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Treatment decisions

Find out how your doctor decides which treatment you need and the types of treatment you might have.

Deciding which treatment you need

A team of doctors and other professionals discuss the best treatment and care for you. They are called a multidisciplinary team (MDT).

The treatment you have depends on:

  • where your cancer is
  • how far it has grown or spread (the stage)
  • the type of cancer
  • how abnormal the cells look under a microscope (the grade)
  • your general health and level of fitness

Your doctor will discuss your treatment, its benefits and the possible side effects with you.

Types of treatment

You might have one or more of the following treatments depending on the stage of your cancer: 

  • surgery
  • chemotherapy and radiotherapy together (chemoradiotherapy)
  • radiotherapy
  • chemotherapy

Treatment by stage

Carcinoma in situ (CIS)

The cells are either removed or destroyed. Treatments include:

  • LLETZ
  • cone biopsy
  • hysterectomy

Early cervical cancer

Early cervical cancer means cancer that is only in the neck of the womb (stage 1A or 1B) or has started to grow into the top of the vagina (stage 2A). It can usually be cured with surgery or a combination of chemotherapy and radiotherapy (chemoradiotherapy).

For some very early cervical cancers (stage 1A1), it might be possible to remove all of the cancer with a large loop excision of the transformation zone (LLETZ) or cone biopsy. Doctors usually use these treatments for women with abnormal cervical cells that are picked up through cervical screening.

Surgery

Surgery usually means that you have your womb and cervix completely removed (hysterectomy).

If you have a stage 1 cervical cancer and want to have children, it may be possible to have an operation called a radical trachelectomy. This removes most of the cervix, but leaves enough behind so that you might be able to become pregnant and carry a baby afterwards.

You need to talk to your doctor to find out if you can have this type of operation. It’s not possible to do it in everyone with early cervical cancer. If you do have a trachelectomy, your doctor still can’t guarantee that you will be able to have children afterwards.

If the cancer has started to grow further into the tissues of the cervix (stage 1A2 and above), your doctor will also remove the lymph nodes in your pelvis (lymphadenectomy). This is because there is a risk the cancer may have spread from the cervix to nearby lymph nodes.

Diagram of the lymph nodes in the pelvis

If you have surgery and your doctor is not sure that all the cancer cells have been removed, they may recommend that you have a course of chemoradiotherapy afterwards. This lowers the risk of the cancer coming back.

Chemoradiotherapy

For some larger early stage cancers (stage 1B or stage 2A), your doctor may suggest chemoradiotherapy instead of surgery. 

You have daily external radiotherapy for 5 days every week, for around 5 weeks. You also have a boost of internal radiotherapy (brachytherapy) at the end of your course.

During your course of radiotherapy, you also have chemotherapy once a week or once every 2 or 3 weeks. This depends on the chemotherapy drugs you have.

Choosing between treatments

Radiotherapy and surgery

Early cervical cancer can usually be cured with surgery or chemoradiotherapy. If you have to choose between hysterectomy and radiotherapy, it can be hard to decide which treatment to have.

There are benefits and drawbacks to both types of treatment. It may just depend on which suits you best. But your doctor might prefer you to have radiotherapy if:

  • you are not fit enough to have a big operation
  • your doctor thinks surgery may not remove all the cancer cells and you may need radiotherapy afterwards anyway

If your doctor thinks you will need radiotherapy after surgery, it may be better for you to have radiotherapy straight away, rather than having surgery first. Having both treatments increases your risk of long term side effects.

You may have reasons of your own to choose one treatment over another. Some women feel they want:

  • surgery because they want all the cancer physically removed
  • radiotherapy because they don't want to have their womb removed

There is no right or wrong way to feel about this. You may not feel strongly either way. If so, you will need to look at the pros and cons of both treatments to make up your mind.

If you can't have surgery

Health problems might mean you can’t have surgery, or you could decide you don’t want it. You have tests to check how fit you are before you have any treatment including heart and lung tests.

When surgery isn’t possible, you might have one or more of these treatments:

  • chemoradiotherapy
  • radiotherapy
  • chemotherapy
  • symptom control

Clinical trials to improve treatment

Your doctor might ask if you’d like to take part in a clinical trial. Doctors and researchers do trials to improve treatment by:

  • making existing treatments better
  • developing new treatments
Last reviewed: 
22 Jun 2017
  • Cervical Cancer: ESMO Clinical Practice Guidelines
    N. Colombo and others
    Annals of Oncology 2012; 23 (Suppl 7): vii27-vii32

  • American Joint Committee on Cancer (AJCC) manual (7th edition)
    S Edge and others
    Springer, 2010

  • Management of locally advanced cervical cancer
    UpToDate, June 2014

  • Invasive cervical cancer: Staging and evaluation of lymph nodes
    UpToDate, June 2014

Information and help

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