Treatment for cervical cancer depends on the stage of the cancer (the size of the tumour and if there is any sign it has spread).
Most cervical cancers are curable, especially those diagnosed when they are at stage 1. If a tumour returns there are treatment options.
Cancer treatments can be complex. Because of this, hospitals use multidisciplinary teams (MDTs) to treat cervical cancer. This is a team of different medical specialists. They advise on the best treatment for you and will explain these to you.
Your cancer team
Members of your MDT may include a:
- gynaecological oncologist (a specialist in cancers of the female reproductive system)
- radiation oncologist (a specialist in radiotherapy)
- medical oncologist (a specialist in cancer medicines)
- pathologist (a specialist who examines tissue for disease)
- radiologist (a specialist in scans and x-rays)
- social worker (a person trained to understand your financial or care problems and how to get the help you need)
- psychologist (a specialist who can help you deal with negative thoughts and feelings)
- specialist cancer nurse, who'll usually be your first point of contact with the rest of the team
Early-stage cervical cancer treatment
Early-stage cervical cancer means it is stage 1 (only inside the cervix).
In most cases, treatment for early-stage cervical cancer is surgery (an operation) to remove some of the the cervix. You will have this surgery under local anaesthetic (you will be awake but not feel pain) in a colposcopy clinic.
Other treatments include:
- surgery to remove some or all of your cervix while you are under general anaesthetic (unconscious)
- surgery to remove the womb
Surgery to remove early-stage cancer
There are 4 main types of surgery for cervical cancer:
- large loop excision of the transformation zone (LLETZ)
- cone biopsy
- trachelectomy
- hysterectomy
You may need more than 1 of these.
Radiotherapy
Radiotherapy is sometimes used as a treatment with surgery. Around 1 in 5 women will need radiotherapy after surgery.
If you have advanced cervical cancer, you might have radiotherapy with cancer medicines.
In this case, it can be used to control bleeding and pain.
You can have radiotherapy either:
- externally
- internally (brachytherapy)
In most cases, a combination of both will be used. You'll usually need to do radiotherapy for around 5 to 8 weeks.
External radiotherapy
A machine beams high-energy waves into your pelvis to destroy cancerous cells.
Internal radiotherapy (brachytherapy)
A radioactive implant is put next to the tumour inside your vagina.
Internal radiotherapy aims to reduce harm to nearby tissue. It does this by delivering the radiation as close as possible to the tumour. But it can still cause side effects.
Side effects of radiotherapy
Radiotherapy destroys cancerous cells.
But sometimes it can also harm healthy tissue. This means it can cause significant side effects.
These side effects can last for months, or even years, after treatment.
But the benefits of radiotherapy often outweigh the risks. For some people, radiotherapy offers the only hope of getting rid of the cancer.
Long-term side effects to the pelvic area can include:
- diarrhoea - medicines can help to reduce this
- bladder inflammation - this can cause pain and a feeling of needing to pee
- pain in your tummy due to urine infection, bowel changes or fine cracks in the pelvic bones
- your digestive system to stop taking in vitamin B12 from food - this can cause a vitamin B12 deficiency
- bleeding from the bladder, bowel or vagina - always let your GP or doctor know if this happens
- weaker pelvic bones - you might have a scan to check them
- tingling or weakness in one or both legs - loss of sensation in one or both legs - but this is very rare
These changes can sometimes take years to appear.
Talk to your GP or doctor if you are worried about side effects.
If you have surgery and radiotherapy, you are more likely to have long-term side-effects.
Fertility
If you are worried about your fertility, it may be possible to surgically remove eggs from your ovaries. This can be done before radiotherapy.
They can then be implanted in your womb later. But you may have to pay for this.
Getting IVF and other specialist treatment through the HSE
Ovarian transposition
Ovarian transposition is a surgery to help prevent an early menopause.
It's done by moving your ovaries away from the area of radiation. This is to protect the ovaries while you have radiotherapy. Your ovaries are moved to outside the pelvis.
Ovarian transposition is not always successful.
Your doctors can give you more information about these options. They will tell you if you're suitable for an ovarian transposition.
Cancer medicines
Your care team may recommend treatment with cancer medicines. These will be to either kill or slow the growth of cancer cells.
Chemotherapy
Chemotherapy uses medicines to kill cancer cells.
It is also known as cytotoxic chemotherapy or cytotoxic cancer medicine. Cytotoxic means toxic to cells.
Immunotherapy
Immunotherapy medicines can either:
- use your immune system to find and kill cancer cells
- boost your immune system and help it work better to fight cancer cells
You may have tests to check if immunotherapy is likely to work for you. These are called biomarker tests.
Targeted therapy
Targeted therapy uses medicines to find and attack cancer cells.
Targeted therapy medicines target parts of cancer cells that have gene changes (mutations) that make them different from normal cells.
You will only be offered targeted therapy if your cancer has these gene changes.
You may have tests to check if targeted therapy is likely to work for you. These are called biomarker tests.
Follow-up after treatment
Treatment should remove the cancer. But you'll need to attend regular appointments for testing.
This will usually involve a doctor checking your vagina and cervix (if it has not been removed).
Because cervical cancer can return, these exams will look to see if this is happening. If anything suspicious is found, a further biopsy can be done.
In some cases, especially after cancer medicines and radiotherapy, CT or MRI scans may be used in follow up.
Follow-up appointments are usually every 3 to 6 months for the first 2 years.
You will then have them every 6 to 12 months for the following 3 years.
Palliative care
If your doctors cannot treat your cancer, they will focus on controlling symptoms. They will try to help you be as comfortable as possible.
This is called palliative care.
Palliative care also includes psychological, social and spiritual support. This support is for you and your family or carers.
There are different options for palliative care in the late stages of cancer. You may want to think about if you'd like to be cared for in hospital, in a hospice or at home. You can talk to your doctor about this.
You can find information about hospice care and how to find a hospice from the Irish Hospice Foundation.
Content supplied by the NHS and adapted for Ireland by the HSE
