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.

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.  

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.

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.

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. 

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. 

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.

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.