Treating cervical cancer

Treatment for a precancerous lesion of the cervix depends on a number of factors. These factors include whether the lesion is of low or high grade, whether the woman wants to have children in the future, the woman's age and general health, and the preference of the woman and her doctor.

A woman with a low-grade lesion as confirmed by biopsy and histology may not need further treatment. She should have regular gynaecological examinations and Pap smears. When a high-grade lesion is present, it should be destroyed. For this, the doctor may use laser surgery, electrocauterisation methods (also called diathermy) such as LLETZ/LOOP or surgical conisation. Sometimes, cryosurgery (freezing) is also used to destroy the abnormal area. Treatment for precancerous lesions may sometimes cause cramping or other pain, bleeding, or a watery discharge.

In a number of cases, women will undergo a standard total hysterectomy, particularly if abnormal cells occur again after previous treatment of HSIL. Total hysterectomy means that the womb is removed together with the cervix, but not the fallopian tubes and the ovaries. This surgery can be performed abdominally (through an incision in the abdomen below the navel) or vaginally (through the vagina without an abdominal incision). Hysterectomy is more likely to be done when there is no further wish to have children in the future.

Treatment for invasive cancer

Once cancer cells have been identified to invade the tissue beneath the epithelial surface lining of the cervix, the condition is not anymore a precursor but called invasive cancer.

The choice of treatment for cervical cancer depends on the exact place and size of the tumour, the stage (extent) of the disease, the woman's age and general health, and other factors.


Staging is a careful attempt to find out whether the cancer has spread and, if so, what parts of the body are affected. Blood and urine tests usually are done. The doctor will do a thorough gynaecological assessment. Other examinations, the doctor may do include procedures called cystoscopy and proctosigmoidoscopy. In cystoscopy, the doctor looks inside the bladder with a thin, endoscopic instrument. Proctosigmoidoscopy is a procedure in which a similar instrument with a light source is used to check the rectum and the lower part of the large intestine.

Because cervical cancer may spread to the bladder, rectum, lymph nodes, or lungs, the doctor also may order x-rays or other tests to check these areas. The woman may first have a sonar examination of her kidneys to see whether the kidney pipes (ureters) are obstructed by the tumour. If this is abnormal it may be followed by a series of x-rays of the kidneys and bladder, called an intravenous pyelogram. To look for lymph nodes that may be enlarged because they contain cancer cells, the doctor may order a CT or CAT scan, which is a series of x-rays put together by a computer to make detailed pictures of areas inside the body. Another rather expensive procedure that may be used to check organs inside the body is magnetic resonance imaging (MRI).

Preparing for treatment

Most women with cervical cancer want to learn all they can about their disease and treatment choices so they can take an active part in decisions about their medical care. The specialist oncologist and others on the medical team can help inform women.

When a woman is diagnosed with cancer, shock and stress are natural reactions. These feelings may make it difficult for patients to think of everything they want to ask the medical team. Often it helps to make a list of questions. To help remember what was said, patients may take notes or ask whether they may use a tape recorder. Some people also want to have a family member or friend with them when they talk to the medical team - to take part in the discussion, to take notes, or just to listen.

Patients should not feel they need to ask all their questions or remember all the answers at one time. They will have more opportunities to ask the doctor to explain things and to get more information.

Here are some questions a woman with cervical cancer may want to ask the doctor before her treatment begins:

•    What is the stage (extent) of my disease?
•    What are my treatment choices? Which do you recommend for me? Why?
•    What are the chances that the treatment will be successful?
•    What are the risks and possible side-effects of each treatment?
•    How long will the treatment last?
•    Will it affect my normal activities?
•    What is the treatment likely to cost?
•    What is likely to happen without treatment?
•    How often will I need to have check-ups?

Methods of treatment

Treatment for cervical cancer can involve surgery, radiation therapy and chemotherapy. Patients are often treated by a team of specialists. The team may include gynaecological oncologists, radiotherapy oncologists and chemotherapists. The doctors may decide to use one treatment method or a combination of methods. Some patients take part in a clinical trial (research study) using new treatment methods. Such studies are designed to improve cancer treatment.


Surgical removal of cervical cancer depends on the stage of the disease. If the cancer is still at a very early invasive stage and has not invaded deeper layers of the cervix, the doctor may perform an operation to remove the tumour by means of a large conisation but leave the uterus, tubes and ovaries.

In most other early stage cases, however, the patient may need to have a radical hysterectomy with removal of the tissue next to the cervix and uterus (parametrium) to offer the best therapeutic chance for long-term survival. In this procedure, the surgical team not only performs a total hysterectomy (uterus and cervix), but also removes the upper third of the vagina, the ovaries and fallopian tubes. In addition, the nearby lymph nodes are removed to learn whether the cancer has spread.

Radiation therapy and chemotherapy

The decision whether to perform surgery or radiation therapy with chemotherapy depends on the stage of the disease. Radiation therapy (also called radiotherapy) uses high-energy rays to destroy cancer cells and stop them from growing. The radiation may come from a large machine (external radiation) or from radioactive materials placed directly into the cervix (implant radiation). Some patients receive both types of radiation therapy in succession.

A woman receiving external radiation therapy is hospitalised or goes to the hospital each day for treatment. Usually, treatments are given five days a week for five to six weeks.

For internal or implant radiation, a capsule containing radioactive material is placed directly in the cervical canal. The implant radiates cancer-killing rays close to the tumour while sparing most of the healthy tissue around it. A special type of cannula with a long pipe is first placed into the cervical canal through which the radioactive material is moved from a safe container into the cervix and back by remote control. This is repeated several times while the patient stays in hospital.

The effect of radiotherapy is enhanced by simultaneous administration of chemotherapy (drugs to kill cancer cells). Radiotherapy and chemotherapy are used when cervical cancer is not localised to the cervix and has spread to other parts of the body or if the tumour is very large. The doctor may use just one drug or a combination of drugs. Chemotherapy for the treatment of cervical cancer is usually given by injection into a vein. This is also referred to as systemic treatment meaning that the drugs flow through the body via the bloodstream.

(Reviewed by Professor Lynette Denny, Gynaecology Oncology Unit, Department Obstetrics & Gynaecology, University of Cape Town/Groote Schuur Hospital)

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