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Treating early cervical cancer

Early cervical cancer means cancer that is only in the neck of the womb (stage 1A or 1B) or cancer that has started to grow into the top of the vagina (stage 2A).

Treatment for very early stage cervical cancer

For some very early cervical cancers, it may be possible to treat the cancer with a cone biopsy or an operation to remove just the cervix. This operation is called a radical trachelectomy. This type of treatment is not possible for everyone. If it is very important for you to be able to have children, your specialist will do it if they can. But your doctor cannot guarantee that you will be able to have children afterwards.

The main treatments

Early cervical cancer can usually be cured with surgery or radiotherapy or both. Surgery usually means that you have your womb and cervix completely removed (hysterectomy). If the cancer has started to grow further into the tissues of the cervix (stage 1A2 and above), you will also have the lymph nodes in your pelvis taken out (lymphadenectomy). This is because there is a risk the cancer may have spread from the cervix to nearby lymph nodes.

Radiotherapy involves having treatment to the womb, cervix and surrounding tissues. Sometimes specialists recommend radiotherapy after surgery to lower the risk of the cancer coming back. 

For larger early cancers (stage 1B or stage 2A), your specialist may suggest combined chemotherapy and radiotherapy (chemoradiation).

Your choice of treatment

If you have to choose between hysterectomy and radiotherapy, it can be hard to decide which to have. There are benefits and drawbacks to both. We have more information about these treatments on our website. Understanding more about the different treatments will help you make the choice. 
 

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What early cervical cancer is

Early cervical cancer means cancer that is only in the neck of the womb (stage 1A or 1B) or cancer that has started to grow into the top of the vagina (stage 2A).

 

Treatment for very early cervical cancer

For some very early, small cervical cancers, it may be possible to treat the cancer with a cone biopsy or to have just the cervix removed. This operation is called a radical trachelectomy. You will need to talk to your specialist to find out if you can have this type of treatment. It is not possible to do this operation in everyone. But, if it is very important for you to be able to have children, your specialist will do it if they can. If you do have a trachelectomy, your doctor still cannot guarantee that you will be able to have children afterwards.

 

The main treatments

Early cervical cancer can usually be cured with surgery or radiotherapy or both. Surgery usually means that you have your womb and cervix completely removed (hysterectomy). If the cancer has started to grow further into the tissues of the cervix (stage 1A2 and above), you will also have the lymph nodes in your pelvis taken out (lymphadenectomy). This is because there is a risk the cancer may have spread from the cervix to nearby lymph nodes.

Radiotherapy involves having treatment to the womb, cervix and surrounding tissues. If you have surgery and your specialist is not sure that all the cancer cells have been removed, they will recommend that you have a course of radiotherapy afterwards. This lowers the risk of the cancer coming back.

For larger early stage cancers (stage 1B or stage 2A), your specialist may suggest combined chemotherapy and radiotherapy. This may be better for you if the cancer cells cover a fairly wide area of your cervix.

 

Choosing between radiotherapy and surgery

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 surgeon 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
  • They want 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.

Your doctor may suggest combined chemotherapy and radiotherapy for any stage of cervical cancer above 1B. The chemotherapy drugs make the cancer cells more sensitive to radiation. So there is a better chance of your cancer being cured. But, having the two treatments together can cause more side effects and make them more intense. If you are at all worried about this, you can speak to your doctor or specialist nurse.

 

Surgery for early cervical cancer

Unless you have a very early stage cancer, this is usually quite a big operation, with two main parts. First, your surgeon will remove the cancer. And second, they will examine the surrounding lymph nodes for signs of cancer. In a radical hysterectomy, you will usually have your womb, cervix, the top of the vagina and all the nearby lymph nodes removed. There is more information about this treatment in our section on surgery for cervical cancer.

Around 1 in 5 women (20%) need radiotherapy after surgery either because the cancer was not completely removed or cancer cells were found in the lymph glands. If your cancer comes back after your operation, you would still be able to have radiotherapy if you have not had it before. In some cases, cervical cancer that has come back can still be cured in this way.

 

Radiotherapy for early cervical cancer

You may need radiotherapy for cervical cancer

You may have both these treatments.

Internal radiotherapy treatment

Internal radiotherapy treatment gives a high dose of radiation to your cervix and womb. It can be given in different ways.

Your doctor may put a small radioactive metal object into your vagina. This may be left in place for 2 or 3 days, or put in 3 or 4 times for a few hours each time. Or, under anaesthetic you may have small metal rods put into the vagina. These are then attached to a machine that fills the rods with tiny radioactive metal balls. There is more information about internal radiotherapy treatment on our page about radiotherapy for cervical cancer.

External treatment

This radiotherapy is given as a daily treatment, five days a week for several weeks. This means you will have to travel to the hospital every day during the treatment period, although the actual treatment only takes a few minutes.

There is more information about this treatment in the section about radiotherapy for cervical cancer. But here are a couple of things to think about when making up your mind which treatment to have

  • You will not have a long stay in hospital as with surgery
  • You will not have to have an operation (although you will have a short anaesthetic for internal radiotherapy)
  • You will have to go to the hospital daily for about 5 weeks for radiotherapy
  • You will keep your womb
  • The treatment will cause an early menopause if you are pre menopausal
  • There are short term side effects of the treatment, such as diarrhoea and cystitis (bladder inflammation)
  • A long term side effect is that your vagina can become narrower, less stretchy and more dry
  • There is a risk of other long term side effects, although most of these are much less common than they were in the past
  • You are unlikely to be able to have radiotherapy to that area of the body again

If your cancer comes back in the pelvis after this treatment, it may be possible for you to have some surgery to remove it. Long term effects of radiotherapy can affect your bladder or bowel. The bladder may become less stretchy and less able to hold urine. So you may find you have to pass urine more often. The bowel can become inflammed. If your bowel is affected, you may have bouts of diarrhoea. Sometimes the side effects of radiotherapy treatment do not show up until some months or years after you have finished your treatment.

 

Combined radiotherapy and chemotherapy (chemoradiation)

Chemotherapy and radiotherapy together is a good option for many cervical cancers. The treatment lowers the risk of the cancer coming back (recurring) near to where it originally started and in other parts of the body. The combined treatment does have more side effects, mainly affecting your bone marrow or bowel, but these generally only last a short time.

There are different ways of having this treatment and it depends partly on the chemotherapy drugs your doctor gives you. You may have chemotherapy once a week throughout a 5 week radiotherapy course. Or you may have chemotherapy every 2 or 3 weeks during your radiotherapy course.

There is more information about combined chemotherapy and radiotherapy in this section.

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Updated: 17 June 2014