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Cervical cancer


Treatment for cervical cancer

Page last updated: January 2024

The information on this webpage was adapted from Understanding Cervical Cancer - A guide for people with cancer, their families and friends (2023 edition). This webpage was last updated in January 2024.

Expert content reviewers:

This information was developed based on international and Australian clinical practice guidelines, and with the help of a range of health professionals and people affected by cervical cancer:

  • Prof Martin Oehler, Director of Gynaecological Oncology, Royal Adelaide Hospital, and Clinical Professor, University of Adelaide, SA
  • Dawn Bedwell, 13 11 20 Consultant, Cancer Council QLD
  • Gemma Busuttil, Radiation Therapist, Crown Princess Mary Cancer Centre, Westmead Hospital, NSW
  • Dr Antonia Jones, Gynaecological Oncologist, The Royal Women’s Hospital and Mercy Hospital for Women, VIC
  • Angela Keating, Senior Psychologist, Royal Hospital for Women, NSW
  • Anne Mellon, Clinical Nurse Consultant – Gynaecological Oncology, Hunter New England Centre for Gynaecological Cancer, NSW
  • Dr Inger Olesen, Medical Oncologist, Andrew Love Cancer Centre, Barwon Health, Geelong, VIC
  • Dr Serena Sia, Radiation Oncologist, Fiona Stanley Hospital and King Edward Memorial Hospital, WA
  • A/Prof Megan Smith, Co-lead, Cervical Cancer and HPV Stream, The Daffodil Centre, Cancer Council NSW and The University of Sydney, NSW
  • Emily Stevens, Gynaecology Oncology Nurse Coordinator, Southern Adelaide Local Health Network, Flinders Medical Centre, SA
  • Melissa Whalen, Consumer.


The treatment recommended by your doctors will depend on the stage of the cancer; your age and 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 or brachytherapy after surgery.
  • Locally advanced cancer (stage 2 or 3) – usually treated with chemoradiation followed by brachytherapy. Surgery is not usually used.
  • Advanced cancer (stage 4) – may have radiation therapy, chemotherapy, targeted therapy, immunotherapy, chemoradiation and/or surgery. Other drug therapies may also be available through clinical trials.

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, an impact on sexuality, lymphoedema, menopause and internal scar tissue (adhesions).

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 people 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. May be used if you have early-stage cancer and 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. You may be able to keep your ovaries if you are premenopausal.
  • 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 often removed. 
  • Bilateral salpingectomy – removes both fallopian tubes. This procedure may be recommended if you are having a total or radical hysterectomy.
  • Bilateral salpingo-oophorectomy removes both fallopian tubes and ovaries. This is considered for those having a hysterectomy when there is a risk that the cancer may have spread to the ovaries.

How the surgery is done

Your surgeon will talk to you about the most suitable surgery for you, as well as any risks.

The surgery will be performed under a general anaesthetic. Research has shown that outcomes for larger cervical cancers are better with open surgery (laparotomy). This means that the surgery is performed through a cut in the abdomen.

This cut is usually made from the pubic area to the bellybutton. Sometimes the cut is made across the pubic hair line instead. The uterus and other organs are then removed through the cut.

Keyhole surgery (laparoscopy or robotic surgery) is usually only used for very early 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. If cancer is found in the lymph nodes, your doctors may recommend you have additional treatment.

Lymphadenectomy (lymph node dissection) – the surgeon will remove a number of lymph nodes from the pelvic and/or abdominal areas to see if the cancer has spread beyond the cervix. 

Sentinel lymph node biopsy – this procedure may be used for 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.

What to expect after surgery

You will usually spend up to five 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 pain medicine for relief. You will usually have injections of a blood-thinning drug and may have to wear compression stockings on your lower legs to reduce blood clots. 

Your recovery time after surgery will depend on the type of operation 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 cells, and weekly blood tests may be needed during treatment to monitor your blood cell levels.

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

Radiation therapy

Radiation therapy (also known as radiotherapy) uses a controlled dose of radiation to kill or damage cancer cells. The radiation is usually in the form of x-ray beams, and is targeted at the parts of the body with cancer.

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.

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.

You may be asked to empty your bowels and/or drink some water so that your bladder is comfortably full before the CT scan and treatments.

This helps to ensure that organs in the pelvic area – including the cervix and uterus – are in the same position for each treatment and the radiation beams are delivered to the targeted area.

The actual treatment takes about 15 minutes each time and is painless. You will probably have EBRT as daily treatments, Monday to Friday, over 4–6 weeks as an outpatient. 

External beam radiation therapy and HDR brachytherapy will not make you radioactive. It is safe for you to be with both adults and children after your treatment sessions.

Internal radiation therapy

Also known as brachytherapy, this delivers radiation 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 required radiation dose.

You will usually have HDR brachytherapy as a day patient and have 3–4 sessions over 2–4 weeks.

You will be given a general or spinal anaesthetic at each session. Applicators are placed into the cervix and used to deliver the radiation source to the cancer.

To hold the applicators in place, you will have gauze padding put into your vagina, and may have a stitch placed in the vulva.

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, which takes about 10-20 minutes. 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. 

Radiation therapy after surgery

If you’ve had a hysterectomy, your doctor may recommend you also have additional 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 cycles 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 cycles (with a cycle every 3–4 week), 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.

Bevacizumab is a type of targeted therapy that can be used to treat advanced cervical cancer. It is given with chemotherapy every three weeks through a drip into a vein (infusion).

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

Immunotherapy

Immunotherapy is a type of drug treatment that helps the body’s own immune system to fight cancer.

Pembrolizumab is an immunotherapy drug that may be offered to certain people with cervical cancer that has not responded to treatment, has spread or has come back. It is given with chemotherapy drugs and sometimes with bevacizumab.

Common side effects include fatigue, diarrhoea, itching and joint pain. Rarely, pembrolizumab can affect other organs including the heart, lungs, bowel or thyroid gland.

It’s important to let your treatment team know about any new or worsening side effects during or after treatment.

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.

Joining clinical trials

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

Understanding Cervical Cancer

Download our Understanding Cervical Cancer booklet to learn more

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