Cervical cancer treatment

There are several treatment options available for cervical cancer. The treatment advised by your Consultant and medical team will be made on the size and position of the cancer, any other health issues or preferences that you may have will also be been taken into consideration. It is important that you ask as many questions as it takes for you to feel comfortable and fully understand the treatment being advised.

I have had an early cervical cancer treated by a LLETZ biopsy – will I now need a hysterectomy?

If I need a hysterectomy, what does this mean?

I have been told that there are several types of hysterectomy.  Are all of them used to treat a cervical cancer?

What is a Wertheim hysterectomy?

Where will the scar be?

What will I experience straight after a Wertheim hysterectomy?

Will I still be able to have sex after a Wertheim hysterectomy?

Will having my lymph nodes removed affect me?

What is lymphoedema?

What is exenteration surgery?

I have been advised to have pelvic radiotherapy treatment for my cancer. Why have I not been offered a hysterectomy?

How do they treat a cervical cancer with radiotherapy?

What is the difference between external and internal radiotherapy?

Are there side effects after radiotherapy?

My doctor has said that I will have radiotherapy and chemotherapy – does this mean my cancer is very advanced?

Is chemotherapy ever used on its own to treat a cervical cancer?

I have had an early cervical cancer treated by a LLETZ biopsy – will I now need a hysterectomy?

No, not necessarily. Some very early cervical cancers that are diagnosed can be treated by a LLETZ biopsy. The diagnosis of a very early cervical cancer is often made following the result of a biopsy taken at the colposcopy clinic. The specialists who examine this specimen under the microscope may see a tiny cancer, which is so small and surrounded by normal tissue that no further treatment is recommended. The doctors may, however recommend further investigation in the form of a further biopsy to check that there is no abnormal tissue in the surrounding area where the initial biopsy was taken from.

If I need a hysterectomy, what does this mean?

The term 'hysterectomy' refers to the surgical removal of the uterus and is a procedure undertaken under a general anaesthetic. It involves the removal of the uterus and (sometimes) the cervix. The surgeon may also remove the fallopian tubes and ovaries if he/she feels that there is a risk of abnormality i.e. one ovary or both may look larger than normal or if the patient requests this. If the ovaries are removed then HRT (Hormone Replacement Therapy) may be recommended to replace the hormones produced by the ovaries. Without functioning ovaries or HRT the woman would, (if pre-menopausal at the time of surgery) experience an early menopause. Some women, following discussion with their consultant/GP/specialist nurse choose not to take HRT after a hysterectomy.

A hysterectomy (of this type) may be advised if a patient has had a very early cervical cancer treated by a LLETZ biopsy and she has experienced gynaecological problems, like heavy periods.

I have been told that there are several types of hysterectomy. Are all of them used to treat a cervical cancer? 

The term ‘hysterectomy’ refers to the surgical removal of the uterus and there are five differing procedures:

• Abdominal total hysterectomy

• Abdominal sub-total hysterectomy

• Laparoscopic hysterectomy

• Vaginal hysterectomy

• Wertheim hysterectomy

A hysterectomy can be advised to patients as the most appropriate management of conditions other than cervical cancer. The Wertheim hysterectomy is the standard management advised by Consultant Gynaecologists for women diagnosed with cervical cancer. This is because it is important that the surgeon removes the cervix and uterus in one whole piece so that he/she can clearly see the surrounding tissue, and that they can take a sample or remove tissue (as appropriate) such as the upper vaginal tissue, parametrium, omentum (fatty tissue) and/or lymph nodes.

The other types of hysterectomy are not usually advised or used as treatment for cervical cancer because:

• A sub-total hysterectomy involves the removal of the uterus (+/- fallopian tubes and ovaries) via an abdominal incision but does not remove the cervix

• A total abdominal hysterectomy involves the removal of the uterus and the cervix (+/- fallopian tubes and ovaries) via an abdominal incision, but does not involve removing other tissue

• A vaginal hysterectomy involves the removal of the uterus and the cervix via the vaginal route. This procedure does not involve the removal of any other tissue and the pelvic organs or surrounding tissues are not visualised in this operation

• A laparoscopic hysterectomy involves the removal of the uterus and the cervix via minute abdominal incisions performed by a surgeon using specialist instruments. A hysterectomy performed in this way is only possible if the uterus is very small and it may not be removed in one whole piece.

What is a Wertheim hysterectomy?

A Wertheim hysterectomy (often referred to as a radical hysterectomy) is when the surgeon removes the uterus and cervix, and some of the tissues which normally lie closest to the cervix. These are the top part of the vagina, parametrium (the broad ligament below the fallopian tubes which holds the womb in place), lymph glands and fatty tissue in the pelvis. The doctor may also remove the ovaries if he/she feels that there is a risk of abnormality i.e. one or both may look larger than normal or if the patient requests this. If the ovaries are removed then HRT (Hormone Replacement Therapy) may be recommended to replace hormones produced by the ovaries. Without functioning ovaries or HRT the woman would experience an early menopause. Some women, following discussion with their consultant/GP/specialist nurse choose not to take HRT after a hysterectomy.

Where will the scar be?

It is usually a horizontal line just above your pubic hair line. It tends to heal extremely well and many women can hardly see the scar once it is healed. Sometimes a doctor will need to make a vertical incision – if this is the case the doctor will explain to you where the scar will be and why he will need to perform the operation in this way. It is usually for a reason other than the cancer, such as the womb being a bit larger than normal, or a cyst is present on one of the ovaries.

What will I experience straight after a Wertheim hysterectomy?

You will usually have a drip (small plastic tube) in your arm. This means that fluids can be given to you, without you needing to drink. A catheter (small tube) will usually be put into your bladder whilst you are asleep. This drains any urine into a bag. The drip and the catheter will usually be removed very soon after your operation – when your body has recovered and you can drink and pass urine independently. A dressing will cover your scar – you may have stitches or clips which will need to be removed some days (usually between 5 and 10) after the operation.

You may have one or more drains in place. These drain any blood or serous fluid from the scar area into a bag or bottle. This helps prevent infection and reduces bruising. These drains are taken out within days of the operation. You will be given pain killers to minimise any discomfort that you experience. This may be in the form of an epidural, hand held pump (where you can press the button when you need more pain relief), injections or/and suppositories. When you are able to drink, then you can have oral medications such as tablets. The staff looking after you will talk to you about your pain relief choices before your operation.

Will I still be able to have sex after a Wertheim hysterectomy?  

Yes, the vaginal tissues are very stretchy, this means that although the top part of the vagina is removed, you will be able to have full intercourse usually without any difficulties. Most people say that they do not notice any difference. The most common changes a woman may feel are: the absence of the uterus moving during orgasm – this does not make the orgasm less pleasurable, if the ovaries have been removed and no HRT has been taken the vaginal tissues may feel a little dry. HRT or a vaginal lubricant should be helpful. Psycho-sexual issues – how a woman (or her partner) feel about their body or/and about sex may affect their arousal and therefore their satisfaction with intercourse. If this is a problem all women who have had a treatment for a cervical cancer are able to see a psycho-sexual counsellor to discuss it further. You can arrange an appointment via your G.P., your hospital consultant or specialist nurse.

Will having my lymph nodes removed affect me?  

The lymph glands in the pelvis are like those that may be affected in the neck if you have a sore throat or a cold. You cannot tell for certain if lymph nodes are free from disease unless you remove them and look at them under the microscope.   There is usually no noticeable difference for you if some of these are removed. Your immune system is not compromised. There is a small risk that you could develop lymphoedema after the operation.

What is lymphoedema?

Lymphoedema is the accumulation of lymphatic fluid. It is not dangerous, but can be uncomfortable as one leg or both can swell after a Wertheim hysterectomy. If you do develop this you should report it to your G.P., consultant or specialist nurse. They will confirm that it is lymphoedema and then refer you to a specialist who will advise you how to ensure the lymphoedema is kept to a minimum. Before your operation do ask your specialist nurse what you should do to help prevent lymphoedema occurring after the operation, what signs to look for and what services are available should you develop it.

What is exenteration surgery?  

This is where a more extensive operation is carried out either because the cancer is more widespread or because the cancer has returned. These operations involve removing the uterus if it hasn’t been removed before, the bladder (known as anterior exenteration) or/and the bowel (known as posterior exenteration if it is just the bowel or total exenteration if it is both the bowel and the bladder).  Sometimes reconstructive surgery is undertaken to the vagina and/or bladder. Sometimes a stoma or stomas (where the bladder or/and bowel is diverted out to a bag on the abdomen) is (are) required for urine or faeces.

I have been advised to have pelvic radiotherapy treatment for my cancer. Why have I not been offered a hysterectomy?

Sometimes radiotherapy treatment can be more effective than surgical treatment. Radiotherapy treatment can be used to cure a woman with a cervical cancer diagnosis. It will depend on the size and place of the cancer as to whether an operation or/and radiotherapy is offered/recommended.

How do they treat a cervical cancer with radiotherapy?  

Radiotherapy cancer treatment is the treatment of cancer using radiation x-rays directed at the body. For cervical cancer you will usually be recommended to have external and internal radiotherapy (brachytherapy).

What is the difference between external and internal radiotherapy?  

External radiotherapy is where beams are directed from a machine to your body – the machine is similar to an x-ray machine. This treatment is often administered in short doses on a daily basis for some weeks. Internal radiotherapy is often given after a course of external radiotherapy has been given. This is where a radioactive source is put into your cervix via your vagina. The time that this needs to stay in the cervix can vary, so do ask your specialist nurse or doctor for further information.

Are there side effects after radiotherapy?  

There are potential side effects with any treatment. The side effects with radiotherapy are less now than they used to be. This is because of the advancement of technology – treatments are more precise now. We also have more knowledge now as to how to prevent or minimise side effects – during and after treatment.

The most common side effects are those to the vagina, bowel and bladder. The vaginal tissues can become drier and less stretchy and the walls of the vagina can, in some circumstances stick together. The radiotherapy staff will advise you about using vaginal dilators and lubricants to prevent or minimise these effects. Sexual intercourse can be continued during and after treatment. If discomfort is experienced during intercourse do speak to your specialist nurse or radiographer who will advise you further. Psycho-sexual issues – how a woman, (or her partner), feels about their body or/and about sex may affect arousal and therefore their satisfaction with intercourse. If this is a problem all women who have had a treatment for a cervical cancer are able to see a psycho-sexual counsellor to discuss it further. You can arrange an appointment via your G.P., your hospital consultant or specialist nurse.

My doctor has said that I will have radiotherapy and chemotherapy – does this mean my cancer is very advanced?

No, not necessarily. Sometimes chemotherapy and radiotherapy (known as chemo-radiotherapy) are used together for an advanced cancer. Increasingly chemo-radiotherapy is being used for an early cancer. The chemotherapy appears, in some situations, to make the radiotherapy more effective.

Is chemotherapy ever used on its own to treat a cervical cancer?  

Yes, it can be used on its own. Sometimes this is because the cancer is advanced or it has come back. Sometimes it is used before another treatment is started – such as radiotherapy.

Last Updated: 26 Sep 2007