Removing very early cancer
Large loop excision of the transformation zone (LLETZ)
This is where the cancerous cells are removed using a fine wire and an electrical current.
It's usually done under local anaesthetic (while you're awake but the area is numbed) and can be done at the same time as a colposcopy.
A cone-shaped area of abnormal tissue is removed during surgery. This is usually done under general anaesthetic (while you're asleep).
There are 3 main types of surgery for cervical cancer:
- trachelectomy – the cervix, surrounding tissue and upper part of the vagina are removed, but the womb is left in place
- hysterectomy – the cervix and womb are removed and, depending on the stage of the cancer, it may be necessary to remove the ovaries and fallopian tubes
- pelvic exenteration – a major operation in which the cervix, vagina, womb, ovaries, fallopian tubes, bladder and rectum may all be removed
Pelvic exenteration is only offered when cervical cancer has come back.
A trachelectomy is usually only suitable if cervical cancer is diagnosed at a very early stage. It's usually offered to women who want to have children in the future.
During the procedure, the cervix and upper section of the vagina are removed, leaving the womb in place. Your womb will then be reattached to the lower section of your vagina.
It's usually done by keyhole surgery.
Lymph nodes (part of the lymphatic system, the body's waste-removal system) from your pelvis may also be removed.
Compared with a hysterectomy or pelvic exenteration, the advantage of this type of surgery is that your womb remains in place. This means you may still be able to have children.
However, it's important to be aware that the surgeons carrying out this operation cannot guarantee you will still be able to have children.
A stitch will be put in the bottom of your womb during the surgery. This is to help support and keep a baby in your womb in future pregnancies. If you do get pregnant after the operation, your baby will have to be delivered by caesarean section.
It's also usually recommended you wait 6 to 12 months after surgery before trying for a baby so your womb and vagina have time to heal.
Trachelectomy is a highly skilled procedure. It's only available at certain specialist centres in the UK, so it may not be offered in your area and you may need to travel to another city for treatment.
A hysterectomy is usually recommended for early cervical cancer. This may be followed by a course of radiotherapy to help prevent the cancer coming back.
Two types of hysterectomies are used to treat cervical cancer:
- simple hysterectomy – the cervix and womb are removed and, in some cases, the ovaries and fallopian tubes are too; only appropriate for very early-stage cervical cancers
- radical hysterectomy – preferred option in advanced stage 1 and some early stage 2 cervical cancers; the cervix, womb, top of the vagina, surrounding tissue, lymph nodes, fallopian tubes and, sometimes, ovaries are all removed
Short-term complications of a hysterectomy include infection, bleeding, blood clots and accidental injury to your ureter, bladder or rectum.
Although the risk of them is small, long-term complications can be troublesome. They include:
- your vagina becoming shorter and drier, which can make sex painful
- urinary incontinence
- swelling of your arms and legs, caused by a build-up of fluid (lymphoedema)
- your bowel becoming blocked by a build-up of scar tissue – this may require further surgery
Because your womb is removed during a hysterectomy, you will not be able to have children.
If your ovaries are removed, it will also trigger the menopause if you have not already experienced it.
See complications of cervical cancer for more information about the menopause.
A pelvic exenteration is a major operation that's usually only recommended when cervical cancer comes back. It's offered if the cancer returns to the pelvis but has not spread beyond this area.
A pelvic exenteration involves 2 phases:
- the cancer and the vagina are removed – it may also involve removing the bladder, rectum or lower section of the bowel, or all 3
- 1 or 2 holes, called stomas, are created in your tummy – the holes are used to pass pee and poo out of your body into pouches called colostomy bags
Following pelvic exenteration, it may be possible to reconstruct your vagina using skin and tissue taken from other parts of your body. This would mean you could still have sex after the procedure, although it may be several months until you feel well enough to do so.
Radiotherapy may be used on its own or in combination with surgery for early-stage cervical cancer. It may be combined with chemotherapy for advanced cervical cancer, where it can be used to control bleeding and pain.
Radiotherapy can be delivered either:
- externally – a machine beams high-energy waves into your pelvis to destroy cancerous cells
- internally (brachytherapy) – a radioactive implant is placed next to the tumour inside your vagina
In most cases, a combination of internal and external radiotherapy will be used. A course of radiotherapy usually lasts about 5 to 8 weeks.
As well as destroying cancerous cells, radiotherapy can sometimes also harm healthy tissue. This means it can cause significant side effects many months, or even years, after treatment.
Brachytherapy aims to reduce harm to surrounding tissue by delivering the radiation as close as possible to the tumour, but it can still cause side effects.
However, the benefits of radiotherapy often tend to outweigh the risks. For some people, radiotherapy offers the only hope of getting rid of the cancer.
Side effects of radiotherapy are common and can include:
- pain when peeing
- bleeding from your vagina or rectum
- feeling very tired
- feeling or being sick
- sore skin, like sunburn, in your pelvis region
- narrowing of your vagina, which can make having sex painful
- damage to the ovaries, which will usually trigger an early menopause if you have not already gone through it
- bladder and bowel damage, which could lead to incontinence
Most of these side effects will resolve within about 8 weeks of finishing treatment, although in some cases they can be permanent. It's also possible to develop side effects several months, or even years, after treatment has finished.
If infertility is a concern for you, it may be possible to surgically remove eggs from your ovaries before you have radiotherapy so they can be implanted in your womb at a later date. However, you may have to pay for this.
It may also be possible to prevent an early menopause by surgically removing your ovaries and replanting them outside the area of your pelvis that will be affected by radiation. This is called an ovarian transposition.
Your doctors can provide more information about the possible options for treating infertility and whether you're suitable for an ovarian transposition.
Chemotherapy can be combined with radiotherapy to try to cure cervical cancer, or it can be used as a sole treatment for advanced cancer to slow its progression and relieve symptoms (palliative chemotherapy).
Chemotherapy for cervical cancer usually involves using either a single chemotherapy drug, called cisplatin, or a combination of different chemotherapy drugs to kill the cancerous cells.
Chemotherapy is usually given straight into your vein using a drip. You will probably be seen as an outpatient so will be able to go home once you've received your dose.
As with radiotherapy, these medications can also damage healthy tissue. Side effects are therefore common and can include:
- feeling and being sick
- feeling tired all the time
- reduced production of blood cells, which can make you tired, breathless and vulnerable to infection
- mouth ulcers
- loss of appetite
- hair loss – cisplatin does not usually cause you to lose your hair, but other chemotherapy drugs may
If you do lose your hair, it usually should grow back within 6 months of the completion of your course of chemotherapy.
Some types of chemotherapy medication can damage your kidneys so you may need to have regular blood tests to assess the health of your kidneys.
After you finish your treatment and the cancer has been removed, you'll need to attend regular appointments for testing. This will usually involve a physical examination of your vagina and cervix (if it hasn't been removed).
Because cervical cancer can return, these examinations will be used to look for signs of this happening. If the examination finds anything suspicious, a further biopsy can be done.
Follow-up appointments are usually recommended every 3 to 6 months for the first 2 years, and then every 6 to 12 months for a further 3 years.
Your multidisciplinary team (MDT)
Members of your MDT may include:
- a surgeon
- a clinical oncologist (a specialist in chemotherapy and radiotherapy)
- a medical oncologist (a specialist in chemotherapy only)
- a pathologist (a specialist in diseased tissue)
- a radiologist (a specialist in imaging scans)
- a gynaecologist (a doctor specialising in treating conditions that affect the female reproductive system)
- a social worker
- a psychologist
- a specialist cancer nurse, who'll usually be your first point of contact with the rest of the team