Cervical Cancer - Surgery
Surgery is usually the first treatment for cancer of the cervix in its early stages (where it is only in the cervix). In this situation radiotherapy is as effective as surgery but the side effects are greater, and for this reason surgery is usually used. If the surgery removed all of the cancer with a good margin of healthy tissue all around, and you have no cancer cells in the lymph nodes, you will not usually need any further treatment. However, if it is thought that some cancer cells may still be left after the surgery, you may be advised to have radiotherapy afterwards to reduce the chance of the cancer coming back in the future. Sometimes this radiotherapy is combined with chemotherapy.
The operation for cancer of the cervix usually involves the removal of the womb (hysterectomy), lymph nodes and a small part of the vagina. If the cancerous cells have spread only very slightly beyond the surface cells of the cervix, it may be possible to treat this with a cone biopsy or trachelectomy.
The ovaries may also be removed but, where possible, they are not taken out in young women as their removal brings on an early menopause. For this reason surgery may be more suitable for young women than radiotherapy, as radiotherapy to the pelvic area stops the ovaries from working and brings on an early menopause. If it is necessary to remove the ovaries, the symptoms of the menopause can often be prevented by replacing the hormones with tablets, skin patches or creams (hormone replacement therapy).
If the cancer has spread beyond the cervix it is not curable with surgery alone and radiotherapy is usually the preferred treatment. It is usually given in combination with chemotherapy.
Cervical Cancer - Trachelectomy
For some younger women with a very early cancer of the cervix it may be possible to carry out a new surgical procedure called a trachelectomy. In this type of surgery the cervix and the upper part of the vagina is removed, but the rest of the womb is left in place. The lymph glands in the pelvis are also removed, usually by surgery through a tiny cut in the abdominal skin (keyhole surgery).
As the womb is not removed trachelectomy can mean that it may still be possible for the woman to have children. A stitch is made at the bottom of the uterus and this takes the place of the cervix during pregnancy. There is a higher chance of miscarriage for women who have this procedure, and the baby needs to be delivered by Caesarian section.
Trachelectomy is only suitable for women with early stage cancer of the cervix.
As this type of surgery is experimental it is only done in a few hospitals in the United Kingdom. You may need to ask your gynecologist to refer you to a specialist hospital if you would like to discuss the possibility of having this treatment. It is important that if you are considering a trachelectomy your doctor fully explains the benefits and possible risks of this type of operation.
Cervical Cancer - Radiotherapy
Radiotherapy
may also be used after surgery (sometimes with chemotherapy) if there is a high risk that the cancer may come back, for example if the lymph glands were affected.
Radiotherapy treats cancer by using high-energy rays, which destroy the cancer cells, while doing as little harm as possible to normal cells. Radiotherapy for cancer of the cervix can be given externally or internally, and often as a combination of the two.
Radiotherapy is usually given if the cancer has spread beyond the cervix and is not curable with surgery alone. Radiotherapy may also be used after surgery if there is a high risk that the cancer may come back.
In this situation radiotherapy may be given alone or with chemotherapy. If the radiotherapy is combined with chemotherapy it is known as concomitant therapy.
It is not unusual to have slight bleeding or discharge once the radiotherapy treatment has ended. If it continues or becomes heavy it is important to let your doctor or nurse know.
Radiotherapy to the pelvic area can cause side effects such as tiredness, diarrhea and a burning sensation when passing urine. These side effects can be mild or more troublesome depending on the strength of the radiotherapy dose and the length of your treatment. The oncologist will be able to advise you what to expect.
Cervical Cancer - Chemotherapy
Chemotherapy may sometimes be used before surgery, to shrink the cancer and make the operation easier, and it is often given with radiotherapy.
Chemotherapy may also be given to women whose cancer has spread to other parts of the body or whose disease has come back after radiotherapy. It is used in this situation to try to shrink and control the disease nd relieve symptoms, with the hope of prolonging a good quality of life.
Your doctor will plan your treatment by taking into account a number of things, including your age, general health, and the type, stage and grade of the tumor. Sometimes, especially in the early stages of cancer of the cervix, either radiotherapy or surgery can be used, as both give similar results.
The chemotherapy drugs are usually given intravenously (by injection into a vein). They can temporarily reduce the number of normal cells in your blood. When the number of healthy cells in your blood is low you are more likely to get an infection and you may tire easily. During chemotherapy your blood will be tested regularly and, if necessary, you may be given antibiotics to treat any infection. Blood transfusions may be given if you become anemic due to the chemotherapy.
Other side effects may include tiredness, feeling sick (nausea), vomiting and hair loss, although nausea and vomiting are now much less of a problem then they used to be because of effective anti-sickness drugs.
You may find that other women at the hospital are having different treatment from yourself. This may be because their illness takes a different form, so they have different needs. It may also be because doctors take different views about treatment. If you have any questions about your own treatment, don't be afraid to ask your doctor or the nurse looking after you. It often helps to make a list of the questions you want to ask and to take a close relative or friend with you to remind you of the things you want to know, but can so easily forget.
Some women find it reassuring to have another medical opinion to help them decide about their treatment. Most doctors will be pleased to refer you to another specialist for a second opinion if you feel this will be helpful.
Taken from: CancerBacup
