Treatment
Getting a Second Opinion
Preparing for Treatment
Methods of Treatment
Surgery
Radiation Therapy
Chemotherapy
Many women with cervical cancer want to take an active part in making decisions
about their medical care. It is natural to want to learn all you can about your
disease and your treatment choices. However, shock and stress after the
diagnosis can make it hard to think of everything you want to ask the doctor.
It often helps to make a list of questions before an appointment.
To help remember what the doctor says, you may take notes or ask whether you
may use a tape recorder. You may also want to have a family member or friend
with you when you talk to the doctor - to take part in the discussion, to take
notes, or just to listen.
You do not need to ask all your questions at once. You will have other chances
to ask your doctor to explain things that are not clear and to ask for more
information.
Your doctor may refer you to a specialist, or you may ask for a referral.
Gynecologists,
gynecologic oncologists,
medical oncologists, and
radiation oncologists
are specialists who treat cervical cancer.
Before starting treatment, you might want a second opinion about the diagnosis
and treatment plan. Many insurance companies cover a second opinion if you or
your doctor requests it. It may take some time and effort to gather medical
records and arrange to see another doctor. Usually it is not a problem to take
several weeks to get a second opinion. In most cases, the delay in starting
treatment will not make treatment less effective. To make sure, you should
discuss this delay with your doctor. Some women with cervical cancer need
treatment right away.
There are a number of ways to find a doctor for a second opinion:
-
Your doctor may refer you to one or more specialists. At cancer centers,
several specialists often work together as a team.
-
NCI's Cancer Information Service, at 1-800-4-CANCER, can tell you about nearby
treatment centers. Information Specialists also can provide online assistance
through
LiveHelp at http://www.cancer.gov.
-
A local or state medical society, a nearby hospital, or a medical school can
usually provide the names of specialists in your area.
-
The American Board of Medical Specialties (ABMS) has a list of doctors who have
had training and passed exams in their specialty. You can find this list in the
Official ABMS Directory of Board Certified Medical Specialists. This Directory
is in most public libraries. Or you can look up doctors at
http://www.abms.org. (Click on "Who's Certified.")
-
The NCI provides a helpful fact sheet called "How To Find a Doctor or Treatment
Facility If You Have Cancer."
The choice of treatment depends mainly on the size of the tumor and whether the
cancer has spread. If a woman is of childbearing age, the treatment choice may
also depend on whether she wants to become pregnant someday.
Your doctor can describe your treatment choices and the expected results of
each. You and your doctor can work together to develop a treatment plan that
meets your medical needs and personal values.
You may want to ask the doctor these questions before treatment begins:
- What is the stage of my disease? Has the cancer spread? If so, where?
- What are my treatment choices? Which do you recommend for me? Will I have more than one kind of treatment?
- What are the expected benefits of each kind of treatment?
- What are the risks and possible
side effects
of each treatment? What can we do to control my side effects?
- How will treatment affect my normal activities?
- What can I do to take care of myself during treatment?
- How long will treatment last?
- Will I have to stay in the hospital?
- What is the treatment likely to cost? Does my insurance cover this treatment?
- How often should I have checkups?
- Would a
clinical trial
(research study) be appropriate for me?
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Women with cervical cancer may be treated with surgery,
radiation therapy,
chemotherapy,
radiation therapy and chemotherapy, or a combination of all three
methods.
At any stage of disease, women with cervical cancer may have treatment to
control pain and other symptoms, to relieve the side effects of therapy, and to
ease emotional and practical problems. This kind of treatment is called
supportive care,
symptom management,
or
palliative care.
Information about such
treatment is available on NCI's Web site at http://www.cancer.gov/cancertopics/coping
and from NCI's Cancer Information Service at 1-800-4-CANCER.
You may want to talk to your doctor about taking part in a clinical trial, a
research study of new treatment methods. The section on
"The Promise of Cancer Research" has more information about clinical trials.
Surgery treats the cancer in the cervix and the area close to the tumor.
Most women with early cervical cancer have surgery to remove the cervix and
uterus (total hysterectomy). However, for very early (Stage 0) cervical cancer,
a hysterectomy may not be needed. Other ways to remove the cancerous tissue
include
conization,
cryosurgery,
laser surgery,
or
LEEP.
Some women need a
radical hysterectomy. A radical hysterectomy is surgery to
remove the uterus, cervix, and part of the vagina.
With either total or radical hysterectomy, the
surgeon
may remove both
fallopian tubes
and
ovaries. (This procedure is a
salpingo-oophorectomy.)
The surgeon may also remove the lymph nodes near the tumor to see if they
contain cancer. If cancer cells have reached the lymph nodes, it means the
disease may have spread to other parts of the body.
You may want to ask the doctor these questions about surgery:
- What kind of operation will I have? Will my ovaries be removed?
- Do I need to have lymph nodes removed? Will other tissues be removed? Why?
- How will I feel after the operation?
- If I have pain, how will it be controlled?
- How long will I have to stay in the hospital?
- Will I have any lasting side effects? If I don't have a hysterectomy, will I be able to get pregnant and have children? Is there increased risk of miscarriage?
- When will I be able to resume normal activities?
- How will the surgery affect my sex life?
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Radiation therapy (also called radiotherapy) uses high-energy rays to kill
cancer cells. It affects cells only in the treated area.
Women have radiation therapy alone, with chemotherapy, or with chemotherapy and
surgery. The doctor may suggest radiation therapy instead of surgery for the
small number of women who cannot have surgery for medical reasons. Most women
with cancer that extends beyond the cervix have radiation therapy and
chemotherapy. For cancer that has spread to distant organs, radiation therapy
alone may be used.
Doctors use two types of radiation therapy to treat cervical cancer. Some women
receive both types:
-
External radiation:
The radiation comes from a large machine outside the body.
The woman usually has treatment as an outpatient in a hospital or clinic. She
receives external radiation 5 days a week for several weeks.
-
Internal radiation
(intracavitary radiation): Thin tubes (also called implants)
containing a
radioactive
substance are left in the vagina for a few hours or up
to 3 days. The woman may stay in the hospital during that time. To protect
others from the radiation, the woman may not be able to have visitors or may
have visitors for only a short period of time while the tubes are in place.
Once the tubes are removed, no radioactivity is left in her body. Internal
radiation may be repeated two or more times over several weeks.
You may want to ask the doctor these questions before having radiation therapy:
- What is the goal of this treatment?
- How will the radiation be given?
- Will I need to stay in the hospital? If so, for how long?
- When will the treatments begin? When will they end?
- How will I feel during therapy? Are there side effects?
- How will we know if the radiation therapy is working?
- Will I be able to continue my normal activities during treatment?
- How will radiation therapy affect my sex life?
- Will I be able to get pregnant and have children after my treatment is over?
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Chemotherapy uses anticancer drugs to kill cancer cells. It is called
systemic therapy
because the drugs enter the bloodstream and can affect cells all over
the body. For treatment of cervical cancer, chemotherapy is generally combined
with radiation therapy. For cancer that has spread to distant organs,
chemotherapy alone may be used.
Anticancer drugs for cervical cancer are usually given through a vein. Women
usually receive treatment in an outpatient part of the hospital, at the
doctor's office, or at home. Rarely, a woman needs to stay in the hospital
during treatment.
You may want to ask the doctor these questions before having chemotherapy:
- Why do I need this treatment?
- Which drug or drugs will I have?
- How do the drugs work?
- What are the expected benefits of the treatment?
- What are the risks and possible side effects of treatment? What can we do about them?
- When will treatment start? When will it end?
- How will treatment affect my normal activities?
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