Cervical cancer treatment
Many years of treating cancer patients and testing treatments in clinical trials has helped doctors to know what is likely to work for a particular type and stage of cancer. Your doctor will advise you on the best treatment for your cancer. This will depend on the results of your tests, where the cancer is and if it has spread, your age and general health, and what you want.
Treatments for cervical cancer include surgery, radiotherapy, chemotherapy or a combination of these treatments.
Some very early cervical cancers may be treated with cone biopsy. However, great care is needed to ensure that all the cancer cells are removed, so the margins of the tissue removed are carefully examined. Most women who have a cone biopsy will not have any long-term side effects.
A hysterectomy is the removal of the uterus by surgery.
There are two kinds of hysterectomy:
- a total hysterectomy, in which the uterus including the cervix is removed
- a radical hysterectomy, in which the uterus, cervix, support ligaments and top part of the vagina are removed. The ovaries are usually not removed in women who are still having periods. Lymph node dissection may also be done during a radical hysterectomy for cervical cancer.
For both types of hysterectomy, you will need a general anaesthetic.
A radical hysterectomy is a longer operation and it may take you longer to recover.
When you wake up from the surgery, you will have several tubes in place. You will have an intravenous drip that will give you fluid and drugs. You may have a drain tube in your pelvis for a few days. You will also have a catheter put into your bladder to drain away urine. As you improve after the operation, these tubes will be removed.
After the operation
As with all major operations, you will have some discomfort or pain. You can have pain relievers to control this. They may be given through an intravenous drip or through an epidural tube into your spine. The epidural pain relief is similar to that given to women during childbirth.
Let the doctor or nurse know if you have any pain - don't wait until the pain becomes severe.
A hysterectomy is a major operation. You may be in hospital for five days for a total hysterectomy. If you have a radical hysterectomy you will need to be in hospital for about five to seven days.
Don't expect to get back to your normal activities too quickly. For some women, recovery may take six weeks or even longer. During this time, avoid heavy work or lifting. It may take some time before you feel completely well.
Before you go home from hospital, ask your doctor what you can do and what you should avoid for a while, for example, when you can start to have sex again.
There are many books about hysterectomy. Check your local library or bookshop.
Radiotherapy uses radiation to destroy or injure cancer cells. The radiation can be targeted to cancer sites in your body. Treatment is carefully planned to do as little harm as possible to your normal body tissue.
Radiotherapy may be advised if you are not well enough for major surgery. It may also be advised if the cancer has spread into the tissues around the cervix, or if the tumour is very large, because this would be hard to cure by surgery alone. Radiotherapy may also be used after surgery or combined with chemotherapy.
Radiotherapy can be given in two ways: from outside or inside the body. Usually both are used to treat cervical cancer.
If radiotherapy is advised, a doctor who specialises in radiotherapy treatment for women with cervical cancer will treat you. This doctor will work closely with your gynaecological oncologist.
In external radiotherapy, rays from a large machine are directed at the part of the body needing treatment. For women with cervical cancer, this is the pelvic area.
You will probably have radiotherapy as an outpatient, five days a week for four to six weeks. The actual treatment takes two to three minutes each time. However the waiting and preparation time is longer.
Like a normal x-ray, radiotherapy does not cause pain or discomfort as it is being given.
If you have external radiotherapy, it is likely that you will also have chemotherapy once a week.
Brachytherapy (internal radiotherapy)
Brachytherapy is radiotherapy given internally. It is put into the cancer from inside your body. Your radiation oncologist will discuss the method to be used with you before you begin treatment.
Brachytherapy is usually given after a course of external radiotherapy with weekly chemotherapy (see above). This is because most cervix cancers become smaller during this treatment. Brachytherapy involves placing implants with a radiation source inside the cervix and vagina, as close to the cancer as possible. This gives adequate radiation to the tumour while minimising the dose (and side effects) to nearby organs, such as the bowel and bladder. You may need three to five treatments.
The implants are inserted for a short time while you are under anaesthetic. The radiation is placed into the implant for only a few minutes. The implant is removed before you wake up. Because the radiation is removed, there is no radiation risk to other people around you. You will usually go home on the same day.
Less commonly, brachytherapy is given over 48-72 hours. You will go into hospital as an inpatient and have a general or spinal anaesthetic.
The implant will be placed in your cervix and vagina and left in place for up to 72 hours. The brachytherapy will be given during this period, with breaks for staff to attend your needs. You may be in a room of your own. Nurses will explain how your visitors can protect themselves from radiation. After the treatment is complete, the implant will be removed and you can go home.
Side effects of radiotherapy
Radiotherapy may cause a number of side effects that are temporary and can be controlled. These include tiredness, loss of appetite, diarrhoea, pain when passing urine and skin problems. The skin between your buttocks may feel sore, like the feeling you get from sunburn. Radiotherapy to this area can also cause shortening, drying and adhesions of the vagina. A dilator or vaginal cylinder with oestrogen cream can be used to treat or prevent these side effects.
Special cream can relieve this burning feeling. If you have not been through menopause, radiotherapy will affect your ovaries and reduce their ability to produce normal hormones. This may cause infertility and symptoms of menopause. Vaginal spotting may also occur. It is unlikely to be a major problem.
When having radiotherapy, allow plenty of time to rest. Drink lots of water and have small but frequent meals. Ask the doctor or nurse how to manage any side effects.
This is the treatment of cancer with anti-cancer drugs. The aim is to destroy all cancer cells while doing the least possible damage to normal cells. The drugs work by stopping cancer cells from growing and reproducing themselves.
Chemotherapy is usually given to women with more advanced cancer or together with radiotherapy.
You will probably have chemotherapy through a vein. You may need to stay in hospital overnight or you may be treated as a day patient. This depends on the drugs you are given and how you are feeling. You will probably have a number of treatments, usually six, every three to four weeks over several months. This depends on the disease and other treatments being used. You will have blood tests before your next treatment to make sure your body's normal cells have had time to recover.
Side effects of chemotherapy
The side effects of chemotherapy vary according to the drugs used. They may include:
- feeling sick (nausea), vomiting
- feeling off-colour and tired
- some thinning or loss of hair from your body and head.
These side effects are temporary, and steps can often be taken to prevent or reduce them. There are effective medications to prevent many of the side effects.
Chemotherapy may also cause periods to stop, either temporarily or permanently, causing premature menopause.
Combined radiotherapy and chemotherapy
A combination of radiotherapy and chemotherapy is used to treat cervical cancer. Trials have found that women with invasive cervical cancer have better rates of survival when they have chemotherapy that includes the drug cisplatin along with radiotherapy.
Combined radiotherapy and chemotherapy can cause more side effects than radiotherapy alone. The side effects include a reduced number of white blood cells (leucopoenia), nausea and vomiting.
These are temporary and can be treated.
Complementary and alternative medicines
It's common for people with cancer to seek out complementary and alternative treatments. Many people feel that it gives them a greater sense of control over their illness, that it's ‘natural' and low-risk, or that they just want to try everything that seems promising.
Complementary therapies include massage, meditation and other relaxation methods, which are used along with medical treatments.
Alternative therapies are unproven remedies, including some herbal and dietary remedies, which are used instead of medical treatment.
Some of these have been tested scientifically and found to be not effective or even to be harmful.
Some complementary therapies are useful in helping people to cope with the challenges of having cancer and cancer treatment. However, some alternative therapies are harmful, especially if:
- you use them instead of medical treatment
- you use herbs or other remedies that make your medical treatment less effective
- you spend a lot of time and money on alternative remedies that simply don't work.
Be aware that a lot of unproven remedies are advertised on the Internet and elsewhere without any control or regulation. Before choosing an alternative remedy, discuss it with your doctor or a cancer nurse at the Cancer Council Helpline on 13 11 20.
Cervical cancer can be effectively treated when it is found early. Most women with early cervical cancer will be cured.
For women whose cancer has progressed further, a cure is often still possible. For other women, treatment can keep the disease under control for long periods of time.
For information about your own prognosis, you should talk with your doctor, who knows your full medical history.
Even if your cancer is curable you may find that you often need to be reassured by your specialist. This is normal because you may feel that you can no longer trust your body. Over time you will find that you feel more confident.
Recovery and follow-up care
Recovering from treatment is different for each woman. It depends on the type and stage of cervical cancer you have and also the amount of treatment you have needed.
You will need to have regular check-ups with your specialist. These may include blood tests and physical examinations. Talk with your doctor about how often these may be.
It may take some time for you to recover from the various types of treatment. You will find that there are physical changes as well as many emotional changes to cope with. It is important that you, your partner and family are prepared for this. You may also need to talk with your employer about how the treatment may affect your work.
When cancer can’t be cured
If your cancer has spread and it is not possible to cure it by surgery, your doctor may still recommend treatment. In this case, treatment may help relieve any symptoms, can make you feel better and may allow you to live longer.
Whether or not you choose to have anti-cancer treatment, symptoms can still be controlled. For example, if you have pain, there are effective treatments for this.
General practitioners, specialists and palliative care teams in hospitals all play important roles in helping people with advanced cancer. For more, contact the Cancer Council Helpline on 13 11 20
Making decisions about treatment
Sometimes it is very hard to decide which is the right treatment for you. You may feel that everything is happening so fast that you do not have time to think things through. Waiting for test results and for treatment to begin can be very difficult.
While some people feel they have too much information, others may feel that they do not have enough. You need to make sure that you know enough about your illness, the possible treatment and side effects to make your own decisions.
If you are offered a choice of treatments, you will need to weigh up the good and bad points about each treatment. If only one type of treatment is recommended, ask your doctor to explain why other treatment choices have not been advised.
For most women, cervical cancer can be cured. However, treatment may make it more difficult, or impossible, for you to become pregnant.
This may be a blow for many women, even if they already have a family. For women who have not yet had children, it can be very hard. Taking time over your decisions is even more important in this situation.
Some people with advanced cancer will always choose treatment, even if it only offers a small chance of cure. Others want to make sure that the benefits of treatment outweigh any side effects. Still others will choose the treatment they think offers them the best quality of life.
Some may choose not to have treatment except to have any symptoms managed to maintain the best possible quality of life.
Talking with doctors
You may want to see your doctor a few times before making a final decision on treatment. It is oft en hard to take everything in, and you may need to ask the same questions more than once. You always have the right to find out what a suggested treatment means for you, and the right to accept or refuse it.
Talking with others
Once you have talked about treatment options with your doctor, you may want to talk them over with family or friends, with nursing staff , the hospital social worker or chaplain, or your own religious or spiritual adviser. Talking it over can help to sort out which course of action is right for you.
You may be interested in searching for cervical cancer on the Internet. While there are some very good websites, you need to be aware that some websites provide wrong or biased information. We recommend that you begin with a Cancer Council website (see link below)
A second opinion
You may want to ask for a second opinion from another specialist. This is okay and can help you make your decision. Your specialist or local doctor can refer you to another specialist. You can ask for a copy of your results to be sent to the second-opinion doctor. You can still ask for a second opinion even if you have started treatment or still want to be treated by your first doctor.
Taking part in a clinical trial
Clinical trials are the most accurate way to determine the effectiveness of promising new treatments or new ways of combining cancer treatments. Always discuss treatment options with your doctor.
If your doctor suggests taking part in a clinical trial, make sure that you fully understand the reasons for the trial and what it means for you. Before deciding whether or not to join the trial, you may wish to ask your doctor:
- What is the standard (best available) treatment for my cancer if I don't go in the trial?
- Which treatments are being tested and why?
- Which tests are involved?
- What are the possible risks or side effects?
- How long will the trial last?
- Will I need to go into hospital for treatment?
- What will I do if any problems occur while I am in the trial?
If you decide to join a randomised clinical trial, you will have either the best existing treatment or a promising new treatment. You will be allocated at random to receive one treatment or the other. In clinical trials, people's health and progress are carefully monitored.
If you do join a clinical trial, you have the right to withdraw at any time. Doing so will not affect your treatment for cancer.
It is always your decision to take part in a clinical trial. If you do not want to take part, your doctor will discuss the best current treatment choices with you.
Research into cervical cancer
Research into cervical cancer is ongoing. Recent clinical trials have involved detection and screening methods, immunotherapy, fertility preserving surgery, targeted therapy and combination therapies. These may not be approved or available as standard treatments. Always discuss all diagnostic and treatment options with your doctor.
For information or cancer support call 13 11 20.
For more information, see the Cancer Council of Victoria website (see the link below).