Treatment for precancerous abnormalities or very early cervical cancer may include loop excision, cone biopsy or laser. These are all methods for removing the abnormal cells.
Treatment for cervical cancer (early stage or localised) may include surgery, or a combination of radiotherapy and chemotherapy.
Not all precancerous abnormalities need treatment. Those that do can be treated quite easily and very successfully. The type of treatment you have after an abnormal Pap test will depend on the type of abnormality.
In most cases, the precancerous tissue can be removed and no further treatment is needed. Tissue can be removed by:
- loop excisions – large loop excision of the transformation zone (LLETZ) or loop electrosurgical excision procedure (LEEP)
- cone biopsy
- laser surgery, which uses a laser beam to make bloodless cuts in tissue, or to remove a surface abnormality such as a tumour.
Sometimes, a very small cancer may be discovered in the sample, and further treatment may be needed.
LLETZ or LEEP are procedures that remove a large sample of the cervix for examination or treatment.
The transformation zone is where the squamous cells in the cervix meet the glandular cells (also called the squamocolumnar junction). Your transformation zone is partly located in your cervical canal, but its position varies, depending on your age and whether or not you have been pregnant.
In a loop excision, a loop of wire carrying an electric current is used to cut out abnormal tissue from the cervix. Sometimes the doctor can completely remove all visible abnormal cells.
This procedure takes about 10 minutes; it may be performed under a local anaesthetic in the doctor’s office or in hospital under general anaesthetic. In some cases, the doctor may do a loop excision at the same time as a colposcopy.
After a loop excision procedure, you may have some vaginal bleeding and cramping. This will usually ease in about 2 weeks.
To give your cervix time to heal and to prevent infection, you should not have sex or use tampons for 4–6 weeks. During this time, you should also avoid submerging your pelvic area into a hot spa or sauna, because this can slow the healing process.
A cone biopsy is a procedure to determine if the abnormal cells have spread to tissue beneath the surface of the cervix. A cone biopsy is also used to treat very early and very small tumours.
This procedure removes a cone-shaped piece of tissue containing the abnormal cells from the cervix. It is usually performed under a general anaesthetic and involves a day or overnight admission to hospital.
Results of a cone biopsy are usually available within 1 week.
After the cone biopsy, it is common to have some light bleeding or cramping for a few days. You may have a small gauze pack put into your vagina to help stop the bleeding.
When the gauze is removed, you should avoid doing anything physically strenuous for about 3 weeks, since this could restart your bleeding or make you bleed more heavily. If the bleeding lasts longer than 2 weeks or has a bad smell, see your doctor.
To allow your cervix to heal and to prevent infection, you should not have sex or use tampons for 4–6 weeks.
If you would like to become pregnant, talk to your doctor before the cone biopsy, because the procedure may weaken the cervix and increase the risk of miscarriage. You may need to have a stitch inserted into the cervix to strengthen it and to reduce this risk. The stitch would be removed before you give birth.
Laser surgery may be used to destroy abnormal cells in the cervix. This procedure directs a very strong, hot beam of light at the abnormal cells to burn them away.
The procedure takes about 10–15 minutes. You will have an anaesthetic to numb the cervix so you don’t feel any pain. You can go home straight after the treatment, and most women can return to their normal activities within 2–3 days.
The extent of the cancer in the cervix will determine the type of treatment that is required.
If the tumour is very small, a cone biopsy may be the only treatment you need.
A trachelectomy is removal of the cervix. For small cancers in young women, this type of surgery may preserve their fertility so they can still have children in the future. You will still have periods (menstruate) after a trachelectomy.
Hysterectomy and bilateral salpingo-oophorectomy
A hysterectomy is the surgical removal of the uterus. Bilateral salpingo-oophorectomy is surgery to remove both ovaries and both fallopian tubes.
You might have 1 of these types of surgery, or both. Whether you have a bilateral salpingo-oophorectomy will depend on your age and how far the cancer has spread (metastasised).
Lymph node removal
Your doctor may discuss the option of removing some of the lymph nodes in your pelvic region. This is not recommended in all women. Removal of lymph nodes is called a lymphadenectomy. If cancer is found in the lymph nodes, your doctor will advise you on additional (adjuvant) therapy.
Pelvic exenteration is done if the cancer has spread beyond the uterus to the surrounding organs, such as the lower colon, rectum, bladder, cervix, vagina, ovaries, and nearby lymph nodes. The surgery involves removing all or part of the affected organs.
Openings called stoma are made to bring the small or large intestine out onto the abdomen. This allows urine and faeces to flow from inside the body to a collection bag. Common stoma include:
- ileostomy (formed from the lower half of the small bowel, called the ileum, which joins up with the colon)
- colostomy (formed from the colon)
- ileal conduit (formed by isolating a small piece of ileum and implanting the tubes from the kidney [ureters] into it).
For more information or to contact a stoma association, see the Stoma Association Contact List.
Plastic surgery to reconstruct the vagina may also be offered at a suitable time after pelvic exenteration.
If you are premenopausal and feel concerned about how surgery or other treatment will affect your fertility, see Effects of treatment on fertility for more information.
Radiation therapy (also called radiotherapy) uses high-energy X-rays or other types of radiation to destroy cancer cells or stop them from growing. You might have radiation therapy to your pelvic area to treat cervical cancer.
If you have not had a hysterectomy or have not been through menopause, you should avoid getting pregnant during your radiation therapy because it can harm your unborn baby. If you become pregnant during treatment, talk to your doctor.
Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by destroying the cells or stopping them from dividing. You might have chemotherapy to treat cervical cancer.
If you have not had a hysterectomy or have not been through menopause, you should avoid getting pregnant during your chemotherapy because it can harm your unborn baby. If you become pregnant during treatment, talk to your doctor.
Chemoradiation causes more severe side effects than either chemotherapy or radiation therapy alone. The side effects include nausea, vomiting and a lowered number of white blood cells (which fight infection). If you have a low number of white blood cells, you may need to stop chemotherapy until your blood counts rise, and then restart the combined treatment.
For more information about side effects of chemotherapy see Cancer Australia’s webpage on cancer treatment.
Some treatments for cervical cancer can affect your ability to have children in the future. There may be some options available that can allow you to have children (called fertility-sparing options) – your doctor will discuss these with you.
In most cases, cervical cancer is treated either by radical hysterectomy (which removes the uterus but leaves the ovaries and fallopian tubes) or by chemoradiation (which destroys cancer cells, but also affects the lining of the uterus and causes the ovaries to stop producing eggs). These treatments can mean that you can no longer have children.
Younger women who have a radical hysterectomy may be able to keep their ovaries, which are usually transposed (moved out of the pelvis) so that they will not be affected by any postoperative radiation treatment. If you still have your ovaries after surgery, you will still produce your own eggs. This means that, in the future, you could choose to have a baby through surrogacy (where your own eggs are fertilised with sperm and the embryo is implanted in another woman to carry the baby for you).
Minor surgery to treat early cervical cancer, such as a cone biopsy, has little effect on fertility because the uterus, cervix, fallopian tubes and ovaries are not removed.
Women who have had a radical trachelectomy may be able to become pregnant because this surgery removes the cervix but not the body of the uterus, ovaries or fallopian tubes. However, there is a higher risk of miscarriage.
Recurrent or advanced cervical cancer
Recurrent cervical cancer is cancer that has recurred (come back) after it has been treated. It grows back from the cells of the original primary cancer that have not responded to treatment. Secondary cancer, or metastasis, is cancer that has spread from the original site to another part of the body. Cervical cancer may come back in the cervix or in another part of the body.
Treatment options for recurrent cervical cancer include the following:
- If the cancer is in the centre of the pelvis, surgery may be possible. This involves removing the lower bowel (rectum) and/or bladder, along with the cervix, uterus and vagina – this is called a pelvic exenteration.
- Surgery may be followed by radiation therapy combined with chemotherapy.
- If the cancer is not limited to the centre of the pelvis, treatment is usually by radiotherapy and/or chemotherapy.
It may be possible for you to join a clinical trial of new anticancer drugs or drug combinations.