Treatment
Surgery
Radiation Therapy
Chemotherapy
Women with cervical cancer have many treatment
options. The options are surgery, radiation therapy,
chemotherapy, or a combination of methods.
The choice of treatment depends mainly on the size
of the tumor and whether the cancer has spread. The
treatment choice may also depend on whether you
would like to become pregnant someday.
Your doctor can describe your treatment choices, the
expected results of each, and the possible side effects.
You and your doctor can work together to develop a
treatment plan that meets your medical and personal
needs.
Your doctor may refer you to a specialist, or you
may ask for a referral. You may want to see a
gynecologic oncologist, a surgeon who specializes in
treating female cancers. Other specialists who treat
cervical cancer include
gynecologists, medical oncologists, and
radiation oncologists. Your health care
team may also include an oncology nurse and a
registered dietitian.
Before treatment starts, ask your health care team
about possible side effects and how treatment may
change your normal activities. Because cancer
treatments often damage healthy cells and tissues, side
effects are common. Side effects may not be the same
for each person, and they may change from one
treatment session to the next.
At any stage of the disease, supportive care is
available to relieve the side effects of treatment, to
control pain and other symptoms, and to help you cope
with the feelings that a diagnosis of cancer can bring.
You can get information about coping on NCI's Web
site at http://www.cancer.gov/cancertopics/coping
and from NCI's Cancer Information Service
at 1-800-4-CANCER or
LiveHelp
(http://www.cancer.gov/help).
You may want to talk to your doctor about taking
part in a clinical trial, a research study of new
treatment methods. See the section on
Taking Part in
Cancer Research.
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?
- May I have a copy of the report from the
pathologist?
- 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 the
side effects?
- What can I do to prepare for treatment?
- Will I have to stay in the hospital? If so, for
how long?
- What is the treatment likely to cost? Will my
insurance cover the cost?
- How will treatment affect my normal
activities?
- What can I do to take care of myself during
treatment?
- What is my chance of a full recovery?
- How often will I need checkups after
treatment?
- Would a clinical trial (research study) be right
for me?
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Surgery is an option for women with Stage I or II
cervical cancer. The surgeon removes tissue that may
contain cancer cells:
- Radical trachelectomy: The surgeon removes the
cervix, part of the vagina, and the lymph nodes in
the pelvis. This option is for a small number of
women with small tumors who want to try to get
pregnant later on.
- Total hysterectomy: The surgeon removes the cervix
and uterus.
- Radical hysterectomy: The surgeon removes the
cervix, some tissue around the cervix, the uterus,
and part of the vagina.
With either total or radical hysterectomy, the
surgeon may remove other tissues:
- Fallopian tubes and ovaries: The surgeon may
remove both fallopian tubes and ovaries. This
surgery is called a salpingo-oophorectomy.
- Lymph nodes: The surgeon may 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.
The time it takes to heal after surgery is different for
each woman. You may have pain or discomfort for the
first few days. Medicine can help control your pain.
Before surgery, you should discuss the plan for pain
relief with your doctor or nurse. After surgery, your
doctor can adjust the plan if you need more pain
control.
After a radical trachelectomy, some women have
bladder problems for a few days. The hospital stay
usually is about 2 to 5 days.
After a hysterectomy, the length of the hospital stay
may vary from several days to a week. It is common to
feel tired or weak for a while. You may have problems
with nausea and vomiting, and you may have bladder
and bowel problems. The doctor may restrict your diet
to liquids at first, with a gradual return to solid food.
Most women return to their normal activities within 4
to 8 weeks after surgery.
After a hysterectomy, women no longer have
menstrual periods. They cannot become pregnant.
When the ovaries are removed, menopause occurs at
once. Hot flashes and other symptoms of menopause
caused by surgery may be more severe than those
caused by natural menopause. You may wish to discuss
this with your doctor before surgery. Some drugs have
been shown to help with these symptoms, and they
may be more effective if started before surgery.
For some women, a hysterectomy can affect sexual
intimacy. You may have feelings of loss that make
intimacy difficult. Sharing these feelings with your
partner may be helpful. Sometimes couples talk with a
counselor to help them express their concerns.
You may want to ask the doctor these
questions before having surgery:
- Do you recommend surgery for me? If so,
which kind? Will my ovaries be removed? Do
I need to have lymph nodes removed?
- What is the goal of surgery?
- What are the risks of surgery?
- How will I feel after surgery? If I have pain,
how will it be controlled?
- How long will I have to be 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? If I get pregnant
later on, is there a bigger chance that I could
have a 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) is an
option for women with any stage of cervical cancer.
Women with early stage cervical cancer may choose
radiation therapy instead of surgery. It also may be
used after surgery to destroy any cancer cells that
remain in the area. Women with cancer that extends
beyond the cervix may have radiation therapy and
chemotherapy
Radiation therapy uses high-energy rays to kill
cancer cells. It affects cells only in the treated area.
Doctors use two types of radiation therapy to treat
cervical cancer. Some women receive both types:
- External radiation therapy: A large machine directs
radiation at your pelvis or other tissues where the
cancer has spread. The treatment usually is given in
a hospital or clinic. You may receive external
radiation 5 days a week for several weeks. Each
treatment takes only a few minutes.
- Internal radiation therapy: A thin tube is placed
inside the vagina. A radioactive substance is loaded
into the tube. You may need to stay in the hospital
while the radioactive source is in place (up to 3
days). Or the treatment session may last a few
minutes, and you can go home afterward. Once the
radioactive substance is removed, no radioactivity is
left in your body. Internal radiation may be repeated
two or more times over several weeks.
Side effects depend mainly on how much radiation
is given and which part of your body is treated.
Radiation to the abdomen and pelvis may cause
nausea, vomiting, diarrhea, or urinary problems. You
may lose hair in your genital area. Also, your skin in
the treated area may become red, dry, and tender.
You may have dryness, itching, or burning in your
vagina. Your doctor may advise you to wait to have sex
until a few weeks after radiation treatment ends.
You are likely to become tired during radiation
therapy, especially in the later weeks of treatment.
Resting is important, but doctors usually advise
patients to try to stay as active as they can.
Although the side effects of radiation therapy can be
upsetting, they can usually be treated or controlled.
Talk with your doctor or nurse about ways to relieve
discomfort.
It may also help to know that most side effects go
away when treatment ends. However, you may wish to
discuss with your doctor the possible long-term effects
of radiation therapy. For example, the radiation may
make the vagina narrower. A narrow vagina can make
sex or follow-up exams difficult. There are ways to
prevent this problem. If it does occur, however, your
health care team can tell you about ways to expand the
vagina.
Another long-term effect is that radiation aimed at
the pelvic area can harm the ovaries. Menstrual periods
usually stop, and women may have hot flashes and
vaginal dryness. Menstrual periods are more likely to
return for younger women. Women who may want to
get pregnant after radiation therapy should ask their
health care team about ways to preserve their eggs
before treatment starts.
You may find it helpful to read the NCI booklet
Radiation Therapy and You.
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? How often
will I have them? When will they end?
- How will I feel during treatment? 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?
- Are there lasting side effects?
- Will I be able to get pregnant and have
children after my treatment is over?
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For the treatment of cervical cancer, chemotherapy
is usually combined with radiation therapy. For cancer
that has spread to distant organs, chemotherapy alone
may be used.
Chemotherapy uses drugs to kill cancer cells. The
drugs for cervical cancer are usually given through a
vein (intravenous). You may receive chemotherapy in a
clinic, at the doctor's office, or at home. Some women
need to stay in the hospital during treatment.
The side effects depend mainly on which drugs are
given and how much. Chemotherapy kills fast-growing
cancer cells, but the drugs can also harm normal cells
that divide rapidly:
- Blood cells: When chemotherapy lowers the levels
of healthy blood cells, you're more likely to get
infections, bruise or bleed easily, and feel very weak
and tired. Your health care team will check for low
levels of blood cells. If your levels are low, your
health care team may stop the chemotherapy for a
while or reduce the dose of drug. There are also
medicines that can help your body make new blood
cells.
- Cells in hair roots: Chemotherapy may cause hair
loss. If you lose your hair, it will grow back, but it
may change in color and texture.
- Cells that line the digestive tract: Chemotherapy
can cause a poor appetite, nausea and vomiting,
diarrhea, or mouth and lip sores. Your health care
team can give you medicines and suggest other
ways to help with these problems.
Other side effects include skin rash, tingling or
numbness in your hands and feet, hearing problems,
loss of balance, joint pain, or swollen legs and feet.
Your health care team can suggest ways to control
many of these problems. Most go away when treatment
ends.
You may wish to read the NCI booklet
Chemotherapy and You.
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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