Cervical Cancer

Where and what the cervix is

The cervix is another name for the neck of the womb. The womb and cervix are part of a
woman's reproductive system, which is made up of the
Vagina
Womb, including the cervix
Ovaries
There are two ovaries, one on each side of the body. The ovaries produce an egg each month in
fertile women. Women are fertile between puberty (when periods start) and the menopause (or
change of life, when the periods stop). Each ovary is connected to the womb by a tube called the
Fallopian tube. The diagram below shows the position of the ovaries in the body.

In the middle of each menstrual cycle (mid way between periods), an egg travels down one of the
Fallopian tubes and into the womb. The lining of the womb gets thicker and thicker, ready to
receive the fertilised egg. If this egg is not fertilised by a man's sperm, the thickened lining of the
womb is shed, as a period. Then the whole cycle begins again.
The cervix is the opening to the womb from the vagina. It is a strong muscle. Normally it is quite
tightly shut, with only a small opening to let sperm in and the flow from a period out of the
womb. During labour, the cervix opens up to let the baby out.
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The cells of the cervix
The cervix is covered with a layer of skin like cells on its outer surface, called the ectocervix.
There are glandular cells lining the inside of the cervix (the endocervix). The glandular cells
produce mucus. The skin like cells of the ectocervix can become cancerous, leading to a
squamous cell cervical cancer. Or the glandular cells of the endocervix can become cancerous,
leading to an adenocarcinoma of the cervix.
The area where cervical cells are most likely to become cancerous is called the transformation
zone. It is the area just around the opening of the cervix that leads on to the endocervical canal.
The endocervical canal is the narrow passageway that runs up from the cervix into the womb.
The transformation zone is the area that your doctor or nurse will concentrate on during cervical
screening.
The vagina is the tube from the outside of the body to the entrance to the womb. The skin like
cells that cover the cervix join with the skin covering the inside of the vagina. So even if you
have had your womb and cervix removed, you can still have screening samples taken from the
top of the vagina.

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Lymph nodes
Like all other areas of the body, there are lymph nodes around the womb and cervix. The nearest
large groups of lymph nodes are in the groin. Lymph nodes or lymph glands are part of the
lymphatic system. The lymphatic system has 2 important roles.
It helps to protect the body against infection.
It filters, drains and circulates the tissue fluid that bathes all body cells and tissues.
Lymph nodes are important in cancer care. Tissue fluid that bathes the area containing the cancer
will drain to the nearest lymph nodes. So if any cancer cells break away from the tumour, the
first place they will end up is in the nearest lymph nodes. When you have surgery for cancer,
your surgeon will usually take out some lymph nodes and send them to the lab to be checked for
cancer cells.

http://www.cancerresearchuk.org/about-cancer/type/cervical-cancer/about/the-cervix
How common cervical cancer is
Around 3,100 women are diagnosed with cervical cancer in the UK each year. Overall, about 2
out of every 100 cancers diagnosed in women (2%) are cervical cancers. But it is the most
common cancer in women under 35 years old.
More than 4 million women are invited for cervical screening each year in England. Around 1 in
100 women screened has a moderate or high grade abnormality (1%). Early treatment can
prevent these cervical changes developing into cancer.
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What a risk factor is
Anything that increases your risk of getting a disease is called a risk factor. Different cancers
have different risk factors. This page discusses the risk factors for cervical cancer. Even if you
have one or more of the risk factors below, it does not mean that you will definitely get cervical
cancer.
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HPV infection
Human papilloma virus (HPV) is the major cause of the main types of cervical cancer
squamous cell cancer and adenocarcinoma. There are over 100 different types of human
papilloma virus (HPV). At least 40 types are passed on through sexual contact. Some types are
called the wart virus or genital wart virus because they cause genital warts. The types of HPV
that cause warts do not usually cause cell changes that develop into cancer.
At least 15 types of HPV are considered high risk for cancer of the cervix - they include types 16
and 18. These 2 types cause about 7 out of 10 cancers of the cervix (70%). If you have persistent
infections with high risk types of HPV, you are more at risk of developing pre cancerous cervical
cells or cervical cancer.
HPV is common. Most sexually active women will come into contact with at least one type of
HPV during their lifetime. But for most the virus causes no harm and goes away on its own. So
other factors must be needed for cancer to develop. If men use a condom during penetrative sex,
this reduces the risk of a woman becoming infected with HPV.
There are now vaccines to prevent HPV infection. All girls aged 12 or 13 in the UK are routinely
offered the HPV vaccine at school. These vaccines protect against the strains of HPV that are
most likely to cause cervical cancer. But they don't protect against all strains. It will take some
years before the introduction of the vaccine has a major effect on reducing the number of cases
of cervical cancer. So it is still important to carry on with cervical cancer screening.
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Other sexually transmitted infections
One study has shown having both herpes and HPV infection may increase the risk of cervical
cancer, after taking into account HPV infection and the number of sex partners women had and
their use of the pill. However, another more recent study has shown no link.
Another study looked at infection with HPV and chlamydia (pronounced klah-mid-ee-ah). The
study found that the risk of squamous cell cancer around doubled in women with both
infections.

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Smoking
If you smoke, you are more likely to develop squamous cell cervical cancer. Researchers have
found cancer causing chemicals (benzyrene) from cigarette smoke in the cervical mucus of
women who smoke. They think that these chemicals damage the cervix. There are cells in the
lining of the cervix called Langerhans cells that specifically help fight against disease. These
cells do not work so well in smokers.
If you have a high risk type of HPV infection and smoke, you are twice as likely to have pre
cancerous cells in your cervical screening test, or to get cervical cancer. The Langerhans cells are
less able to fight off the virus and protect the cervical cells from the genetic changes that can lead
to cancer.
A type of study called a meta analysis combines the results of several individual studies looking
into a particular topic. This is more reliable than the results of a single study. A recent meta
analysis showed the risk of squamous cell cervical cancer is doubled in women who currently
smoke. An estimated 7% of cervical cancers in the UK are linked to smoking.

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A weakened immune system
If you have a weakened immune system, then your risk of many cancers, including cervical
cancer, is higher than average. People with HIV and AIDS, or people taking drugs to suppress
their immune systems after an organ transplant, are more at risk of developing cervical cancer if
they also have HPV infection. However, if you have had an organ transplant and have regular
cervical screening, your risks will be the same as the general population.
This is because a healthy immune system normally protects you from cells that have become
abnormal. Your immune system will kill off the cells and so prevent them from becoming
cancerous.
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The pill
Research that looked at a number of studies together shows that taking the pill could increase a
woman's risk of developing cervical cancer. It is not clear why this is. The researchers took
account of other factors, such as the number of sexual partners, smoking, and most importantly,
infection with HPV. Researchers suspected that there was a link with taking the pill, but clear
evidence has not come out of the studies until more recently.
Before now we thought that the pill was statistically linked to cervical cancer because women on
the pill are more likely to be sexually active and so more at risk of picking up HPV. Also, they
do not necessarily use barrier contraception (condom or cap) which could prevent them picking
up the HPV. But now it seems that it may actually directly increase the risk.
Recent research suggests that amongst women who have taken the pill for at least 5 years, risk is
almost doubled. But this is still a small risk, and it is important to know that taking the pill can
help to protect you against womb and ovarian cancers.
The evidence suggests that the increased risk of cervical cancer begins to drop as soon as you
stop taking the pill. After 10 years the risk is the same as if you had never taken it. The important
thing to remember is that regular screening can pick up changes in the cervix before they develop
into a cancer. Obviously, screening is now very important for women taking the pill.
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Circumcision
Some research suggests that women with partners who have been circumcised are less likely to
get cervical cancer. This may be because men who are circumcised are less likely to carry HPV
infection. This research took into account different factors relating to sexual behaviour.
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Your sex life
You will quite often hear that women who started having sex young or women who have a lot of
different sex partners are more likely to get cervical cancer. But really, this is only true because
the earlier you start having sex and the more men you have sex with, the more likely you are to
pick up an infection with a high risk (cancer causing) human papilloma virus (HPV). And so
then you are more at risk of developing cervical cancer.
It is not correct to say that women who get cervical cancer have it because they were
promiscuous (slept around). After all, you could have only slept with one man and still caught
the virus if he had it. If he's had lots of partners, that will increase your risk, because it indirectly
exposes you to possible sexual infections from lots of other people.
Health education may help women reduce their exposure to HPV and so reduce the risk of
cervical cancer. Some studies have shown that teaching women about healthy sexual behaviour,
such as using condoms, avoiding sex when they are young, learning how to talk to their partner
about safe sex and reducing the number of sexual partners, can help them behave in ways that
may lower their cervical cancer risk.
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Pregnancy
There is no evidence to say that pregnancy is linked with the risk of cervical cancer. Women who
are pregnant may have cervical screening and so this can lead to women being diagnosed with
pre cancerous changes or cervical cancer while they are pregnant.

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How many children you have, and when
Women who have had children are at an increased risk of squamous cell cervical cancer
compared to those who haven't. Women who have had 7 or more children have double the risk of
squamous cell cervical cancer compared to women who have had only 1 child. Having your first
baby before the age of 17 also gives a higher risk, compared to women who had their first baby
after the age of 25. There is no link to adenocarcinoma. This research took into account HPV
infection, number of sexual partners and the age women were when they first had sex. And they
found that HPV infection did not explain the increase in cervical cancer. However the reasons for
this are unclear.

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Genetics - ethnic groups and family links
One study showed that women with a first degree relative (mother, sister or daughter) diagnosed
with adenocarcinoma or squamous cell carcinoma of the cervix have around double the risk of
developing cervical cancer, compared to women without a family history. But we dont know
whether this is linked to faulty genes, or whether it is due to common lifestyle factors and it is
just one study.
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Chemicals at work
Around 1 out of 100 cervical cancers in women in the UK (1%) are thought to be linked to
occupation. This is due to exposure to a chemical called tetrachloroethylene. This is used in dry
cleaning and metal degreasing.
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Social Class
It has also been shown that women living in the poorest (most deprived) areas of the UK are
more likely to develop cervical cancer than those living in more wealthy areas.
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A drug called diethylstilboestrol
Diethylstilboestrol is also called DES. It is a drug that doctors gave women in the 1940s to 60s to
stop them having a miscarriage. The daughters of women who took DES during their pregnancy
are more at risk of developing a rare type of cervical cancer called clear cell adenocarcinoma.
DES hasn't been used for 40 years and so is becoming less important as a risk factor.
Why we need screening
Cervical screening is very important because we can stop cervical cancer from developing in the
first place. This is one of the few cancers that is preventable because abnormal cell changes can
be picked up before they have a chance to develop into a cancer.
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What the test is
The screening test involves a nurse or doctor taking a small sample of cells from the surface of
your cervix. They do this by putting an instrument called a speculum inside your vagina and then
scraping the cervix with a small soft brush. The doctor or nurse either rinses the brush in a pot of
liquid, or removes the head of the brush and leaves it in the liquid. They then send the sample to
the laboratory. This is called liquid based cytology. In the lab, a pathologist puts your sample
under a microscope. They examine the cells and report any abnormal ones.
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Who has screening?
If you are between the ages of 25 and 64, the NHS cervical screening programme will contact
you every 3 to 5 years and ask you to go for a cervical screening test. Currently, the exact age
groups for screening vary slightly between Scotland and the rest of the United Kingdom.
In England, Wales and Northern Ireland, women between the ages of 25 and 64 are
screened. Between the ages of 25 and 49 you have screening every 3 years. Between 50 and 64
years you have screening every 5 years.
In Scotland, women between 20 and 60 years are invited for screening every 3 years.
We know from research that cervical cancer is very rare before the age of 25. But changes in the
cervix are quite common in younger women. So screening younger women can lead to
unnecessary treatment and worry. Following recommendations from the UK National Screening
Committee in 2012, Scotland plan to raise the screening age to 25. They will also extend
screening for women up to the age of 64. This is due to start in 2015.
Make sure that you begin having regular cervical screening as soon as you are 25 if you are
sexually active. If you are under 25 and are at all concerned about screening or have any
symptoms, talk to your GP or go to a well woman clinic.
If you are 65 or over and have never had a cervical screening test you can ask to have one.
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Why the screening interval varies
The screening interval is the time between the screening tests. This used to vary between health
authorities. But research reported in 2003 by Cancer Research UK showed that the screening
interval should be decided by age. We can pick up the most cancers by screening women every 3
years if they are 25 to 49 years old and every 5 years if they are between 50 and 64.
For women between 25 and 49, 3 yearly screening prevents 84 cervical cancers out of every 100
(84%) that would develop without screening. 5 yearly screening will only prevent 73 cancers out
of 100 (73%). So guidelines recommend screening women 3 yearly if they are under 50.
It is acceptable and safe for women of 50 or more to have 5 yearly smears. Screening 3 yearly
doesn't give any extra protection for this age group.
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Where you can have the test
You can have a cervical screening test at
Your GP surgery
A well woman clinic
A family planning clinic
A genito urinary clinic (clinic for problems with the genital or urinary organs)
An antenatal clinic if you are pregnant
A private health clinic
A voluntary organisation clinic, such as Marie Stopes
You can ask for a female nurse or doctor to do your cervical screening test. All clinics will have
women available to chaperone a male doctor. But if you only want a woman to do the test, you
may have to make an appointment to go back at a later date. So if you are concerned about this, it
is best to mention it when you first make your appointment.
Remember that you should try to make your screening appointment for the middle of your
menstrual cycle if possible. In other words, between periods. It is more difficult for your doctor
or nurse to see the cervix and take a sample of cells if you have your period when you go. You
may get an inadequate result and have to go back for another test.
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How you have the test
You take off your underwear and lie on your back on a couch. You have to lie with your knees
drawn up and spread apart. If this position is difficult for you to get into, you can ask your nurse
to take the test when you are lying on your side with your knees drawn up.
To take the sample of cells, the doctor or nurse puts an instrument called a speculum inside your
vagina. This may be a little uncomfortable but it shouldn't hurt. It can be more uncomfortable if
you are very tense. Try to relax. Taking a few deep breaths can help.
The speculum has 2 arms that spread the sides of your vagina apart so that the doctor or nurse
can see the cervix clearly. Then they scrape the surface of your cervix with a small soft brush.
This collects a sample of cells from the outer layer of the cervix. As soon as the doctor or nurse
takes the sample, they will put it into a pot of liquid. This is then sent to the laboratory. The
speculum is gently removed. Then the test is over and you can get down from the couch.
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How you get the results
The lab will automatically send the results back to the surgery or clinic where you had the test.
Your surgery may not contact you if the test is normal. But they should if there is anything
wrong, or if the test could not be read properly for some reason. Just to make sure, it is best to
contact your GP or clinic for your own result. Ask them when the results should be back. Then
you can ring if you haven't heard.
In some areas, you will get a letter directly from the hospital with the result, and an appointment
for the colposcopy clinic if necessary. The letter will usually include a small booklet to explain
more about what an abnormal result means.
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What the results mean
There are several different results you can have after a screening test. Some of the results are due
to problems with the test rather than because there are any abnormal cells. You could be told you
need a repeat test because yours could not be read properly (sometimes called having an
inadequate sample). This could be because
There were not enough cells in the sample
You have an infection which meant the cells could not be seen clearly enough
You were having a period and there is too much blood to see the cells clearly
The cervix was inflamed and so the cells could not be seen clearly enough
In all these cases, you will just be asked to go back and have another test. This is usually about 3
months later. If you have an infection, you will have some treatment first.
Although most women will have normal results, it's not uncommon to have an abnormal result.
This happens in around 1 in 20 women (5%). An abnormal result means that there are some
changes to the cells on the cervix. Many of these changes will go back to normal by themselves.
But in some cases, if left untreated, these changes could develop into cancer in the future. It
would be very rare for an abnormal result to show that a cancer had already developed,
especially if you have been having regular screening.
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Cervical erosion
Cervical erosion is a condition often picked up by cervical screening tests. You may hear it
called an ectropion. It has nothing to do with cervical cancer. It means that glandular cells, which
are only normally seen inside the cervical canal, can be seen on the surface of the cervix. The
cervix often looks a little inflamed in this area. An erosion is nothing to worry about. It is
common in teenagers, in pregnancy, and in women on the pill. It can cause slight bleeding,
especially after sex. Usually the condition goes away by itself without any treatment.
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Abnormal test results
Abnormal results can be reported in 2 different ways. In the UK, if you have abnormal cells you
are most likely to be told you have
Borderline or mild cell changes (low grade dyskaryosis)
Moderate or severe cell changes (high grade dyskaryosis)
More rarely your screening test result may say CIN 1, CIN 2, or CIN 3 instead of mild, moderate
or severe. CIN stands for cervical intraepithelial neoplasia. This just means cervical cell changes.
This classification is not strictly accurate as CIN can only really be diagnosed with a biopsy. But
these results do indicate that you probably have
CIN 1 if you have mild cell changes
CIN 2 if you have moderate cell changes
CIN 3 if you have severe cell changes
The 3 grades of CIN relate to the thickness of the skin covering the cervix that is affected. CIN 1
means up to one third of the thickness of the skin covering the cervix has abnormal cells. CIN 2
means between one third and two thirds of the skin covering the cervix has abnormal cells. CIN
3 means the full thickness of the skin covering the cervix has abnormal cells. Both the level of
cell abnormality (mild, moderate or severe) and the CIN level will be taken into account when
deciding whether you need treatment.
All these results mean that cells have been found on your test that have abnormal changes. This
does not mean you have cervical cancer. It means that some of the cells are slightly abnormal
and if they are left untreated, they could go on to develop into cervical cancer.
Remember that we are talking about the test as screening for cervical cancer here. Screening
means testing healthy women. If you have symptoms of cervical cancer, you may have a liquid
based cytology test as part of the tests used to investigate your symptoms. This is a very different
situation to having the test as a routine screening test. If you have any symptoms, you should talk
to your GP.
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Mild cell changes
Currently, what happens if you have borderline or mild cell changes (low grade dyskaryosis)
varies depending on if you live in
England and Northern Ireland
Scotland and Wales
England and Northern Ireland
If you have borderline or mild cell changes, the laboratory will test your sample for the human
papilloma virus (HPV). Certain types of this virus increase the risk of cervical cancer. If there is
no HPV (HPV negative), the cell changes are likely to go back to normal or stay the same. So
you will go back to the routine screening programme of having tests every 3 to 5 years.
If you have a high risk type of HPV, you will be invited for colposcopy to see if you need
treatment for the abnormal cells.
Scotland and Wales
If you have borderline or mild cell changes, your doctor or nurse will either suggest a colposcopy
straight away or ask you to go back for another screening test in 6 months time. Sometimes these
slightly abnormal cells can go back to normal by themselves. But you should definitely go for
your repeat test. You can't assume that the cells will go back to normal. If your next test is
normal you may have 2 further tests, 6 months apart, before returning to regular screening every
3 to 5 years. If your repeat test is abnormal, you will then have a colposcopy to check it out
further. You may need some treatment.
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Moderate or severe cell changes
If you have moderate or severe cell changes (high grade dyskaryosis), you will be referred to
colposcopy straight away. Your doctor or specialist nurse will take a sample of cells (biopsy)
from the abnormal area. They may ask you to go back for treatment depending on the result of
the biopsy. Or in some clinics, they may offer you treatment at the same time as the colposcopy.
There is information about treatment for abnormal cervical cells in this section.
You usually only need treatment once. Then you have follow up tests. If you have an abnormal
test and have successful treatment you are very unlikely to get cervical cancer if you continue
having screening. If you do not have treatment, you are very much at risk of developing cervical
cancer in the future.
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Carcinoma in situ (CIS)
CIN 3 is sometimes called carcinoma in situ. This sounds like cancer, but it isn't. It means that
some of the cells look cancerous. But they are all contained within the skin layer covering the
cervix. It will not be a true cancer until the cells break through the layer covering the cervix and
spread into the tissue underneath. You must have treatment as soon as possible if you have
carcinoma in situ. As long as the affected area is removed, cancer can be prevented.
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How reliable the test is
You may have heard various news reports in the past about women being recalled for cervical
screening tests because the system went wrong. And even about some women dying from
cervical cancer because their tests were not checked properly and so they missed out on the
treatment they needed. But this is very, very rare. As a result of these very rare mistakes, the
screening system has been tightened up even further.
Two trained technicians now check all cervical screening tests. The abnormal cells that were
missed in the past were all in health authorities who didn't make sure two people checked their
samples. And in some cases because technicians were not trained or supervised properly. So you
can feel reassured that if there are abnormal cells in your screening test they are highly likely to
be found and treated so that they cannot develop into a cancer.
Lastly, always make sure you get your result. If you do not get the result, there is always the tiny
chance that the test was reported as abnormal but that this result was not sent back to you or your
GP.
Cervical cancer symptoms
The most common symptom of cervical cancer is bleeding from the vagina at times other than
when you are having a period. You may have bleeding
Between periods
After or during sex
At any time if you are past your menopause
Some women also have
A vaginal discharge that smells unpleasant
Discomfort or pain during sex
Doctors call pain related to sex dyspareunia. There are many other conditions that cause these
symptoms. Most of them are much more common than cervical cancer. But you should go to
your doctor straight away if you have any of these symptoms. You probably don't have cancer.
But if you do, the sooner you are treated, the more likely you are to be cured and usually the less
treatment you will need to have.
Pre cancerous cell changes do not usually have any symptoms. Which is why it is so important to
have a regular smear test.
Types of cervical cancer

This page is about the main types of cervical cancer. If you are looking for information about
abnormal smears, you need to go to either the screening page, which has information about what
smear results mean. Or you can go to the section about treating abnormal cervical cells.
There are two main types of cervical cancer
Squamous cell cancer
Adenocarcinoma
They are named after the type of cell that becomes cancerous.
Squamous cell cancer
Squamous cells are the flat, skin like cells that cover the outer surface of the cervix (the
ectocervix). Around 7 to 8 out of 10 cervical cancers are squamous cell cancer (70 to 80%).
Adenocarcinoma
Adenomatous cells are gland cells that produce mucus. The cervix has these gland cells scattered
along the inside of the passageway that runs from the cervix to the womb (the endocervical
canal). Adenocarcinoma is a cancer of these gland cells. It is less common than squamous cell
cancer, but has become more common in recent years. More than 1 in 10 cervical cancers are
adenocarcinoma (10 to 15%). It is treated in the same way as squamous cell cancer of the cervix.
Other rarer types of cancer
Very rarely, other types of cancer can occur in the cervix. An example is lymphoma, which is a
cancer of the lymphatic system. If you have this rare cancer, then this section is not the right one
for you. We have another section about lymphoma and its treatment.
Why you need treatment
If you have an abnormal cervical screening test result, you have changes in the cells covering the
neck of your womb (cervix). If these abnormal cells are left untreated, there is a risk that some of
them could go on to develop into cervical cancer in the future. Your screening result may say
you have
Borderline or mild cell changes (low grade dyskaryosis)
Moderate or severe cell changes (high grade dyskaryosis)
Or you may have been told you have
CIN 1 up to one third of the thickness of the lining covering the cervix has abnormal cells
CIN 2 two thirds of the thickness of the lining covering the cervix has abnormal cells
CIN 3 the full thickness of the lining covering the cervix has abnormal cells
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What happens after the screening test result
If you have moderate or severe cell changes on your cervix, your doctor will refer you for a
colposcopy. Most colposcopy clinics are held in hospital outpatient departments. But they are
sometimes held at community hospitals or health centres.
A colposcopy is a close examination of your cervix. A colposcope is basically a magnifying
glass. It doesn't go inside your vagina. The doctor or specialist nurse uses it to look more closely
at the abnormal areas on your cervix and may take samples of them (biopsies) to send to the lab.
You may have treatment at the same time as your colposcopy. Or you may go back to the
colposcopy clinic for treatment once they have the results of your biopsy. There is more about
colposcopy in this section.
If your screening test showed you have mild cell changes, your doctor may send you for a
colposcopy straight away. Or your doctor may ask you to go for another cervical screening test
in 6 months. This is slightly different for women having screening in England and Northern
Ireland. The NHS cervical screening programme in these countries now test the samples of
borderline or mild cell changes for the human papilloma virus (HPV). Women who test positive
for high risk types of HPV are referred for a colposcopy straight away. If you do not have HPV,
the cell changes are likely to go back to normal on their own. So you will continue to have
routine screening tests every 3 to 5 years.
If you smoke and have had a mildly abnormal screening test result, it is a good idea to try and
give up smoking if you can. You will increase the chance of your cervical cells recovering. And
your lungs will feel healthier too.
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What the treatment does
Basically all the treatments aim to do the same thing - remove or destroy the abnormal cells.
Laser ablation, cold coagulation, and cryotherapy treat just the part of the cervix that contains
abnormal cells. This allows normal cells to grow back in their place.
LLETZ, cone biopsy and hysterectomy remove the whole area of the transformation zone. This
is the area containing all the cells that could become abnormal or develop into cervical cancer.
It is a little confusing that the terms LLETZ, NETZ, LEEP and diathermy all mean basically the
same thing - using a small tool and electric current to remove the area containing abnormal cells
from the cervix. In theory, diathermy can be used to remove just a small area of abnormality. In
practice it is the same as LLETZ as the whole transformation zone is usually removed.
Needle excision of the transformation zone (NETZ) is similar to LLETZ. But the thin wire used
to cut away the area is straight rather than a loop.
These treatments can cause period type pains for a short time. Your usual over the counter
painkiller, such as paracetamol or ibuprofen will help.
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Laser therapy
Laser therapy is sometimes called laser ablation. This just means the laser burns away the
abnormal cells. You have this treatment as an outpatient. First, you lie on a couch, with your legs
in stirrups. Your doctor will put a speculum into your vagina to hold it open and then puts local
anaesthetic onto your cervix to numb it. Then they point the laser beam at the abnormal areas. A
laser beam is a very strong, hot beam of light. It burns away the abnormal area. So you may
notice a slight burning smell during the treatment. This is nothing to worry about. It is just the
laser working. You can go home as soon as this treatment is over.
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Cold coagulation
This is not treatment with cold as the name suggests. In fact the specialist will use a hot probe to
burn away the abnormal cells. You lie on a couch, with your legs in stirrups. The doctor puts a
speculum into your vagina to hold it open. Then the doctor uses a hot probe to destroy the
abnormal cells. You shouldn't be able to feel the probe on the cervix, but you might get a period
type pain while you are being treated and for a short while afterwards.
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Cryotherapy
The specialist uses a cold probe to freeze away the abnormal cells. You lie on a couch, with your
legs in stirrups. The doctor will put a speculum into your vagina to hold it open. Then the doctor
uses the probe to destroy the abnormal cells. You shouldn't be able to feel the probe on the
cervix, but you might get a period type pain while you are being treated and for a short while
afterwards.
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Diathermy
You have diathermy under local anaesthetic. The treatment uses an electric current to cut away
the tissue containing the abnormal cells. It is quite quick and you will be able to go home
afterwards. Bring a sanitary towel with you. You will have some bleeding or discharge for about
4 weeks after the treatment. You shouldn't wear tampons or have sex for 4 weeks because this
will increase your risk of infection.
The advantage of diathermy, LLETZ and LEEP over laser treatment is that the piece of cervical
tissue that the doctor removes can be sent for examination under a microscope. With laser
ablation, the cells are destroyed, so the pathologist can't examine them after the treatment.
In the laboratory, the pathologist will re check the level of cell changes in the piece of tissue to
make sure your screening result was accurate. They will also closely examine the whole piece of
tissue to make sure that the area containing the abnormal cells has been completely removed.
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LLETZ
LLETZ stands for large loop excision of the transformation zone. In the USA, this procedure is
called LEEP loop electrosurgical excision. It is basically the same as diathermy. The area of
abnormal cells is removed completely.

It is an outpatient treatment and you usually have a local anaesthetic. If you need to have a large
area of tissue removed, or if you are very anxious about the treatment, you may have a general
anaesthetic.
You may have this treatment at the same time as your colposcopy. The transformation zone is an
area that is usually inside the endocervical canal. Its exact position varies, depending on your age
and whether you've had children. So it cannot always be seen clearly when a screening test is
taken. But it can be seen during colposcopy. It is quite common to have abnormal cells in this
area. Some doctors like to treat straight away when they find the abnormal cells, rather than
asking you to come back another time.
The transformation zone is cut away using a loop of wire and an electric current. You should
bring a sanitary towel with you to the hospital. You will need one after the treatment as there will
be some bleeding. You will have some bleeding for about 4 weeks after LLETZ. You shouldn't
wear tampons or have sex for 4 weeks because this will increase your risk of infection.
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Cone biopsy
Your doctor may suggest this minor operation to diagnose cervical cancer or to treat abnormal
cells. As with LLETZ, the doctor removes the entire area where cells can become abnormal (the
transformation zone). It is called a cone biopsy because the surgeon removes a cone shaped
wedge of tissue from the cervix.
You may have a cone biopsy under general or local anaesthetic. There is more information about
cone biopsy in the section on diagnosing cervical cancer.
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Hysterectomy
If you are past your menopause or have had all the children you want to have, your doctor may
suggest removing the whole of your womb. This is more likely if you have had abnormal cells
found on your cervix more than once. Or if the abnormality found was severe. In other words,
you have not got cervical cancer, but the abnormal cells on your cervix are closer to becoming
cancerous cells. There is more information on hysterectomy in the section on treating cervical
cancer.
Physical effects of treatment
Most women feel fine after having treatment for abnormal cervical cells. But some may feel
quite ill and need to go home and rest. Unless you have had a hysterectomy (or possibly a cone
biopsy) you will be able to go home from hospital the day that you are treated. But you shouldn't
plan to do anything else that day.
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Pain
You may have period type pains for the rest of the day. About 1 in 3 women report having some
pain after this type of treatment. Having pain seems to be more likely in women who haven't had
any children. Simple painkillers, such as paracetamol or ibuprofen usually help.
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Bleeding or discharge
You should expect to have some bleeding or discharge for some days after the treatment. It can
carry on for up to 4 weeks. How long it lasts depends partly on the type of treatment you have
had. You may have
Light bleeding for days or weeks
Watery vaginal discharge
Light bleeding or discharge can go on for a couple of weeks after treatment. You are more likely
to have bleeding, and it is more likely to be heavier if you are treated when your period is due.
This is why doctors prefer to treat you between periods if possible. There is no need to worry
unless the
the discharge starts to smell bad
the bleeding starts to get heavier
Sometimes the bleeding gets heavier 10 to 12 days after your treatment. This is probably nothing
to worry about. But if it seems heavier to you than a heavy period, you must either go back to the
clinic, contact your GP or go to your local accident and emergency department (A & E). You
will need a check up to make sure nothing is wrong. Your doctor may be able to give you
something to help control the bleeding. If you have a discharge that starts to smell, you may have
an infection and should go back to your doctor.
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Your emotions and feelings
These are often overlooked. But many women find this type of treatment does have an emotional
effect on them. About 1 in 4 women say that after treatment to their cervix they feel
Traumatised
Depressed
Vulnerable
Invaded
This is not really surprising. This is a very private area of your body. The undignified position
needed for cervical screening or treatment can upset many women. Usually you get over these
feelings with a little time. But if you feel you need help, you can talk to your GP about
counselling.
If you would like to talk to someone outside your own friends and family, look in our coping
with cancer section for counselling organisations. To find out more about counselling look in the
counselling section.
Your privacy and dignity should be protected at all times when you are having these sorts of
investigations and treatments. If you feel your privacy or dignity were not properly protected,
write to the nurse manager of the unit where you were treated. Your suggestions for improving
things will help other women in the future and writing it down can also help you to get over your
experience.
Some women find that needing to have treatment for abnormal cervical cells really worries them.
This condition is often confused with cervical cancer. But even if you are clear about the
difference the experience can make you more worried about cancer of any type.
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Getting back to normal
You should have fully recovered from this type of treatment in about 6 weeks at the most. If you
have had a small amount of laser treatment, you will get over it quicker than that. You shouldn't
have sex before 4 weeks because of the risk of infection. But after any of these treatments, you
should be able to have sex and do any work or exercise you wish to within six weeks. None of
these treatments will make any difference to your enjoyment of sex in the future.
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Follow up
It is very important that you go back to the hospital or GP practice for check ups after treatment
for abnormal cells. The chances are that you will not have any further problems. Treatment is
successful in 4 out of 5 women. But if the abnormal cells come back you will need to have more
treatment.
You will be invited back for a follow up screening test about 6 months after treatment. This is
usually done at your GP practice. In most parts of the UK now, the NHS screening programme
has brought in testing for the human papilloma virus (HPV) as part of follow up.
If your cell sample is normal, or shows borderline or mild cell changes, the sample will be
checked for HPV. If no HPV is found, you will not need to have another screening test for 3
years.
If HPV is found, or you have moderate or severe cell changes, you will go back to colposcopy to
see if you need more treatment.
HPV testing as part of follow up has been introduced in stages, starting with women who have
most recently had treatment. So if you had treatment for abnormal cells a while ago, or live in an
area where they haven't started HPV testing yet, you may still have follow up screening tests
every year.
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Cervical screening after hysterectomy
You will still need follow up even if you have had a hysterectomy for abnormal cells. The cells
for the test are taken from the top of the vagina, near where your cervix was. Your doctor may
call this a vault smear. Very rarely, the abnormal cells can come back in this area, so you will be
offered tests at 6 months and 18 months (you may have one sooner than this) after your
hysterectomy. If everything is fine, you won't need to have any more tests after that.
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What happens if abnormal cells come back
Usually you can have more laser treatment, diathermy or loop excision. You may need to have a
cone biopsy.
But if the abnormal cells come back more than once, or if your doctor thinks the risks are too
great, they may ask you to have a hysterectomy. This is to prevent you from developing cancer
of the cervix in the future. Your doctor will talk through all the treatment options with you at
every stage.
Your wishes will need to be taken into account in order to decide what is the best treatment for
you. Your decision may depend on whether you have had all the children you wish to have. Or
whether you have reached your menopause. Some women prefer to have a hysterectomy because
they can then be satisfied that all the potentially cancerous cells should have been taken away. It
is usually possible for you to keep your ovaries if you are having a hysterectomy for this reason
so the operation should not affect your hormones or send you into an early (premature)
menopause. If your ovaries are removed before the menopause you may need hormone
replacement therapy (HRT).
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Pregnancy after treatment
Unless you have had a hysterectomy, no treatment for abnormal cervical cells should make any
difference to you getting pregnant in the future. Some of the treatments can lead to a small risk
of pregnancy complications. There is more about this in the section about treating abnormal
cervical cells in pregnancy.
Cervical screening during pregnancy
We hope the following information will help put your mind at rest. But it is best to talk to your
own doctor, who is in the best position to answer your questions.
The NHS cervical screening programme recommends that in most cases women should not have
cervical screening tests if they are, or could be, pregnant. Pregnancy can make the result of the
test harder to interpret and it is likely to be inaccurate.
If you are planning to become pregnant, it is a good idea to check with your GP that you are up
to date with your cervical screening. Then you can have the test and any treatment necessary
before you become pregnant.
If you are already pregnant, and are due to have a cervical screening test, you can usually wait to
be screened until 3 months after your baby is born. When you are invited for your test, you
should let your GP or clinic know that you are pregnant. They will postpone the test until after
the baby is born.
If you have previously had an abnormal result from a cervical screening test, you may need to
have another screening test while you are pregnant. Your GP or midwife may ask you to have the
test at your first antenatal appointment. This test will not interfere with your pregnancy. If the
results come back abnormal, or if a test you had just before you became pregnant shows
abnormal results, you don't need to worry. This doesn't mean that you have cancer, but that there
are some abnormal cells that can be easily treated a few months after the birth.
You may need to have a colposcopy (a close examination of your cervix and vagina). This
examination is safe to have during pregnancy, and your doctor can see how much the cells on
your cervix have changed.
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Treatment for abnormal cells during pregnancy
If you only have mild changes to the cells on your cervix (CIN 1), you will not need to have any
treatment until around 3 months after your baby is born. After that, you may have another
colposcopy to check the cervical cells again. In many women with mild changes, they go back to
normal without any treatment. But if the cells are more abnormal (CIN 3), your doctor may ask
you to have another colposcopy when you are approximately 6 months pregnant to keep an eye
on them. The abnormal cells are not likely to change much over the time of your pregnancy.
If the cells on your cervix have not gone back to normal after you have given birth, you may then
have treatment to remove them. You can discuss your treatment options and any worries you
have with your GP and midwife. It is important to make sure that you go to all of your follow up
appointments after you have had your baby.
Remember - if your doctor tells you that you have abnormal cells or CIN 1, 2 or 3, you do not
have cervical cancer. You have a pre cancerous condition that can easily be treated.
If you are pregnant and your colposcopy shows that the CIN has started to turn into an invasive
cancer, your doctor will need to take a tissue sample, probably by loop diathermy or LLETZ.
These are procedures where the doctor uses a small metal loop with an electric current, to cut out
a small piece of the cervix. But your specialist will not do this unless it is absolutely necessary.
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Pregnancy after a cone biopsy
We have separated cone biopsy out, because it can cause particular problems. But these are not
common. Firstly there is a very, very small chance that the cervix can become so tightly closed
after cone biopsy that sperm cannot get in at all. This is called cervical stenosis. If this happened,
you would not be able to get pregnant naturally. If you are having periods after a cone biopsy
you have not got complete cervical stenosis. If the lining of the womb can get out, when it is
shed as a period, then sperm can get in.
Studies have shown that some treatments for CIN or stage 1A cervical cancer can lead to a small
risk of complications in future pregnancies. Women who have had a cone biopsy are more likely
to have their babies born before 37 weeks (preterm delivery). And the risk of having a baby that
weighs less than 2.5kg (low birthweight) is higher. There may also be an increase in birth by
Caesarean section for women who have had cone biopsy.
You may have an increased risk of early birth because the cone biopsy has weakened your
cervix. The cervix is really a muscle that keeps the entrance to the womb closed unless you are in
labour. In some women who have had a cone biopsy, there is a risk that the cervix may start to
open too soon because of the weight of the growing baby. Serious problems can usually be
prevented. If your doctor thinks your cervix may start to open too soon, you can have a sort of
running stitch put around it to hold it shut. Your doctor may call this a purse string suture. The
stitch is cut before you go into labour, usually at about week 37 of your pregnancy. The cervix
can then open normally for the baby to come out.
Some people have reported labour being longer in women who have had cone biopsy because the
cervix takes longer to open. But this has not been confirmed by research.
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Pregnancy after other treatment
It is very unlikely that any other treatment for abnormal cells, such as laser therapy, diathermy,
cold coagulation or cryotherapy will affect your ability to get pregnant in the future.
There have been reports of laser treatment causing a lack of mucus in the cervix, making it more
difficult to get pregnant (because this would affect sperm swimming up into the womb). But a lot
of research has been done, and this has never been shown to be true.
The most likely way that treatment for abnormal cervical cells can affect your ability to get
pregnant, is if you got an infection after you were treated. And if the infection then spread up
into your fallopian tubes. Infection in the fallopian tubes can cause them to become blocked. If
both your tubes are blocked, then you cannot get pregnant because your eggs cannot travel down
the tubes into the womb.
Such a severe infection is unlikely after treatment for an abnormal smear. If you do have any
symptoms of infection after treatment such as
Heavy bleeding, especially if more than during your period
A vaginal discharge that smells or is green or yellow in colour
Period like pains that last more than a day or two
Fever
then go straight back to your doctor. You may need antibiotics which should clear the problem
up before the infection can spread and do any damage.
As with cone biopsy, studies looking at LLETZ (large loop excision of the transformation zone)
show that there is a small rise in risk of birth before 37 weeks and having a low birthweight
baby. This risk may depend on the amount of cervical tissue that has been removed. Some
studies have also shown a slight increase in the risk of waters breaking early (premature rupture
of membranes) for women who have had LLETZ.
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What to remember
You may feel worried about these risks, but do bear in mind
The risk of developing serious side effects during pregnancy is small
If you have cervical abnormalities, having the necessary treatment is very important
Your doctor will talk through the treatment options, and discuss any potential risks to future
pregnancies
Why you need tests
Your doctor or nurse will suggest more tests if you've had an abnormal result after a cervical
screening test, or if you have symptoms which could be caused by cervical cancer. These tests
are different ways of looking at the cervical cells more closely. To find out more about the
abnormality, and to see whether you have cervical cancer, your specialist may ask you to have
one of these tests
Colposcopy
Cone biopsy
This may be all that you need to have done. Do remember that most women who have an
abnormal result, or suspicious symptoms, do not have cancer. Treating abnormal precancerous
cells will stop a cancer from developing. Cone biopsy may successfully treat the problem by
removing the abnormal area. If your doctor sees an obvious abnormality with the colposcope,
they may treat you there and then. But you will have to go for follow up tests to make sure the
abnormal cells don't come back.
If any of the tests do show you have an invasive cervical cancer, you will need further tests and
more treatment. Invasive means that the cancerous cells have started to grow into the deeper
layers of the cervix, for example, into the muscle layer.
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Colposcopy
This is another examination of the cervix similar to when you have a cervical screening test. A
doctor or specialist nurse uses a colposcope to look at the surface of the cervix. This is really just
a large magnifying glass that they use to closely examine the skin like covering of the cervix. It
doesn't go inside you. But by looking through it, the nurse or doctor can see changes that may be
too small to see with the naked eye. They will take a biopsy of any abnormal areas.
For most women, this is a painless examination. It may be a little uncomfortable because you
will be in the position you need to be in for the liquid based cytology screening test (smear test).
Some people find it uncomfortable to stay in that position for more than a couple of minutes, but
other than that, it should be fine.
You usually have colposcopy in the outpatient clinic, or in a local community hospital. You lie
on your back on the couch with your feet drawn up and your knees apart. As with the screening
test, if you can't get into that position for any reason, the doctor or specialist nurse may be able to
do the examination with you lying on your side with your knees drawn up.
The doctor or nurse puts in a speculum to open up the vagina. And then they look through the
colposcope at the surface of the cervix. The examination takes up to 20 minutes. If they need to
take biopsies, you can have some local anaesthetic injected into the cervix first. You will be able
to go home as soon as the colposcopy is over.
If your doctor or specialist nurse finds an area of abnormal cells, you may have treatment there
and then. They may call this see and treat. But you can choose to go back for treatment if you
prefer.
LLETZ (Large Loop Excision of the Transformation Zone) means cutting out the area of the
cervix where the abnormal cells develop. The transformation zone is the area just inside the
cervical canal. LLETZ is the most common treatment used in the UK. It is simple and quick to
carry out, works well and can be done under local anaesthetic. It also provides a clear tissue
sample for the laboratory to examine. There are quite a few other treatment options, including
laser, cold coagulation and cone biopsy, and these can work equally well. Look at the section
about treating abnormal smears for more information about other treatments that you may have.
Sometimes the doctor or specialist nurse cannot see clearly enough because the abnormal cells
go further up into the cervical canal than can be seen with a colposcope. If they cannot see all the
cells that are abnormal you will need to have either a LLETZ or a cone biopsy.
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Cone biopsy
This is a minor operation that you usually have under general anaesthetic. You will probably stay
in hospital overnight.
While you are under anaesthetic the doctor cuts out a cone of tissue from your cervix. The cone
includes the whole area of the cervical canal where there might be abnormal cells. The cone of
tissue is sent to the laboratory for examination under the microscope.
When you wake up after the cone biopsy, you may have some gauze packed into your vagina to
help stop any bleeding. If you have a pack, you will probably have a tube to drain urine from
your bladder as well (a catheter). This is because the gauze pack presses on the bladder and the
tube that carries urine out of the body (the urethra). Your nurse or doctor will take the pack out
before you leave hospital the following day. It is normal to have bleeding for up to 4 weeks after
a cone biopsy. Your doctor may prescribe a drug called vasopressin or tranexamic acid that can
reduce the bleeding.
You will probably have period type pains when you wake up. If you do, tell your nurse and ask
for some painkillers. You can take painkillers home with you if you need to, but the pains
usually only last a couple of hours.
When you get home, try to rest as much as you can for the first week or so. You do not have to
stay in bed. But you mustn't be too active either. Don't do any heavy housework or carry heavy
loads. It will help if you can arrange for a relative or friend to help you for a few days,
particularly if you have children to look after. You shouldn't do any vigorous exercise or have
sexual intercourse for 4 to 6 weeks after your cone biopsy. By that time your cervix will have
healed.
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What happens if you are pregnant
You can have a colposcopy if you are pregnant. It is perfectly safe for you and your baby, and
will not affect the delivery. It won't affect your ability to get pregnant in future either. In most
cases, any treatment for pre cancerous cells can be planned for after you've had the baby. Your
doctor will be very careful about taking biopsies.
Your doctor will not suggest a cone biopsy if you are pregnant unless he or she suspects there is
a cervical cancer. Cone biopsy during pregnancy can weaken the cervix and bring on a
miscarriage. There is more information about the effect cone biopsy might have on future
pregnancy in this section.
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Getting your results
Before you leave hospital, whether after a colposcopy or a cone biopsy, make sure you know
how you will be given the results. You may be asked to go back to the hospital for an outpatient
appointment to see the specialist to get the results. Or the results may be sent in the post.
If you have abnormal cells on your cervix, you will be asked to go back to hospital to have them
treated. There is information about treating abnormal cervical cells in this section.
If you had abnormal cells and have had a cone biopsy, the area with the abnormal cells will
usually have already been removed. As long as the abnormal cells were completely removed and
there is no sign of cervical cancer, you will not need any further treatment. But you will need
regular cervical screening tests for a while to keep an eye on the area.
If you are diagnosed with cervical cancer, then your doctor will ask you to go back to hospital
for further tests.
Why you need more tests
If your doctor has seen signs of invasive cancer in biopsies of your cervix, they will suggest you
have more tests. Invasive means there are cancer cells that have started to grow down through
the tissue they started in and into the deeper tissues of the cervix. With any invasive cancer, there
is a risk that some cancer cells have broken away and spread to nearby lymph glands or to other
parts of the body. You need more tests to see how far the cancer has grown, whether it has
spread and to decide on the best treatment. In other words, the tests help decide the stage of your
cancer. Your specialist may ask you to have any of the tests listed on this page.
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Pelvic examination under anaesthetic
You have this under general anaesthetic so that your specialist can examine you thoroughly and
take biopsies if necessary. The examination includes checking
The size of your womb and whether it moves as it should
Inside your vagina for cervical cancer
Inside your rectum to see if the cancer has spread there
Inside your bladder to see if the cancer has spread there
The doctor may scrape the inside of your womb to get tissue samples to send to the laboratory.
These biopsies can show whether the cancer has grown into the inside of the womb.
To check inside your rectum, the doctor can use a gloved finger to feel for any growths. Or they
may use a sigmoidoscope to examine the rectal wall more closely. To check inside your bladder
the doctor uses a cystoscope. If the doctor sees any abnormal areas during these tests, they will
take a biopsy and send it to the laboratory for examination under a microscope.
These examinations can leave you feeling quite uncomfortable, and you may need to take some
mild painkillers afterwards.
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MRI or CT scan
Your doctor might want you to have a scan to stage your cancer and check for cancer spread. An
MRI scan uses magnetism to build up a picture of the body. It can be better than X-ray at
showing the soft tissues of the body. MRI scans are painless, but take a while and are quite
noisy. They are usually done to check for cancer spread within the pelvis or to other parts of the
body.
A CT scan is a type of computerised X-ray. It can show the size of your primary cancer and
enlarged lymph nodes that may contain cancer. There is information about having an MRI scan
and having a CT scan in the about cancer tests section.
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PET-CT scan
At some centres a PET-CT scan may be used to show the size of your primary tumour and any
cancer spread. It may help to plan your treatment more accurately. These scans are only available
at a few centres. There is information about having a PET-CT scan elsewhere on our website.
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Blood tests
Routine blood tests are taken to check your general health. Blood tests can also check whether
your kidneys and liver are working properly.
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Chest X-ray
A chest X-ray may be done to see if there is any sign that the cancer has spread to the lungs. But
it is also done routinely to check your fitness for a general anaesthetic.
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After the tests
You will be asked to come back to the hospital when your test results have come through. After
the first round of tests you may need further scans such as a CT or MRI scan. This is to assess for
possible spread in more detail. This is bound to take a little time, even if only a day or two. You
may feel very anxious during this time. While you are waiting for results it may help to talk to a
close friend or relative about how you are feeling. If you would like to talk to someone outside
your own friends and family, contact your clinical nurse specialist (CNS) or look in our coping
with cancer section for counselling organisations. You can also talk things through with one of
our cancer information nurses.
What staging is
Your doctor will use tests to help stage your cancer. The stage of a cancer tells the doctor how
far it has spread. It is important because treatment is often decided according to the stage of a
cancer. Doctors use different systems to stage cancers. The system usually used for cervical
cancer numbers the different stages from 1 to 4. There is more about staging cancers in the
Cancers in general section.
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Carcinoma in situ (CIS)
Carcinoma in situ means that some of the cells of the cervix have cancerous changes. But the
abnormal cells are all contained within the surface layer of the cervix. Carcinoma in situ is not a
cancer but in some women the changes will develop into a cancer after some years. It is
important to have treatment as soon as possible for carcinoma in situ. As long as the affected
area is removed, cancer can be prevented. Carcinoma in situ can be found during cervical
screening tests. We have information about abnormal screening results on our cervical screening
page.
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Stage 1
Stage 1 means that the cancer is just in the neck of the womb. It is often divided into
Stage 1A
Stage 1B
These days, stage 1A and 1B are both divided into two smaller groups
Stage 1A1 and stage 1A2
Stage 1B1 and stage 1B2
In stage 1A the growth is so small it can only be seen with a microscope (or colposcope). Stage
1A1 means the cancer has grown less than 3 millimetres (mm) into the tissues of the cervix, and
it is less than 7mm wide. Stage 1A2 means the cancer has grown between 3 and 5 mm into the
cervical tissues, but it is still less than 7mm wide.

In stage 1B the cancerous areas are larger, but the cancer is still only in the tissues of the cervix
and has not usually spread. It can usually be seen without a microscope, but not always. In stage
1B1 the cancer is no larger than 4 centimetres (cm). In stage 1B2 the cancer is larger than 4cm
across.

Stage 1 cervical cancer is generally treated with surgery or radiotherapy. But if you have stage
1B2 cervical cancer, your doctor may suggest combined chemotherapy and radiotherapy
(chemoradiation).
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Stage 2
In stage 2 cervical cancer, the cancer has begun to spread outside the neck of the womb into the
surrounding tissues. But it has not grown into the muscles or ligaments that line the pelvis
(pelvic wall), or to the lower part of the vagina. Stage 2 can be divided into
Stage 2A
Stage 2B
In stage 2A the cancer has spread down into the top of the vagina.

Stage 2A is divided into
Stage 2A1
Stage 2A2
In stage 2A1 the cancer is 4 cm or less. In stage 2A2 the cancer is more than 4 cm.
In stage 2B there is spread up into the tissues around the cervix.

Stage 2A cervical cancer may be treated with surgery or combined chemotherapy and
radiotherapy (chemoradiation).
Stage 2B cervical cancer is usually treated with chemoradiation. Research studies have shown
that this combined treatment can improve the survival rates of stage 2 cervical cancer.
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Stage 3
In stage 3 cervical cancer, it has spread away from the cervix and into surrounding structures in
the pelvic area. It may have grown down into the lower part of the vagina and the muscles and
ligaments that line the pelvis (pelvic wall). And it may have grown up to block the tubes that
drain the kidneys (the ureters). It can be divided into
Stage 3A
Stage 3B
Stage 3A is when the cancer has spread to the lower third of the vagina but not the pelvic wall.

Stage 3B means the tumour has grown through to the pelvic wall or is blocking one or both of
the tubes that drain the kidneys.

This stage is usually treated with radiotherapy and chemotherapy (chemoradiation). We know
from research that this combined treatment can improve the survival rates of stage 3 cervical
cancer.
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Stage 4
Stage 4 cervical cancer is advanced cancer. The cancer has spread to other body organs outside
the cervix and womb. It can be divided into
Stage 4A
Stage 4B
Stage 4A is when the cancer has spread to nearby organs such as the bladder or rectum (back
passage).

If the cancer has spread to organs further away, such as the lungs, your doctor may call it stage
4B.

This stage of cancer may be treated with surgery, radiotherapy, chemotherapy or a combination
of these treatments. Some women may choose just to have treatment to control symptoms at this
stage.
Cervical cancer statistics and outlook
What you need to know about this information
This page contains quite detailed information about the survival rates of different stages of
cervical cancer. We have included it because many people have asked us for this. But not
everyone who is diagnosed with a cancer wishes to read this type of information. If you are not
sure whether you want to know at the moment or not, then perhaps you might like to skip this
page for now. You can always come back to it.
Please note: There are no national statistics available for different stages of cancer or treatments
that people may have had. The statistics we present here are pulled together from a variety of
different sources, including the opinions and experience of the experts that check each section of
Cancer Research UK's patient information. We provide statistics because people ask us for them.
But they are only intended as a general guide and cannot be regarded as any more than that.
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Cancer statistics in general
We have a section explaining more about the different types of cancer statistics. Unless you are
very familiar with medical statistics, it might help to read this before you read the statistics
below.
Remember that statistics are averages based on large numbers of patients. They cannot predict
exactly what will happen to you. Everyone is different and response to treatment also varies from
one person to another.
You should feel free to ask your doctor about your prognosis, but not even your doctor can tell
you for sure what will happen. You may hear your doctor use the term 5 year survival. This
doesn't mean you will only live 5 years. It relates to the number of people in research who were
still alive 5 years after diagnosis. Doctors follow what happens to people for a number of years
after treatment in any research study so that they can compare the results of different treatments.
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Outcome overall and by stage
Of all the women diagnosed with cancer of the cervix, about 83 out of every 100 (83%) live for
at least a year after they are diagnosed. Around 67 out of every 100 (67%) will live for at least 5
years. And around 63 women out of every 100 (63%) will live for at least 10 years.
As with many other types of cancer, the outcome depends on how advanced your cancer is when
it is diagnosed. In other words, the stage of your cancer. Since the 1970s, the number of deaths
from cervical cancer in the UK has been falling. The main reason for this is the introduction of
the national screening programme in the 1960s. Regular screening has meant that pre cancerous
changes and early stage cervical cancers have been picked up and treated early. Figures suggest
that cervical screening is saving 5,000 lives each year in the UK by preventing cervical cancer.
The links below take you down the page to specific information about the outlook for each stage
of cervical cancer.
Stage 1
Stage 2
Stage 3
Stage 4
Stage 1
Stage 1 cervical cancer means the cancer is only in the cervix. It is is now divided into 4 groups:
stage 1A1, stage 1A2, stage 1B1 and stage 1B2, depending on the size of the cancer. The
outcome or chance of being cured is better the earlier the cancer is detected. Smaller cancers
have a better prognosis. The smallest tumours of only a few millimetres (stage 1A1) are very
unlikely to recur and have a cure rate of 98 to 99%, if they are completely removed. For stage
1A2 cancers the cure rate is between 95 and 98%. For stage 1B1 cancers the cure rate is between
90 to 95%. A stage 1B2 cervical cancer, which may be larger than 4cm in diameter, still has a
very good chance of cure. 8 out of 10 women (80%) with stage 1B2 cervical cancer will be
cured.
Stage 2
Stage 2 means that the cancer has spread to tissue close to the cervix. It is divided into 2 main
groups: stages 2A and 2B. For all those women diagnosed with stage 2A cervical cancer,
between 7 and 9 out of 10 (70 to 90%) will be alive 5 years later.
For stage 2B the figures are slightly lower. Between 6 and 7 out of every 10 women (60 to 70%)
will be alive 5 years after diagnosis.
Stage 3
Stage 3 means the cancer has spread to the lower vagina or the side of the pelvis. As you might
expect, the survival statistics fall with the more advanced stages of cervical cancer. Between 3
and 5 out of 10 women (30 to 50%) live at least five years after a diagnosis of stage 3 cervical
cancer.
Stage 4
Stage 4 means the cancer has spread to distant organs or into the bladder or bowel. As it is the
most advanced stage, the survival statistics are lowest for stage 4 cervical cancers. 20 out of 100
women (20%) will live 5 years or longer with stage 4 cervical cancer. These are figures for all
stage 4 cervical cancers. The figures will be slightly higher for women with stage 4A cancers and
lower for those with stage 4B cancers.
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Other factors
There are other factors that can affect your outlook (prognosis), apart from the stage of your
cancer. For example, how well you are overall. Doctors have a way of grading how well you are.
They call this your performance status. A score of 0 means you are completely able to look after
yourself. A score of 1 means you can do most things for yourself, but need some help. The
scores continue to go up, depending on how much help you need.
If you are weak from losing weight or being in pain, and feel very tired, you will need more day
to day help, so your performance score will be at least 1. You may see performance status
written PS.
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How reliable these statistics are
No statistics can tell you what will happen to you. Your cancer is unique and so are you. The
same type of cancer can grow at different rates in different people. The statistics are not detailed
enough to tell you about the different treatments people may have had. And how that treatment
may have affected their prognosis. Chemotherapy, surgery and radiotherapy may help people to
live longer, as well as relieving their symptoms. There are many individual factors that will
determine your treatment and prognosis. If you are fit enough to have treatment, you are likely to
do better than average, particularly if your cancer is more advanced.
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Clinical trials
We have detailed information about clinical trials on this website. You can search our clinical
trials database for trials for cervical cancer. Choose 'cervical (cervix)' from the drop down menu
of cancer types.
Treating early cervical cancer
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).
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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.
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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.
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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.
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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.
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Radiotherapy for early cervical cancer
You may need radiotherapy for cervical cancer
Internally
Externally
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.
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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.
Treating advanced cervical cancer
What advanced cancer is
Advanced cervical cancer means cancer that has grown into tissues around the cervix (stage 2B),
or spread further. It is sometimes possible to cure advanced cervical cancer even if it has come
back after your first phase of treatment (recurrent cervical cancer). Whether your cancer can be
cured will depend on
How much cancer there is
How widespread the cancer is
Exactly where it has spread to
Unfortunately, it is not usually possible to cure cervical cancer that is stage 4B. That is cervical
cancer that has spread to another body organ further away from the cervix, such as the lungs or
liver. If you are looking for information about treating this stage of cancer, go to the section on
controlling symptoms of advanced cervical cancer.
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The main treatments
Doctors now usually treat advanced cervical cancer with combined chemotherapy and
radiotherapy (chemoradiation). Some women may have surgery after this.
Treatment often depends on whether you have had treatment before. If you have already had
radiotherapy for cervical cancer, you may not be able to have any more. There is a maximum
amount of radiotherapy normal body tissues can take. So you may have chemotherapy on its
own, or with surgery.
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If it's spread to nearby tissues
Cancer that has spread to nearby tissues is called stage 2B or stage 3 cervical cancer. If your
cancer is at this stage when you are diagnosed, you will usually have internal and external
radiotherapy along with chemotherapy. There is more about radiotherapy and about combined
chemoradiation in this section.
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If it's spread to nearby organs
If your cancer has spread to your bladder or bowel it is called stage 4A. If your cancer is this
stage when you are diagnosed, you may have internal and external radiotherapy, along with
chemotherapy (chemoradiation) or radical surgery.
Radical surgery means removing the womb and vagina as well as any part of the bladder, bowel
or rectum that is affected by the cancer. Or you may have a smaller operation to stage your
cancer. This means finding out exactly which areas are affected.
After surgery, if this is your first phase of treatment, you would then have external radiotherapy
to the affected areas. There is more about the operations you may have in this section.
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If cancer has come back
Cervical cancer can grow and spread locally, within the pelvis. It can also spread to nearby
lymph nodes. There are lymph nodes in a chain running up from both groins. It is these lymph
nodes that can be a common site of cervical cancer spread.

If you have cervical cancer that has come back after previous radiotherapy treatment, you may be
able to have surgery if the cancer has not spread too far. The extent of the surgery depends on
how much cancer there is and where exactly it has come back.
Your specialist will usually ask you to have a CT scan to see where the cancer is. Or you may
have a PET scan if your specialist thinks that you need a large operation (radical surgery). You
will usually need to have an examination under anaesthetic as well. You will probably need to
have your womb and cervix removed as well as any part of the bladder or bowel that is affected.
You will also need to have any lymph nodes removed that are linked to the areas where the
cancer has come back.
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Chemoradiation
You may have chemotherapy to treat any stage of advanced cervical cancer, usually alongside
radiotherapy or possibly surgery.
Chemotherapy and radiotherapy together (chemoradiation) is a good option for many cervical
cancers. You don't have chemotherapy every day. So some days you'll have both treatments, and
others you'll just have radiotherapy. There are different ways of giving this treatment and it
depends partly on the drugs your doctor chooses. You may have chemotherapy once a week
throughout your 5 week radiotherapy course. Or you may have it every 2 or 3 weeks during your
radiotherapy course.
The combined treatment has more side effects, mainly affecting your bone marrow or bowel, but
these generally only last a short time. There is more information about combined chemoradiation
and the side effects in this section.
Controlling advanced cervical cancer
symptoms
What advanced cervical cancer means
Sometimes cervical cancer can't be cured. This may be because it keeps coming back in the
pelvis and abdomen despite all the treatment you have had. Or because it has spread from where
it started in the cervix to another part of the body. This is called a secondary cancer or metastasis.
Some of the cervical cancer cells have travelled through the lymphatic system or bloodstream
and lodged in another part of the body. They have then started to grow there. If cervical cancer
does spread to another part of the body it most often spreads to the
Liver
Lungs
Bones
Click on the links to find out more about secondary cancers.
It can also spread to the ureters (these are the tubes that run from each kidney to the bladder).
Even if your cervical cancer can't be cured, there is treatment available to control your
symptoms. This treatment may also shrink the cancer and slow it down, even if it cannot get rid
of it altogether.
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Which treatments are available
Surgery, chemotherapy and radiotherapy can all be used to treat cervical cancer that has spread
or cannot be cured. Which treatment you have will depend on
Where your cancer has spread
The size and number of secondaries you have
The symptoms the cancer is causing
The treatment you have already had
How well you are - whether you are strong enough to have a particular treatment
There may be trials of experimental treatments going on which you could take part in. These
could be trials for new chemotherapy drugs or new types of treatment. Look in the page on
cervical cancer research in this section.
We also have a trials and research section which includes a database of clinical trials. Choose
'cervical' from the drop down menu of cancer types. You can choose to search for trials that are
open and recruiting patients, trials that have finished recruiting and are following up the patients
who took part, and trials that have produced results.
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Deciding about treatment
It can be difficult to decide which treatment to try, or whether to have treatment at all, when you
have advanced cancer. You will need to consider how the treatment will affect you. This means
finding out about side effects as well as thinking about travelling back and forth to the hospital
for appointments and treatment.
Most importantly, you will need to understand what can be achieved with the treatment you are
being offered. Your doctor will discuss the options for treatment with you. There may be a
counsellor or specialist nurse you could chat to. You may also wish to talk things over with a
close relative or friend.
It can be helpful to talk over difficult decisions with someone who is outside your own circle of
family and friends. If you would like to talk to someone else, contact our cancer information
nurses. Or look for a cervical cancer organisation that can help put you in touch with a support
group. We also have information about counselling oganisations who can help you to find
sources of emotional support and counselling in your area.
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Radiotherapy
Doctors can use radiotherapy to
Shrink lung secondaries
Control pain
Radiotherapy can control pain by shrinking tumours that are pressing on nerves or are growing
inside the bones. When you have radiotherapy to control symptoms, you usually only have a
short course. You may only have one or two treatments and you'd very rarely have more than 10.
So you should not have many side effects. There is more about radiotherapy in our section on
treating cervical cancer with radiotherapy. And there is general information about radiotherapy
for symptoms in the radiotherapy section.
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Surgery for a blockage
Surgery is used in particular situations in advanced cervical cancer that cannot be cured. It can
only be used if you are fit enough to have an operation. And it is important to think about how
getting over an operation will make you feel. In other words, the benefits of the surgery should
be more than the discomfort you will have to go through.
If your cancer begins to grow into or around your bowel, there is a risk that it may cause a
blockage. This means that the waste that normally passes through the bowel cannot get through.
This does not happen to everyone. But if it happens to you, you may
Feel bloated
Be constipated
Feel sick
Have griping pains in your abdomen
Vomit large amounts
Your doctor may suggest surgery to clear a blocked bowel. It may be possible to operate to
remove the blockage, or in some cases, bypass it by making a colostomy. There is more
information about having a colostomy operation in our section about colorectal cancer: if you
need a colostomy.
No one can say how much you will benefit from this operation. The cancer may not come back
quickly. And it may not come back to block the bowel again. On the other hand, it may be quite
a big operation to have when you are feeling low.
Sometimes, instead of a colostomy, it is possible to have a tube called a stent put in, to allow
motions (poo) to pass along the bowel. The specialist will use X-rays to guide the stent into
place.
Sometimes doctors use a drug called octreotide to help control the symptoms of a blocked bowel
instead of an operation. The drug works by reducing the amount of fluid that builds up in your
stomach and digestive system. Unfortunately this treatment is only a temporary measure.
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Experimental surgery
With some types of cancer, doctors have had limited success in removing secondary cancers
from the liver or lungs. This can only be done if there are just one or two small and isolated areas
of secondary cancer in either the liver or lungs. It is not often tried with cervical cancer
secondaries, usually because the secondary cancer is too widespread. Or because other
treatments are tried instead. When deciding whether this treatment is possible for you, your
doctor will have to think about
Your general health
How advanced your cancer was when it was diagnosed
How quickly your cancer came back before
There is more information about this type of treatment in the section on treating cervical cancer
with surgery.
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Treating a waterlogged kidney
You may hear this called hydronephrosis. In cervical cancer, one (or sometimes both) of the
tubes from the kidney to the bladder can get blocked by the tumour. This means that the urine
made by that kidney cannot drain away and the kidney becomes overloaded with it. If not treated
this can make you feel extremely ill and can cause that kidney to fail. Obviously, it is even more
serious if both your kidneys are affected.
To treat this, your doctor will put in a tube to drain the urine. This can be done in two ways
Your doctor may be able to put a tube through the blockage. The tube is entirely inside your
body. It allows the urine to get past the blockage and drain into the bladder. The tube is called a
stent.
It isn't always possible to put a stent in straight away, or at all. If it can't be done straight away,
your doctor will put in a tube called a nephrostomy tube. This allows urine to drain out of the
body into a bag. The bag has a tap on it so you can empty it. After this type of surgery, you will
have a district nurse visit you at home to help you manage the tube and drainage bag. You may
be able to have a stent put in after things have settled down a bit with that kidney.
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Chemotherapy
This treatment is still being researched for advanced cervical cancer. This means doctors cannot
be sure how much help it will be. But good results have been reported in some cases. It is
sometimes possible to stop the spread and growth of the cancer for some months (in rare cases,
even years). Particularly if the cancer has only spread to one part of the body.
Treatment is usually with a combination of chemotherapy drugs. Using more than one drug
generally increases the chances of shrinking the tumour. You will almost certainly have some
side effects with chemotherapy treatment. The side effects vary depending on the drugs that are
being used to treat you. So ask your doctor or nurse what the side effects are likely to be. This
will help you decide whether to have the treatment or not.
There is more information about this type of treatment in the section on chemotherapy and also
in the section on treating cervical cancer with chemotherapy. There is information about specific
chemotherapy drugs in our cancer drug section.
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Treatment for particular symptoms
As well as having treatment to control symptoms by shrinking your cancer, there are treatments
that are directed straight at the symptoms. If you are having any troublesome symptoms, such as
pain or sickness, make sure that your doctor and specialist nurse know. They will be able to
suggest ways of making you more comfortable, and so improve the quality of your day to day
life.
Your hospital doctor, nurse or GP may suggest referring you to a team of symptom control
specialists. These doctors and nurses specialise in relieving symptoms of cancer and other
chronic diseases. You may hear them called Macmillan teams, palliative care teams or symptom
control teams. Some are hospital based and some are community based. They may be based at
your local hospice.
The community based teams are able to come and see you in your own home. The nurse or
doctor who visits will ask you questions about your symptoms - how bad they are, whether
anything makes them better or worse, for example. It may take a while to get good control of
your symptoms, but there is very little that they can't help you with. You may also find them a
source of emotional support. They have experience of working with people in your situation and
will be sensitive to how you are feeling.
There is such a wide range of possible symptoms, and ways of helping them, that we can't go
into them all here. We have a large section on coping physically with cancer. It includes
information about pain control and controlling sickness.
Cervical cancer and pregnancy
Pregnancy after treatment for cervical cancer
Unfortunately, after most treatment for cervical cancer, you cannot get pregnant. This can be
very distressing and occurs if you
have your womb removed (a hysterectomy)
have radiotherapy that stops your ovaries working
If you have very early cervical cancer and want to become pregnant after your treatment, you
may be able to have a cone biopsy or LLETZ. With these treatments your womb is not removed,
and so you could still get pregnant. When deciding on treatment, your doctor will take into
account your wishes to become pregnant in the future. But it will only be safe to have a cone
biopsy or LLETZ if the cancer is so early that it can be completely removed. There may be a
small increase in risk of early delivery of the baby (premature birth) after these treatments. This
may depend on the amount of cervical tissue that is taken away.
Another option is called a trachelectomy. Not everyone can have this type of treatment. It can
only be done if you have a very early cervical cancer - no more than a small stage 1 cancer. Most
of the cervix is removed, together with the upper part of the vagina. The womb and the upper
opening of the cervix (where it joins onto the womb) are left behind and rejoined to the vagina.
Your vagina will be shortened by this type of surgery.
The surgeon puts a stitch around the upper opening of the cervix to hold it closed. Babies have
been born safely to women who have had it done. But there is a risk of miscarriage or premature
birth after this operation. The babies have to be born by caesarean section because the cervix is
permanently stitched closed after the trachelectomy. With trachelectomy, fertility is not as good
as after cone biopsy. But radical trachelectomy is more likely than cone biopsy to cure slightly
larger cancers.
Before the operation, your surgeon will not be able to guarantee that you can definitely have a
trachelectomy. It isn't possible to tell how far the cancer cells have spread into the cervix. The
tissue removed by the surgeon has to be checked for cancer cells. This may be done while you
are still under anaesthetic. If cancer cells are found in the deeper levels of the cervix, more tissue
will have to be removed to cure the cancer. You may then need to have a hysterectomy or
combined chemotherapy and radiotherapy (chemoradiation).
If your surgeon finds you have a stage 1A2 or 1B cervical cancer, they will want to remove some
of your lymph nodes as well as the cancer. This is to check that no cancer cells have broken
away from the cancer and lodged in the lymph nodes around the womb. If there are, and these
are not treated, the cancer is likely to come back.
With a stage 1 cancer, there is only a small risk of the cancer spreading to the lymph nodes. But
if any of your lymph nodes are found to contain cancer cells, your specialist is likely to
recommend radiotherapy. Unfortunately, radiotherapy will make you infertile and so you will not
be able to have children even after the trachelectomy.
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Being pregnant when you are diagnosed
If you are diagnosed with invasive cervical cancer when you are pregnant, what will happen
depends on
What type of cervical cancer you have
How big the tumour is and whether it has spread (its stage)
How many weeks pregnant you are
What your wishes are
To make a decision, you will need full information from your medical and nursing team about
your options. They can tell you about the benefits and possible risks of each option. Your doctor
is part of a multi disciplinary team who will discuss your situation, and decide together what the
best treatment options are in your case. This team includes a
Doctor specialising in cancer drug treatment such as chemotherapy (medical oncologist)
Doctor specialising in cancer drug treatment and radiotherapy (clinical oncologist)
Surgeon specialising in the female reproductive system (gynaecological surgeon)
Doctor specialising in the care of women during pregnancy (obstetrician)
Doctor specialising in the care of newborn babies (neonatal doctor)
Expert in examining and identifying cells (pathologist)
Nurse specialist
Most women diagnosed with cervical cancer during pregnancy have early stage disease.
Research so far suggests that cervical cancers diagnosed during pregnancy grow no more quickly
and are no more likely to spread than cervical cancers in women who are not pregnant.
If you are in the second or third trimester of pregnancy (more than 3 months pregnant), your
doctor will probably say that you can continue the pregnancy but you may have the baby early
by caesarean section. The surgeon may remove your womb at the same time. You may then need
further treatment with radiotherapy and chemotherapy.
If you are less than 3 months pregnant, your doctor may want to treat you straight away. Your
doctor may feel more than 6 months is too long to leave a cervical cancer without treatment. If
you decide to have treatment then you may need to end the pregnancy. This can be very
distressing but remember that you will have support from your nurses and doctors. If you wish to
continue with your pregnancy, your doctor will delay treatment until you are over 3 months
pregnant, during the second trimester. Cancer treatment during pregnancy is experimental as
there are few cases and no large trials. Also there is little information on the long term outlook of
women treated during pregnancy.
For some small tumours it may be possible to have treatment with cone biopsy or trachelectomy.
There are very few women who have had a trachelectomy during pregnancy. There is a risk of
bleeding and of losing the baby shortly after the operation. For larger tumours, your doctor may
suggest having chemotherapy to shrink or control the cancer until the baby is born. You cannot
have chemotherapy during the first trimester as it can damage the baby or cause a miscarriage.
Research looking at chemotherapy given after the first trimester of pregnancy has so far not
shown an increased risk of birth defects compared to the general population. But researchers
need to collect more information over a longer time so we can understand more about the long
term outlook for children.
Deciding on treatment when you are pregnant can be very difficult. You will need to have time
to think and to find out what all your options are. It will not matter if your treatment is delayed
by a week or so. Make sure you have had the opportunity to ask all the questions you need to
ask. You can also ask if there is anyone else you (and your partner) can talk to such as a
specialist nurse or counsellor.
Cervical cancer surgery
Surgery for early cervical cancer
If you have surgery for early cervical cancer you will usually need to have a hysterectomy. For a
small number of women, there may be a choice of operation. For some very early cervical
cancers, it is possible to remove most of the cervix, but leave enough behind so that you may be
able to become pregnant and have a baby afterwards. This is called a radical trachelectomy.
Surgery for early cervical cancer is covered below on this page. On the next page in this section
there is information about surgery for cervical cancer that has spread beyond the cervix or has
come back after treatment.
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Surgery to remove part of the cervix (radical trachelectomy)
In this operation, your surgeon will try to remove all of the cancer, but leave behind the internal
opening of the cervix. This is then stitched closed, leaving a small opening to allow the flow of
your period to escape. The idea is that the stitch will support a growing pregnancy until the baby
can be born by caesarean section. This operation can only be done if you have a small stage 1
cervical cancer. Before the operation, your surgeon will not be able to promise you that
trachelectomy is possible. They can't tell for sure how far up into the cervix the cancer has
grown.

The part of the cervix that is removed during the surgery is checked under a microscope, often
while you are still in the operating theatre. If there are no cancer cells around the edge of the
tissue that has been removed and your surgeon is sure that all the cancer has gone, you will not
need to have any more tissue removed. If the lab results show that some cancer has been left
behind, you will have to have more tissue taken away. Your surgeon may then have to do a
hysterectomy after all. This can only be done during the same operation if you have given your
consent beforehand. Some women may have combined chemotherapy and radiotherapy
(chemoradiation) instead of hysterectomy.
Once all the checks have been done, your surgeon will put in the stitch that will hold your cervix
closed. Because there is a small risk of cancer spread to the lymph nodes in stage 1B cancers and
some stage 1A cancers, your surgeon may also need to remove some lymph nodes from around
your womb. They usually do this with a laparoscope (so it is sometimes called keyhole surgery).
You will have up to 5 small cuts (incisions) around your lower abdomen when you wake up.
These are the openings the surgeon used to remove your lymph nodes.
The lymph nodes will be checked under a microscope to see if they contain any cancer cells. If
they don't, then you will not need any further treatment. If cancer cells are found in any lymph
nodes, it is a sign that some cancer cells could have escaped from your cervix and a cancer could
begin to grow again. Your doctor is then likely to suggest that you have some radiotherapy to kill
off any other cancer cells that may have been left behind. If you need to have radiotherapy, you
will not be able to have a baby after the treatment. This can be very upsetting if you were hoping
to have a family. Your medical and nursing team will do all they can to support you.
Radical trachelectomy is a smaller operation than radical hysterectomy (the traditional
alternative). You will usually only have to be in hospital for 2 or 3 days. Most women recover
very quickly and complications are uncommon. There is more about pregnancy after cervical
cancer surgery in this section.
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Surgery to remove the womb (radical hysterectomy)
Surgery to remove the womb is quite a big operation, and may be necessary to make sure that all
the cancer has gone. You will be in hospital for between 4 and 7 days. And recovering at home
afterwards for at least another month or so. During the operation, the surgeon will remove
Your womb
All the tissues holding your womb in place
The top of your vagina
All the lymph nodes around the womb
This is called a radical hysterectomy (or Wertheim's hysterectomy).

If you have had your menopause, your doctor will talk to you about taking out your ovaries as
well. They are not usually affected by the cancer, but some surgeons think it is a good idea to
take them out and remove your risk of getting ovarian cancer in the future. It is important to
know that you are at no higher risk of cancer of the ovary than any other woman in the general
population.
If you have not had your menopause, it may be possible to leave the ovaries because removing
them would put you into an early (premature) menopause. If your ovaries do have to be removed,
you may need to take hormone replacement therapy (HRT) to prevent menopausal symptoms
and the effects of the menopause on your bones and other body organs.
After having the lymph nodes in your pelvis removed, there is a risk of developing swelling in
one or both of your legs. This is called lymphoedema. Your nurse will talk to you before your
operation about what you can do to try to lower your risk of developing lymphoedema.
If you notice one or both of your legs becoming more swollen anytime after having surgery, let
your nurse or doctor know. If it is caused by lymphoedema they can refer you to a lymphoedema
nurse specialist. The sooner it is diagnosed, the easier it is to treat.
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Keyhole surgery
Increasingly, surgeons are doing hysterectomies for early cervical cancer using keyhole surgery.
This is also called minimal access surgery or laparoscopic surgery. Instead of having a major
wound site, you have several smaller wounds. The doctor uses these to put in small surgical
instruments and a laparoscope. This is a bit like a telescope. There is an eyepiece attached to a
camera so that the surgeon can see inside the body.

Some hospitals are now using robotic surgery to remove cervical cancer. This is a type of
keyhole (laparoscopic) surgery. The surgeon sits at a control unit a few feet away from the
patient. The surgeon controls the movement of a set of robotic surgical equipment, guided by a
video camera. This gives the surgeon a 3D view, which they can magnify a number of times.
This helps the surgeon carry out difficult operations using very precise movements. In the photo
you can see the surgeon sitting at the control unit on the right hand side of the picture.

Keyhole surgery can take longer than traditional open surgery. But women generally recover
quicker, staying in hospital for 2 or 3 days. And most women have little pain. It is normal to feel
tired after major keyhole surgery and most women need at least 2 weeks of rest and plenty of
sleep before returning to most normal activities. Compared to open surgery, keyhole surgery may
also reduce the risk of other problems that can happen after any surgery such as wound infection,
blood clots and the need for blood transfusion.
Surgery for advanced cervical cancer
What advanced cervical cancer is
Advanced cervical cancer includes both cervical cancer that has spread at the time of your
diagnosis, and cervical cancer that has come back after previous treatment.
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What surgery involves
Surgery for advanced cervical cancer can involve many of the structures within the pelvis (the
lower part of your abdomen). All the cancer will need to be removed, together with any lymph
nodes the cancer may have spread into. How much surgery you have will be very individual. It
will depend on where the cancer is.
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Types of surgery
Removing the womb, cervix, top of the vagina and lymph nodes as well as other organs is called
pelvic exenteration. The aim of exenteration is to try to cure your cancer. Because it is a big
operation, it is important that you are fit enough to make a good recovery. It is not suitable for
everyone. You usually have an examination under anaesthetic and a scan first to check if an
operation is possible for you. This may be a CT scan, an MRI scan or a PET scan. It is important
to discuss this type of operation fully with your doctor or specialist nurse so that you know
exactly what to expect after the operation.
There are 3 types of exenteration operations
Anterior (front) exenteration
Posterior (back) exenteration
Total exenteration
Anterior (front) exenteration
In this operation you will have your womb, ovaries, cervix, top of the vagina and lymph nodes
removed. Your bladder and lymph nodes around the bladder will also be removed.
After this operation you will have a urostomy and will need to have bags to collect your urine.
There is information about a urostomy in our section about bladder cancer. If you look at this
section, do remember to use the back button to come back to the cervical cancer section. The
rest of the information in the bladder cancer section will not apply to you.

Posterior (back) exenteration
In this operation you will have your womb, ovaries, cervix, top of the vagina and lymph nodes
removed. Part of your bowel and rectum will also be removed.
After this operation you will need to have a colostomy and you will have a bag to collect your
bowel movements (poo). There is information about a colostomy in our section about bowel
(colorectal) cancer. If you look at this section, do remember to use the back button to come
back to the cervical cancer section. The rest of the information in the bowel cancer section will
not apply to you.

Total exenteration
In this operation you will have your womb, ovaries, cervix, top of the vagina and lymph nodes
removed. You will also have the lower bowel, rectum and the bladder removed.
After this operation you will have both a colostomy and a urostomy. You will need to have a
bag to collect your bowel movements and a bag to collect your urine. There is information
about a colostomy in our section about bowel (colorectal) cancer and information about a
urostomy in our section about bladder cancer. If you look at either of these sections, do
remember to use the back button to come back to the cervical cancer section. The rest of the
information in the bowel cancer and bladder cancer sections will not apply to you.

What happens before your surgery
Your surgeon will need to be sure you are fit for your operation. You may have had some of
these general tests when your cancer was being diagnosed. If so, you won't need to have them
again. You will probably have
Chest X-ray
Blood tests
Urine test
Heart trace (ECG)
CT or MRI scan
These tests are to check your general health before your operation and to get as much
information about the cancer in advance. Some hospitals do these tests when you are an
outpatient. Some do them when you get to the hospital the night before your operation.
When you go into hospital for your surgery, you will see your anaesthetist, one of the junior
doctors working for your surgeon and a nurse who will be involved in your care. They will ask
you to sign a consent form for the operation. The doctor should explain the form fully to you
before you sign it. If you are having very major surgery, you may see more than one doctor, as
other specialist surgeons may be involved in your care. For example, if you are going to have
your bladder removed, a urologist will be working with your gynaecologist.
If you are having very major surgery, which could involve the removal of your bladder or
rectum, a member of the stoma care team will come to see you before your operation. A stoma is
an opening in the body. A stoma is made if the rectum or bladder is removed. The stoma is
covered with a bag that collects your urine or bowel motions. The stoma care team is a team of
nurses who can help you to manage if you need this type of surgery. They will go through with
you what will happen and what you will have to do after the operation. If you agree, they may be
able to introduce you to someone who has already had this type of surgery and can help to
explain to you what it will involve and what it is like coping with this type of treatment. The
stoma nurse will visit you after your operation too and help you to learn to look after your stoma
and bag.
Before your operation, you may be asked to follow a diet sheet for a few days and take quite
strong laxatives to make sure the bowel is as clean as possible. This helps to lessen the risk of
infection after surgery and make the operation easier. You may also need to have an enema when
you get to hospital. Your nurse may need to shave your pubic hair to make sure the operation site
is as clean as possible.
You will not be able to eat or drink anything for six hours before your anaesthetic. It is very
important to stick to this. If you don't your operation may have to be postponed because there is a
risk that you may be sick (vomit) under anaesthetic.
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After a hysterectomy
When you wake up after your operation you will have a few tubes in place. You will have
A drip (intravenous infusion) into your arm to give you fluids until you are eating and drinking
again
A tube (catheter) into your bladder to drain your urine
One or more fine tubes (wound drains) into your abdomen to drain away any fluid that collects.
This helps the wound to heal
You may have a very fine tube into your spine (an epidural), carrying painkillers to control your
pain after the surgery
You will not be able to eat or drink much at first. But as soon as you are fully awake you will be
able to wet your mouth with sips of water. Your doctor will listen to your abdomen with a
stethoscope to see if your bowel is working normally (sometimes the bowel stops working for a
while after abdominal surgery). As soon as it is, you will be able to increase the amount you are
drinking and then progress to something light to eat. You should be eating and drinking normally
again within a couple of days at the most.
Because you will not be able to move around freely, you will have daily injections of a drug
called heparin, to thin your blood and help prevent clots in the legs (deep vein thrombosis or
DVT) or lung (pulmonary embolism or PE). You will also have elastic stockings to wear. These
help the blood to flow back to the heart (normally the movement of the leg muscles does this).
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After other types of major surgery for cervical cancer
As with hysterectomy, you will wake up with quite a few tubes in place. You may have
A drip to give you fluids
A tube into a blood vessel in your neck, that your doctor uses to give you fluids and to measure
your blood pressure
Wound drains coming out of your abdomen and connected to drainage bottles or bags
A catheter to drain your urine (unless your bladder has been removed)
A urostomy tube, that goes into an opening on your abdomen to drain your urine (if you have
had your bladder removed)
A very fine tube into your spine (an epidural), carrying painkillers to control your pain after the
surgery
After very major surgery, you will probably wake up in the intensive care unit or surgical high
dependency unit. This is routine and nothing to worry about. You are in one of these wards
because they have a higher number of nurses to patients and so are able to give you all the
attention you need for the first few hours. If your condition is stable, your doctor will arrange for
you to go back to the regular ward about 36 to 48 hours after your surgery finished.
There is more about recovering from an operation to remove the bladder in our section on
surgery for bladder cancer and about colostomy surgery in the bowel cancer section. Remember
this information is not in the cervical cancer section, so you'll need to use the back button at the
top left of your screen to get back to information about cervical cancer.
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Painkillers
You may have pain for the first week or so. But there are many different painkillers you can
have. It is important to tell your doctor or nurse as soon as you feel any pain. They need your
help to find the right type and dose of painkiller for you. Painkillers work best when you take
them regularly.
When you first wake up, you may have a pump attached to your drip that contains painkillers.
You may have a hand control connected to the pump that has a button you can press. You can
use this to give yourself extra painkillers as you need them. You can't overdose - the machine is
set to prevent that. Do tell your nurse if you need to press the button very often. You may need a
higher dose in the pump.
You may have painkillers into the spine (epidural analgesia) for the first day or so after surgery.
This is the same type of pain control that is sometimes used for labour pains. These painkillers
work very well for controlling pain after an operation. They don't make you drowsy and don't
make you feel sick, unlike some other strong painkillers. They do numb the legs, but this doesn't
matter when you are in bed for a couple of days after a major operation. You may come back
from the theatre with the epidural all set up. You'll have a very fine tube taped to your back. This
connects to a pump, which gives you a continuous dose of painkiller into the space around the
nerves in your back.
Whatever method of pain control you are having, tell your nurse if you are in pain. You may
need a different type of painkiller, or you may need a higher dose. We have a whole other section
on pain and pain control.
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Your wound
If you have had a hysterectomy, you are most likely to have a wound that runs vertically, up and
down your lower tummy (abdomen). This is called a mid line incision. It allows the surgeon
good access to all parts of the abdomen, so they can check the tissues around the womb
thoroughly. Or, you may have a wound that runs across your lower abdomen, from right to left -
a transverse incision. If you are overweight, this may be easier for the surgeon and will heal
more easily. If you've had keyhole (laparoscopic) surgery you may have about 5 smaller wounds
on your abdomen rather than one large wound. If you've had other surgery, the wound site will
vary according to what you've had done.
Your wound will be covered up when you come round from the operation. It will be left covered
for a couple of days. Then your nurse will change the dressing and clean the wound. The wound
drains will stay in until they stop draining fluid. Your nurse will change the bottles attached to
them every day. Wound drains usually come out about 2 to 7 days after the operation. Taking
them out is most often very straightforward. Your nurse will snip the stitch holding the drain in
and then pull it out smoothly. This may feel quite odd, and you may feel a twinge, but it doesn't
usually hurt any more than that.
Your stitches or clips will stay in for at least 7 to 10 days. Your nurse may take them out before
you go home. But if they are still in, you can either have an appointment to go back and have
them taken out at the hospital, or a district nurse can go to your home to remove them. Many
hospitals use stitches that gradually dissolve, so you don't need to have them taken out. If you
have these, you may have sticky strips (steristrips) over the wound.
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Getting up
This may seem impossible at first. Moving about helps you to get better, but you will usually
need to start gradually. Your physiotherapist will visit every day after your operation to help with
your breathing and leg exercises. Your nurses will also remind you to do the exercises. The
physio can be very helpful for teaching you how to get out of bed without it hurting too much.
Your nurses will encourage you to get out of bed and sit in a chair as soon as possible. Once all
the drips and drains are out it will be much easier to get around. Then you will really feel that
you are making progress.
Wind pain is quite common after hysterectomy. This is a colicky type of pain, caused by your
gut shutting down for a while. Moving around as early as possible helps to prevent this. It also
helps to lower the risk of more serious complications such as blood clots in the legs (DVT).
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Getting over your surgery
After this type of abdominal surgery, you will need to rest at home for at least a month after you
come out of hospital. Your first outpatient appointment is usually arranged for about 6 weeks
after the date of your surgery. Until this time, you will not be able to
Do heavy housework, such as vacuuming
Carry heavy bags of shopping or washing
Drive
This is because all these activities put pressure on your abdominal muscles and skin. These need
time to heal and it will take longer to get over your operation if you put too much strain on the
area. You will gradually be able to increase the amount you can do. A short walk every day is a
good idea. You will get a bit of fresh air and you can gradually go further as you regain your
strength. Do take it easy at first though. Remember that however far you walk, you'll have to
cover the same distance again to get back home!
Cervical cancer radiotherapy
This section tells you about radiotherapy for cancer of the neck of the womb (cervix).
Having radiotherapy for cervical cancer
Radiotherapy uses high energy waves to treat cancer. You can have radiotherapy for cervical
cancer externally or internally.
External radiotherapy treatment means the beams are directed at your body from a machine
that is similar to an X-ray machine. This type of treatment is given in the hospital radiotherapy
department. You usually have this once a day from Monday to Friday with a rest over the
weekend. External radiotherapy treatment for early cervical cancer usually lasts for 5 weeks.
Internal radiotherapy means a radioactive source is put into your vagina and up into the womb.
This stays in for either hours or days to give an extra boost of treatment to the cancer itself and
the area close by. Usually you have both these treatments for early cervical cancer. Sometimes
doctors use radiotherapy after surgery.
Before starting radiotherapy you will have a blood test to check for anaemia. Anaemia is
common if you have been bleeding from the vagina. You may need to have a blood transfusion
before you start your treatment.
There is information on the next page about short term side effects and possible long term side
effects of radiotherapy treatment for cervical cancer.
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Radiotherapy and chemotherapy together
For the past few years, combined radiotherapy and chemotherapy (chemoradiation) is the
recommended treatment for most women with a cervical cancer that is anywhere between stage
1B2 and stage 4A. That is, anything from a cancer that is just on the cervix, but bigger than 4 cm,
to a cancer that has spread to other body tissues outside the womb, such as the bladder or bowel.
There has been a great deal of research to show that this combination of treatment is more likely
to cure a cervical cancer than radiotherapy alone.
For chemoradiation, you have external radiotherapy as normal, but you have chemotherapy at the
same time. Most often, this means an injection of a chemotherapy drug called cisplatin once a
week throughout your course of radiotherapy. There is more about combination radiotherapy and
chemotherapy in this section.
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Planning external radiotherapy
Before you begin your treatment, the radiotherapy team carefully plan your external beam
radiotherapy. This means working out how much radiation you need to treat the cancer and
exactly where you need it. Your planning appointment may take from 15 minutes up to a couple
of hours. You will have a planning CT scan. The scan shows the cancer and the structures around
it.
The 360 photo is of a CT scanner. You can use the arrows to look around the room.
You lie on the scanner couch with the treatment area exposed. The radiographers will put some
markers on your skin. You need to lie very still. Once you are in position the radiographers move
the couch up and through the scanner. The scanner is a doughnut shape. The radiographers leave
the room and the scan starts. It takes up to 5 minutes. You won't feel anything. The radiographers
watch from the next door room.
Before the planning appointment you may also have other scans, such as MRI scans or PET
scans. Your treatment team can feed the other scans into the planning scanner.
Ink marks
Once the treatment team has planned your radiotherapy, they may put ink marks on your skin to
make sure they treat exactly the same area every day. They may also make pin point sized tattoo
marks in these areas. We have information about radiotherapy skin markings.
After your planning session
You may have to wait a few days or up to 2 weeks before you start treatment. During this time
the physicists and your radiotherapy doctor decide the final details of your plan. Your doctor will
plan the areas that need treatment and outline areas to limit the dose to or avoid completely. They
call this contouring. Then the physicists and staff called dosimetrists plan the treatment very
precisely using advanced computers.
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Having external radiotherapy
Radiotherapy machines are very big. The machine may be fixed in one position or able to rotate
around your body to give treatment from different directions. Before your first treatment your
radiographers will explain what you will see and hear. The treatment rooms usually have docks
for you to plug in music players. So you can listen to your own music.
You can't feel radiotherapy when you actually have the treatment. It takes anything from 1
minute to several minutes. It is important to lie in the same position each time, so the
radiographers may take a little while to get you ready.

Once you are in the right position the staff leave you alone in the room for a few minutes. They
watch you carefully through a window or on a closed circuit television screen. They may ask you
to hold your breath or take shallow breaths during the treatment.
Our page about having external radiotherapy has a video about having radiotherapy that you may
want to watch.
External radiotherapy doesn't make you radioactive. It is perfectly safe to be with other people,
including children, throughout your course of treatment.
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Internal radiotherapy
Internal radiotherapy (also called brachytherapy) means the radiation source (the substance that
gives off the radiation) is put inside your body. For cervical cancer, the source is put into the
vagina, through the cervix up into the womb. This way, a high dose of radiation can be given
very locally to the cervix and the lower part of the womb. You usually have your internal
radiotherapy within 1 or 2 weeks of finishing your external radiotherapy. You can have this
treatment in different ways. The total radiation dose will be about the same, whichever type of
treatment you have. You may have your treatment as an outpatient or with overnight stays.
You may have an MRI or CT scan a few days before you start internal radiotherapy to help plan
your treatment.
Treatment as an outpatient
Outpatient treatment is sometimes called high dose rate treatment (HDR). The doctors use a
machine that can safely deliver the radioactive source to the right place and remove it when the
treatment is over.
The machine contains a radiation source that gives off radiation quite quickly (irridium or
cobalt). You have several short treatments, up to a week apart. If you had the total dose in one
go, you would have too many side effects. You are most likely to have between 2 and 5 separate
treatments (these are called fractions). There is information about possible side effects of
brachytherapy for cervical cancer on the next page in this section.
You can have this treatment as an outpatient or an inpatient. This will depend on your doctor's
advice and how well you are feeling once the treatment is over. You will probably be asked to go
into hospital on the morning of your treatment. But some units may ask you to go in the night
before. You should not eat or drink that morning, as you will be having an anaesthetic. When
you are due to have the treatment, you will go down to theatre and have your anaesthetic. The
anaesthetic may be an injection into your spine (epidural) which will make you feel numb below
the waist. Or you may have a general anaesthetic, which will put you to sleep.
Once you have had your anaesthetic, the doctor will put the applicators in place, passing them
through your vagina and into your womb. You may have an MRI or CT scan with the applicators
in place. This is so the doctor can see the tumour and areas of healthy tissue, and can give the
treatment more safely.
You will then be moved to a room that houses the radiotherapy machine containing the radiation
source. The applicators are connected to the machine. The machine moves the radiation sources
into the applicators and give the treatment. This usually takes about 10 to 15 minutes. Then the
machine pulls the radiation sources back and your applicators are removed. Then, you can go
back to your ward to recover. If you have had a general anaesthetic, this may all take place while
you are still asleep and you will just wake up on the ward.
In some treatment units, a small plastic cuff stays in place in the opening of your cervix
throughout your treatment course. This is a narrow plastic tube, through which the applicators
can be guided for the next treatment. If your hospital gives the treatment this way, you may not
have an anaesthetic the second time around. Once your final treatment is over, the plastic cuff is
pulled out. This is quick but can be a bit painful and you may want to ask for gas and air or other
pain relief while it is done.
You may be able to go home the same day, once you have fully recovered from the anaesthetic.
You may have some bleeding from the vagina after this treatment. But that should clear up
within 48 hours. Your doctor may advise you to stay overnight. If you do go home, someone will
have to take you and stay with you once you get there. If you live alone, your doctor will almost
certainly want you to stay in hospital overnight. If you are having loose or frequent bowel
movements your nurse will advise you about diet. And you'll need to drink plenty of fluids and
make sure you get enough rest.
As an inpatient
The pulsed dose rate (PDR) radiotherapy system gives a dose of radiation for 10 minutes every
hour for 12 to 24 hours.
During a short anaesthetic, plastic holders (called applicators) for the radioactive source are put
in place in your vagina and womb. You may have an ultrasound scan at the same time to help
doctors guide the applicators into the right place. Once you are awake, you may have an MRI or
CT scan to help plan your treatment with the applicators in place. This helps doctors make sure
the healthy tissue near to the cervix is exposed to as little radiation as possible and reduces side
effects.

You will also have have a tube into your bladder (a catheter) so that you don't have to get out of
bed to pass urine. When you get back to the ward, you will be in a room on your own (or
sometimes with one other woman having the same treatment). A member of your treatment team
will connect the applicators to the machine and it gives the radiotherapy each hour.
The applicators are packed into your vagina with gauze to stop them moving about. This can be
uncomfortable, if not a little painful. So you will have regular painkillers to help keep you
comfortable. If you are uncomfortable or in pain, tell your nurse so that your medication can be
changed.
If you are having loose or frequent bowel movements, your doctor or nurse will prescribe drugs
so that you don't have bowel movements during this treatment.
You will not be able to get out of bed in case you dislodge the applicators. You should have a
call bell to hand at all times so you can ring the nurses if you need anything. Your room will
have a camera in so that the nurses can monitor you on a closed circuit television (CCTV)
screen. If you think the applicators have moved, tell the nurse or doctor straight away.
A nurse takes the applicators out for you on the ward. You will have painkillers beforehand. You
may also have gas and air to breathe when they are being removed as this helps to relax you.
Once the radioactive sources have been removed, all the radiation has gone. You can go home
that day, or the next, depending on how you are feeling.
Internal radiotherapy using needles
In some situations, for example if your cancer is more advanced, you may have hollow needles
put directly into the tissue next to the cervix (interstitial brachytherapy). These are put in at the
same time as the applicators into your vagina and womb. The needles and the applicators are
attached to the machine that contains the radiation source. The machine can move the radiation
sources into the needles and applicators at the same time. Interstitial needles can be used with
both PDR and HDR.
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Looking after yourself during radiotherapy
Some doctors may ask you to use a vaginal douche from the start of your radiotherapy. The idea
is that this keeps your vagina clean and reduces infection. Although some specialists still suggest
douching, it is not generally recommended now. If you have questions or concerns about
douching do talk them over with your doctor or specialist nurse.
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Finding out more about radiotherapy
Look at our radiotherapy section for more information about this type of treatment, including
What it involves
How your radiotherapy treatment is planned
Possible side effects
Follow up after radiotherapy
You can phone the Cancer Research UK nurses on freephone 0808 800 4040. The lines are open
from 9am to 5pm, Monday to Friday. They will be happy to answer any questions that you have.
Our general organisations page gives details of people who can provide information about
radiotherapy. Some organisations can put you in touch with a cancer support group. Our cancer
and treatments reading list has information about books, leaflets and other resources about
radiotherapy treatment.
Side effects during and just after treatment
Radiotherapy to the pelvic area usually causes a few side effects. These are
Diarrhoea
Irritable bladder (or radiation cystitis)
Feeling sick
Bleeding from the vagina after internal radiotherapy
Soreness and redness of your vulva or back passage
Diarrhoea is quite common during radiotherapy to the lower tummy (the pelvis). Your doctor
may give you some medication to help control it, and changing to a low fibre diet may help.
If your bladder is affected, you will have a feeling of always needing to go to the toilet (as with
cystitis). It may also be painful when you do pass urine. Although you may not feel like it, it will
help to drink plenty. Talk to your radiotherapy doctor or nurse. They may want to test your urine
just to make sure that there is no bladder infection making things worse.
You may feel sick, although this is not so common with radiotherapy to the pelvic area. If you
do, tell your doctor or nurse. They can give you anti sickness medication to take an hour or so
before each treatment.
After internal radiotherapy, you may have some bleeding from the vagina after the applicators
are taken out. This should clear up within 48 hours (2 days). If it becomes heavy or goes on for
longer, you should tell your radiotherapy doctor or nurse.
All these side effects usually disappear within a few weeks of finishing your treatment. There is
more information about these side effects in our section on abdominal side effects of
radiotherapy.
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Long term side effects
Generally, radiotherapy can cause body tissues to become tighter and less elastic. Doctors call
this fibrosis. This can have some lasting effects, depending on the part of the body being treated.
It can cause thickening of the skin in the treatment area, for example. Everyone treated will have
changes to the ovaries, womb and vagina. But you may not have other lasting effects from
radiotherapy. If you do get any, they can come on months or even years after your treatment
finishes. Some people may have
Swelling in their legs
Bladder and bowel side effects
Changes to the ovaries, womb and vagina
After your treatment you will find that your
Ovaries stop working, causing an early menopause
Vagina becomes narrower and less stretchy
Vaginal area becomes drier
If you have already had your menopause, your ovaries will have stopped working before your
treatment, so the radiotherapy will not make as much difference to you.
If you have not already had the menopause, the radiotherapy usually stops the production of sex
hormones by the ovaries. The hormone levels start to fall from about 3 months after the start of
treatment. It is important to use effective contraception during this time. Your periods will
gradually stop and you will get symptoms of the menopause. The symptoms may be more severe
than after a natural menopause. You can take hormone replacement therapy (HRT) after
treatment for cervical cancer. And there are gels and creams available that can help with vaginal
dryness.
Radiotherapy can have long term effects on your vagina which can affect your sex life. It can
make healthy tissues become stiffer and less stretchy. Doctors call this fibrosis, and it can
shorten and narrow your vagina. To try to prevent or minimise this, it is important to start using
vaginal dilators after your course of radiotherapy treatment. If you do not use these, it can be
difficult to have sex comfortably.
Dilators are cone or penis shaped objects, made of plastic or metal. They come in different sizes.
You gently put the dilator into your vagina for 5 to 10 minutes about 3 times a week. This will
stretch the vagina and help to stop it from narrowing. It is important not to force this. If you find
it difficult to get the dilator in, you should switch to a smaller size. You may find it easier with a
water soluble lubricant such as Astroglide, Durex lube or KY jelly. You can use the dilator in the
bath if you prefer. You can also use a moisturiser such as Replens which you use 2 or 3 times a
week.
If you find the dilator you have been using is getting a tighter fit, you may need to use it more
often. You can talk to your doctor or nurse about this. You may find you have slight bleeding or
spotting after using your dilator. This is normal. However, it isn't normal to have heavy bleeding
or pain. If you have either of these, stop and contact your doctor or nurse.
You usually start using your dilator from anything between 2 and 8 weeks after your
radiotherapy ends. This varies depending on your radiotherapy centre. Your doctor may advise
you to use the dilators for 2 years or more, even if you are sexually active.
There is more about these side effects and how to manage them in our section on how
radiotherapy affects sex and fertility for women.
Swelling
This is not a common side effect but sometimes one or both legs can swell if you have
radiotherapy to the lymph nodes. This swelling is called lymphoedema. In advanced cervical
cancer, the swelling is sometimes caused by the cancer, rather than treatment. If you think either
of your legs are getting swollen, tell your specialist straight away. You will need to be assessed
by a lymphoedema specialist. The sooner it is diagnosed, the easier lymphoedema is to treat.
Bladder and bowel side effects
You may have some permanent effects from your treatment. This doesn't happen to everyone,
but it isn't possible to tell before you are treated who will have them and who won't.
We don't know exactly how many women have long term effects. Treatment has altered over the
years and we are always looking back with this type of statistic, so often the available figures
don't relate to the way people are treated now. In March 2006, NICE (the National Institute of
Health and Clinical Excellence) published guidance on the use of high dose rate internal
radiotherapy. They reviewed the likelihood of side effects as part of their guidance. One large
study followed the progress of women for 8 years after their treatment. The study reported that as
many as 1 in 3 women (35%) had a bowel or bladder side effect after high dose rate treatment. In
nearly all these women, the side effect was relatively mild. There were more severe problems in
about 7 out of every 100 women treated (7%). Over all the studies NICE looked at, there were
bladder side effects in between 4 and 24 out of every 100 women (4% and 24%). And there were
rectal (back passage) side effects in between 4 and 20 out of every 100 women (4% and 20%).
After any type of radiotherapy for cancer of the cervix, you may find that you have to pass urine
more often. The treatment can make the bladder less elastic. So it won't stretch as far and feels
full sooner. You may also be more prone to urine infections.
You may have loose, or more frequent, bowel motions. This is because the radiotherapy irritates
the lining of the bowel. If you are troubled by these side effects, tell your doctor. You may be
able to take medicine to firm up your bowel motions and make them less frequent.
In rare cases, radiotherapy can cause constipation with pain, sickness and bloating. You should
contact your doctor if you have these symptoms. Your doctor will need to check your bowel for a
possible blockage.
Occasionally, radiotherapy to the pelvis can cause bleeding, which will show up in your bowel
movements or urine. This is usually caused by an increased growth of small blood vessels in that
area after the treatment. If you notice this, tell your doctor. Your doctor may call this problem
telangiectasia (pronounced teel-an-gee-ek-tay-zee-a).
Cervical cancer chemotherapy
When and why you have chemotherapy
Chemotherapy uses anti cancer or cytotoxic drugs to destroy cancer cells. They work by
disrupting the growth of cancer cells. The drugs circulate in the bloodstream around the body.
Your doctor may suggest chemotherapy
As part of your treatment when you are first diagnosed
For cancer that has come back
Before surgery as part of a clinical trial
Trials in the past few years have found that giving chemotherapy at the same time as
radiotherapy is the best choice of treatment for certain stages of cervical cancer. Your doctor
may call this chemoradiation or concurrent chemotherapy and radiotherapy. This is now the most
likely treatment if you have anything from a stage 1B2 cancer to a stage 4A cancer. We have
more information about chemoradiation and its side effects in this section.
Chemotherapy can shrink advanced cervical cancer. Your doctor may suggest it to help relieve
any symptoms that advanced cervical cancer is causing. You may have chemotherapy on its own
or alongside radiotherapy or surgery. There is more about this in our section on treating
advanced cervical cancer.
Sometimes, doctors try to use chemotherapy before surgery or radiotherapy to shrink a cancer. If
it works, this can mean that you need a smaller operation or radiotherapy treatment to a smaller
area. Doctors call this type of treatment neoadjuvant therapy. But it remains experimental for
cervical cancer. If your doctor suggests this treatment approach, it should only be as part of a
clinical trial.
Don't be afraid to ask your doctor about the different treatment options available to you.
Answering your questions is part of your doctor's job. It is very important that you feel confident
in the treatment your doctor suggests for the stage of cervical cancer you have. There is a list of
questions for your doctor that you may find useful at the end of this section.
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How you have chemotherapy
Most chemotherapy drugs are injections, although some are available as tablets. How often you
have the drug depends on which one you are having and on whether you are having a single drug
or several.
Generally, a course of chemotherapy takes a few days every 3 or 4 weeks. The drugs are injected
into one of your veins. So they can circulate through your bloodstream. You have about 3 or 4
weeks rest after each round of treatment. Then another few days of chemotherapy injections.
This is usually repeated six or more times to make up a complete course.
If you are having chemoradiation, you usually have chemotherapy once a week for about 5
weeks while you are having your course of radiotherapy. Because you are having weekly
chemotherapy, rather than 3 weekly, you have a slightly lower dose.
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Which drugs are used
If you are having chemoradiation, you are most likely to have a drug called cisplatin. For
advanced cervical cancer, clinical trials are still going on to find which other drugs and
combinations of drugs may help. Drugs that have been tested include
Cisplatin
Carboplatin
Ifosfamide
Fluorouracil
Irinotecan
Paclitaxel (Taxol)
Docetaxel
Gemcitabine
Topotecan
A commonly used combination of drugs is carboplatin and paclitaxel. The links above take you
to another page with information on the specific side effects of each drug. Just click your back
button at the top left of your screen to get back to this page.
In the UK, the organisations that approve treatments for the NHS have recommended a
combination of cisplatin and topotecan as a treatment option for women whose cancer has come
back after radiotherapy, or who have stage 4B cervical cancer, but only if they have not been
treated with cisplatin before.
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Side effects of chemotherapy
Chemotherapy has side effects. The effects you get will depend on
Which drugs you have
How much of each drug you are given
How you individually react
Not everyone gets every side effect with every drug. Some people react more than others. And
different drugs have different side effects. So we can't tell you exactly what will happen to you.
Most side effects only last for the few days that you are actually having the drugs. And there is
quite a bit that can be done to help. Here is a list of some common side effects
A drop in the number of blood cells
Feeling sick
Diarrhoea
Hair loss or thinning
Sore mouth and mouth ulcers
Feeling tired and run down
There is more about these side effects and how to deal with them in our section about
chemotherapy.
Ask your doctor or nurse which of these side effects are most common with the chemotherapy
drugs you will be having. Tell them about any side effects you have straight away so that they
can help you as much as possible.
Chemotherapy courses can seem to go on forever, particularly if you are getting very tired
towards the end of your course. But they do finish. And the side effects will go once your
treatment has ended.
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Dietary or herbal supplements and chemotherapy
We don't yet know much scientifically about how some nutritional or herbal supplements may
interact with chemotherapy. Some could be harmful. It is very important to let your doctors
know if you take any supplements. Or if you are prescribed them by alternative or
complementary therapy practitioners.
Talk to your specialist about any other tablets or medicines you take while you are having active
treatment. We have information about the safety of herbal, vitamin and diet supplements in our
complementary therapies section.
Some studies seem to suggest that fish oil preparations may reduce the effectiveness of
chemotherapy drugs. If you are taking or thinking of taking these supplements talk to your doctor
to find out whether they could affect your treatment.
Chemoradiation for cervical cancer
Combined chemotherapy and radiotherapy treatment
Until recently cervical cancer was most likely to be treated with radiotherapy or surgery to
remove the cervix, womb and lymph nodes. This type of surgery is called a hysterectomy.
Following clinical trials, doctors now know that giving chemotherapy at the same time as
radiotherapy (chemoradiation) gives the best chance of curing cervical cancer.
Giving radiotherapy and chemotherapy at the same time seems to work better at killing cancer
cells than having these treatments on their own. The reason for this is not very clear but
researchers think it may be because the chemotherapy makes cancer cells more sensitive to
radiotherapy.
Many clinical trials have compared different ways of giving this treatment. A review in 2010 of
these trials reported that chemoradiation helped women with cervical cancer to live longer.
Chemoradiation also lowered the risk of the cancer coming back or spreading to other parts of
the body.
Some trials have shown that cisplatin works best alongside radiotherapy for cervical cancer, but
this review reported that other chemotherapy drugs worked as well as cisplatin.
Combination chemotherapy and radiotherapy is not suitable for you if
You have very early stage cervical cancer (stage 1A and 1B1), because this can be successfully
treated with surgery or radiotherapy alone
You are not healthy enough for example because your kidneys dont work as well as they
should
You have very advanced stage cervical cancer (stage 4B) that has spread to other parts of your
body, such as the lungs or liver.
Unfortunately very advanced cervical cancer is unlikely to be cured by the radiotherapy and
cisplatin combination. Instead, you may have surgery, radiotherapy, chemotherapy or a
combination of these, depending on what best suits your particular circumstances.
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How you have chemoradiation
There are different ways of having chemoradiation treatment and it depends partly on the
chemotherapy drugs that you have. Cisplatin is one of the most common chemotherapy drugs
that doctors use.
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.
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Side effects of chemoradiation
The side effects of combined chemotherapy and radiotherapy are the same as if you had each
treatment separately. But some side effects are likely to be more severe. In particular, there is a
risk of developing a very low white blood cell count. This means you are at risk of getting an
infection. If you have any signs of infection, such as a raised temperature, a sore throat, or pain
when passing urine, you must contact your doctor.
You may also have a low platelet count. Platelets help your blood to clot. So if your platelets are
low, this may cause symptoms such as nosebleeds, bleeding gums, or a rash of red spots caused
by bleeding under the skin. If you have any of these symptoms, let your doctor know as soon as
possible. If your blood counts fall very low, you may need to stop chemotherapy for a while until
they recover.
Women having this treatment may be more likely to have digestive side effects, such as
diarrhoea, during their radiotherapy treatment. Again, do tell your doctor, nurse or radiographer.
They may not be able to get rid of the problem, but they may be able to give you something to
lessen it. Or they can help you to cope in other ways.
Cisplatin chemotherapy doesn't generally cause hair loss.
Most side effects are temporary and manageable. There is information in this section about the
particular side effects of radiotherapy and the side effects of chemotherapy for cervical cancer.
What happens at follow up appointments
This page tells you about follow up after treatment for cervical cancer. After your treatment has
finished, your doctor will want you to have regular check ups. These may include
Being examined by your doctor
Brushing a sample of cells from the cervix or colposcopy
Blood tests
X-rays
CT scans or MRI scans
Liver ultrasound scans
You will not have all these tests at every visit to your specialist. But you will probably be
examined at each appointment. And you may have blood tests regularly too. Your doctor will ask
how you are feeling and if you have any side effects from treatment. They will also want to
know whether you have had any new symptoms or are worried about anything.
Immediately after your treatment is over you will have a sample of cells taken from the cervix
using a small brush. Or you may have a colposcopy. You have this repeated once a year. If
you've had your womb removed, your doctor may suggest taking a sample of cells from the top
of the vagina if you have unusual symptoms. This is called a vaginal vault test.
Cervical cells can be very difficult to interpret after radiotherapy, and so you will not continue to
have regular tests as part of the UK cervical screening programme. But your doctor will still
want to have a look at the cervix using a speculum during your appointments to make sure there
are no problems.
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How often you have check ups
Your check ups will continue for some years after your treatment. At first they will be every few
months. But if all is well, they will gradually become less and less frequent. How often you have
appointments may vary according to the guidelines your doctor uses. One example of follow up
is 3 to 4 month check ups to start with. Then if all is well at a year after treatment they will
change to 6 monthly for 2 years. And then yearly for another 3 years.
Some hospitals see patients less often, if the outcome of their treatment is likely to be good.
Some are also arranging for specialist nurses to follow up patients with phone calls, to save them
having to come to the hospital unnecessarily.
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Worrying about your appointments
If you are worried, or notice any new symptoms that you think may be related to your cancer,
you can contact your doctor between appointments. Many people find their check ups very
stressful. If you are feeling well and getting on with life, a hospital appointment can bring all the
worry about your cancer back to you. You may find it helpful to tell someone close to you how
you are feeling. If you are able to share your worries, they may not seem quite so bad.
It is quite common nowadays for people to have counselling after cancer treatment. You can find
out more about counselling in our coping with cancer section.