Therapies, treatments and care
Many women with cancer of the cervix want to take an active part in making decisions about their
medical care. It's 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—t
o take part in the discussion, take notes, or just to listen. 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.
Getting a second opinion
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 (several weeks) and effort to gather medical records and arrange to see another
doctor. In most cases, the delay in starting treatment will not make treatment less effective, but
to make sure, you should discuss this delay with your doctor. Some women with cervical cancer need
treatment right away.
Preparing for treatment
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?
Methods of treatment
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/cancerinfo/coping and from NCI's Cancer Information Service at
1-800-4-CANCER.
Surgery
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.
- 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?
It takes time to heal after surgery, and the recovery time is different for each woman. You may
be uncomfortable for the first few days. However, medicine can usually control the 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 relief.
If you have surgery to remove a small tumor on the surface of the cervix, you may have
cramping or other pain, bleeding, or a watery discharge.
After a hysterectomy, women no longer have menstrual periods and cannot become pregnant. If
you have 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.
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.
After surgery, some women may be concerned about sexual intimacy. Many women find that it
helps to share these concerns with their partner. A couple may want to ask a counselor to help them
express their concerns.
Radiation therapy
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?
Side effects depend mainly on the dose of radiation and the part of your body that 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. The radiation may also make your
vagina narrower. The doctor or nurse may suggest ways to relieve discomfort. There also are ways to
expand the vagina, which will help make follow-up exams easier. Your doctor may advise you not to
have intercourse during treatment. But most women can resume sexual activity within a few weeks
after treatment ends.
You are likely to become very 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 distressing, your doctor can
usually find ways to relieve them.
Chemotherapy
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?
- Blood cells: These cells fight infection, help your blood to clot, and carry oxygen to all parts of the body. When drugs affect your blood cells, you are more likely to get infections, bruise or bleed easily, and feel very weak and tired.
- Cells in hair roots: Chemotherapy can cause you to lose your hair. The hair will grow back, but it may be somewhat different 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.
The drugs used for cervical cancer also may cause skin rash, hearing problems, loss of balance,
joint pain, or swollen legs and feet. Your doctor can suggest ways to control many of these side
effects.
Follow-up care
Follow-up care after treatment for cervical cancer is important. Even when the cancer seems to
have been completely removed or destroyed, the disease sometimes returns because undetected cancer
cells remained somewhere in the body after treatment. Your doctor will monitor your recovery and
check for recurrence of the cancer. Checkups help ensure that any changes in your health are noted
and treated as needed. Checkups may include a physical exam as well as Pap tests and chest x-rays.
Between scheduled visits, you should contact the doctor right away if you have any health problems.
Complementary and alternative medicine
Some people with cancer use complementary and alternative medicine (CAM) to ease stress or to
reduce side effects and symptoms. An approach is generally called complementary medicine when it is
used along with standard treatment, and is called alternative medicine when it is used instead of
standard treatment. Acupuncture, massage therapy, herbal products, vitamins or special diets,
visualization, meditation, and spiritual healing are types of CAM. Many people say that such
approaches help them feel better.
However, some types of CAM, including certain vitamins, may interfere with standard
treatment. Combining CAM with standard treatment may even be harmful. Before trying any type of
CAM, you should discuss its possible benefits and harmful effects with your doctor. Also be aware
that some types of CAM are expensive, and health insurance may not cover the cost.