cervical cancer a radiation source is placed inside the body next to the cancer in the cervix. This reduces the effect radiation has on nearby organs such as the bowel and bladder.

The most common type of brachytherapy for cervical cancer is high-dose rate (HDR). Less commonly, pulsed-dose-rate (PDR) is offered. Ask your radiation oncologist for more details on PDR.

During treatment

At each HDR session, you will be given a general or spinal anaesthetic. Your radiation oncologist will examine you to choose a suitable applicator for your situation.

Applicators are used to deliver the radiation source to the cancer and they are available in different sizes. The applicator is placed through the cervix and into your uterus using ultrasound to make sure it is in the right place.

To hold the applicator 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 location and size of the cancer. This scan will help your doctor deliver the brachytherapy to the correct area. Once your doctor is happy with the treatment plan, the radiation source will be placed into the applicator for 10–20 minutes. If you have a general anaesthetic, this will happen while you are asleep.

If you've had surgery to remove the cervix and uterus (hysterectomy), your doctor may want to deliver some extra radiation to the top of the vagina. An applicator will be placed inside your vagina. You will not need to have a general anaesthetic or gauze padding.

At the end of each treatment, the radiation source is removed from the applicator. You will not be radioactive and you can safely interact with other people.

After treatment

The applicator is removed between treatments. You will probably have 3–4 sessions over 2–4 weeks.

Side effects of radiotherapy

The side effects you experience vary depending on the dose of the radiotherapy and the length of the treatment. Many will be short-term side effects that occur during treatment or within a few weeks of finishing. Some side effects may be late effects, not appearing until some time after treatment.

Tiredness

During radiotherapy, your body uses a lot of energy dealing with the effects of radiation on healthy cells. Travelling to treatment can also be tiring. Tiredness usually builds up slowly during the course of the treatment, particularly towards the end. It may last for weeks after treatment ends.

Hair loss

If radiotherapy is aimed at your pelvis area, 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 or other parts of your body.

Diarrhoea

Radiation can irritate the bowel and bowel motions may be more frequent or urgent or may become loose (diarrhoea). See suggestions on managing diarrhoea.

Bladder problems

Radiation passes through the bladder to reach the treatment area, which can cause a burning feeling when passing urine (cystitis) and an urge to urinate more often (urinary urgency). You may need a urine test to rule out infection, so talk to your doctor about your symptoms. Drinking water and taking an over-the-counter urinary alkaliser (e.g. Ural) can help relieve symptoms of cystitis. You may also be given pain relief.

Skin problems

Radiotherapy may make the skin in the treatment area dry and itchy. Your skin may look red and peel. The treatment team will recommend creams to use to make you more comfortable.

Swelling of the legs

If the pelvic lymph nodes are treated with radiotherapy, this may lead to swelling in the leg. This is known as lymphoedema.

Menopause

If your ovaries have not been removed, radiotherapy will cause them to stop working permanently, causing menopause.

Narrowing of the vagina

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 suggestions on coping with vaginal side effects.

Pelvic fracture

Radiotherapy to the pelvic area can weaken the bones and cause a fracture. Hip fractures are the most common. This may not occur for 2–4 years after treatment.

See more information about radiotherapy and its side effects or call Cancer Council 13 11 20.

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. They will also depend on if you have chemotherapy alone, or as part of chemoradiotherapy. 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 blood cells affected, you may feel very tired and be more prone to infections, such as colds. If your temperature rises to 38°C or above, seek urgent medical attention. You will have regular blood tests during treatment to monitor the levels of blood cells.

Most side effects are temporary, and your treatment team can help you to prevent or reduce them. Our chemotherapy section has more information or call Cancer Council 13 11 20.

Targeted therapy

A new type of drug treatment known as targeted therapy is being used to treat some women with cervical cancer that has spread to other parts of the body or has come back and cannot be treated by surgery or radiotherapy.

Cancers develop their own blood vessels to help them grow. This process is called angiogenesis. Some targeted therapy drugs are designed to stop this process. These are known as angiogenesis inhibitors.

Bevacizumab (Avastin) is an angiogenesis inhibitor that can be used to treat advanced cervical cancer. It is given with chemotherapy every three weeks as an infusion into a vein. The number of infusions you receive will depend on how you respond to treatment. For more information about targeted therapies, talk with your medical team.

Side effects of targeted therapy

The most common side effects experienced by women taking bevacizumab include high blood pressure, feeling tired and loss of appetite. Less common side effects include bleeding and wound healing problems.

Palliative treatment

Palliative treatment helps to improve people's quality of life by alleviating symptoms of cancer without trying to cure the disease, and is best thought of as supportive care.

Many people think that palliative treatment is for people at the end of their life: however it may be beneficial for people at any stage of advanced cervical cancer. It is about living 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 radiotherapy, chemotherapy or other medicines such as hormone treatment.

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

See more information about palliative care or living with advanced cancer or call Cancer Council 13 11 20.

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 an operation to remove the cervix and uterus.
  • Some women also need a bilateral salpingooophorectomy, 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.
  • 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.
  • Chemoradiotherapy is a combination of chemotherapy and radiotherapy. It is usually given to treat more advanced cervical cancer.
  • Targeted therapy drugs work by stopping the cancer developing new blood vessels. The most commonly used drug for cervical cancer that has spread is bevacizumab.
  • Palliative treatment can treat symptoms and side effects at any stage of advanced cancer.

Expert content reviewers:

Prof Ian Hammond, Gynaecological Oncologist (retired), WA and Chair, Cancer Council Australia Cervical Cancer Screening Guidelines Working Party, National Cervical Screening Program: Guidelines for the management of screen-detected abnormalities, screening in specific populations and investigation of abnormal vaginal bleeding. Cancer Council Australia, Sydney, 2016; Jennifer Duggan, Clinical Nurse Consultant Gynaecological Oncology, Royal Hospital for Women, NSW; Dr Rhonda Farrell, Gynaecological Oncologist, Royal Hospital for Women, Prince of Wales Private Hospital, St George Hospital, and Conjoint Lecturer, School of Women's & Children's Health, University of NSW; Melinda Grant, Consumer; Karen Hall, 13 11 20 Consultant, Cancer Council SA; Dr Pearly Khaw, Consultant Radiation Oncologist, Peter MacCallum Cancer Centre, VIC; Megan Smith, Program Manager – Cervix/HPV and Breast Group, Cancer Research Division, Cancer Council NSW.

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