Cancer of the cervix can be treated with either surgery, radiotherapy, chemotherapy or a combination of these treatments. Your doctor will be able to advise you on the best plan of treatment, taking into account a number of factors. These include your age and general health, and the type, stage and grade of the cancer.

Surgery is often the main treatment for cancer of the cervix in its early stages (where it is only in the cervix).

Radiotherapy is as effective as surgery in this situation but can cause more side effects. For this reason, surgery is usually used. Radiotherapy is sometimes used after surgery if there is a risk that some cancer cells may be left behind, to help reduce the risk of the cancer coming back. Sometimes radiotherapy is combined with chemotherapy, which is known as concomitant therapy or chemoradiotherapy.

Chemotherapy is occasionally used before surgery, to shrink the cancer and make the operation easier, but this is not common.

If the cancer has spread beyond the cervix, and is not curable with surgery alone, radiotherapy is the usual treatment. It is usually given in combination with chemotherapy.

Chemotherapy may be given to women whose cancer has spread to other parts of the body or if the cancer comes back after radiotherapy. It is used in this situation to try to shrink and control the cancer and relieve symptoms, to prolong a good quality of life. This is known as palliative treatment.

In most hospitals a team of specialists will work together to decide which treatment is best for you. This multidisciplinary team (MDT) will include:

• a surgeon who specialises in gynaecological cancers
• a clinical oncologist (chemotherapy and radiotherapy specialist)

and may include a number of other healthcare professionals such as:

• a nurse specialist
• dietitian
• physiotherapist
• occupational therapist
• psychologist or counsellor.

If two treatments are equally effective for your type and stage of cancer, your doctors may offer you a choice of treatments. Sometimes people find it very hard to make a decision. If you are asked to make a choice, make sure that you have enough information about the different treatment options, what is involved and the side effects you might have, so that you can decide which is the right treatment for you.

Remember to ask questions about any aspects of your treatment that you don’t understand or you feel worried about. You may find it helpful to discuss the benefits and disadvantages of each option with your cancer specialist, a specialist gynaecological nurse at the hospital or with the nurses at Cancerbackup.

If you have any questions about your treatment, don’t be afraid to ask your doctor or nurse. It often helps to make a list of questions and to take a close friend or relative with you.

Before you have any treatment your doctor will explain the aims of the treatment to you and you will usually be asked to sign a form saying that you give your permission (consent) for the hospital staff to treat you. No medical treatment can be given without your consent, and before you are asked to sign the form you should have been given full information about:

• the type and extent of the treatment you are advised to have
• the advantages and disadvantages of the treatment
• any other treatments that may be available
• any significant risks or side effects of the treatment.

If you do not understand what you have been told, let the staff know straight away so that they can explain again. Some cancer treatments are complex, so it is not unusual for people to need their treatment to be explained more than once.

Patients often feel that the hospital staff are too busy to answer their questions, but it is important for you to be aware of how the treatment is likely to affect you and the staff should be willing to make time for you to ask questions.

You can always ask for more time to decide about the treatment, if you feel that you can’t make a decision when it is first explained to you. You are also free to choose not to have the treatment. The staff can explain what may happen if you do not have it. It is essential to tell a doctor, or the nurse in charge, so that they can record your decision in your medical notes. You do not have to give a reason for not wanting to have treatment, but it can be helpful to let the staff know your concerns so that they can give you the best advice.

Many people are frightened at the thought of having cancer treatments, because of the side effects that can occur. Although the treatments can cause side effects, it is usually possible to control these with medicines. Some people want to know what would happen if they do not have any treatment.

Treatment can be given for different reasons and the potential benefits will vary depending upon the individual situation. In women with early-stage cervical cancer, surgery is often done with the aim of curing the cancer. Occasionally, additional treatments are given to help reduce the risks of it coming back.

With advanced cancer, treatment may only be able to control it, leading to an improvement in symptoms and a better quality of life. However, for some women the treatment will have no effect upon the cancer and they will have the side effects without any of the benefit.

If you have been offered treatment that is intended to cure your cancer, the decision whether to accept treatment may not be a difficult one. However, if a cure is not possible and the treatment is being given to control the cancer for a period of time, it may be more difficult to decide whether to go ahead.

Making decisions about treatment in these circumstances is always difficult, and you may need to discuss in detail with your doctor whether you wish to have treatment. If you choose not to, you can still be given supportive (palliative) care, with medicines to control any symptoms.

A number of cancer specialists work together as a team to decide the most suitable treatment for each patient. Even so, you may want to have another medical opinion. Most doctors will be willing to refer you to another specialist for a second opinion, if you feel it will be helpful. The second opinion may cause a delay in the start of your treatment, so you and your doctor need to be confident that it will provide useful information. If you decide to have a second opinion, it may be a good idea to take a friend or relative with you, and to have a list of questions ready, so that you can make sure your concerns are covered during the discussion.