Chemoradiation for cervical cancer

You may have chemoradiation after surgery. This is to help reduce the risk of the cancer coming back.       

Having chemoradiation after surgery is called adjuvant treatment. Not everyone needs adjuvant treatment after surgery. You may only need it if:

• the cervical cancer has spread to your lymph nodes
• the cervical cancer was larger and more likely to spread.

You may have chemoradiation if you have locally advanced cervical cancer that can’t be treated with surgery. This is called radical treatment.

Less commonly, you may have chemoradition before surgery. It is done as part of a clinical trial and is called neoadjuvant treatment.  The idea is that chemoradiation may help shrink the tumour and make surgery easier.

Chemoradiation can damage your ovaries. This will mean you almost definitely won’t be able to get pregnant and have a child or more children after treatment. 

You will probably feel very emotional about this, which can make it hard to think about some practical steps you could take. But it is important to discuss these options with your healthcare team before you start treatment. Before treatment, you may be able to:

• freeze and store eggs
• freeze and store embryos – these are eggs that have been fertilised
• have an operation to move your ovaries (ovarian transposition).

This may delay treatment, so you will need to consider any risks of doing that. Your healthcare team can explain how it might affect your individual situation. Unfortunately, egg freezing, embryo freezing and ovarian transposition are not always possible and these services are not available in every hospital.

Ovarian transposition

Ovarian transposition is a surgery to move your ovaries away from where the radiotherapy part of your treatment will be aimed. It is done to try and prevent early menopause, which means you may still be able to have a child or more children through surrogacy.  

You have it before radiotherapy starts. Whether it can be done will depend on:

• the stage of the cancer 
• the risk of the cancer having spread to the ovaries. 

Unfortunately, ovarian transposition does not always work. You may have the surgery but still go through early menopause and be unable to have children. 

Read about fertility preservation on the Macmillan Cancer Support website >

Your immune system protects the body from infection by finding and killing germs, bacteria or viruses.  

Chemotherapy can affect your immune system. This means that chemotherapy may mean you have a higher risk of becoming ill with coronavirus. Radiotherapy and brachytherapy usually don’t have a big impact on the immune system. 

Your hospital is doing as much as possible to reduce the risk of getting or becoming ill with COVID-19. When your healthcare team are supporting you to make treatment decisions, they will consider the risk of COVID-19 as part of this. In most hospitals we have spoken to, chemoradiation is continuing as usual for cervical cancer patients. But your healthcare team may talk to you about:      

• delaying your treatment – this may only be for the chemotherapy part of your treatment 
• changing how often you have treatment – so you visit the hospital less 
• changing to oral chemotherapy – topotecan can be given as tablets, although this is rarely used to treat cervical cancer
• changing to a different treatment.
• using telephone calls and video calls to avoid face to face appointments where possible
• having a test to check for COVID-19  before each treatment session.

Your healthcare team will probably ask you to self-isolate for about 2 weeks before and after chemoradiation. They will let you know what you should and shouldn’t do during this time. When you are having chemotherapy, you are considered extremely clinical vulnerable by government standards – this means you should follow specific guidance in your area:

• England > 
• Scotland > 
• Wales > 
• Northern Ireland > 

Read about COVID-19 and healthcare >

You usually need a CT scan before you start radiotherapy. This shows the cancer and the area around it. It helps your healthcare team to understand the best course of treatment for you. 

Read about planning radiotherapy >

If the cancer has not spread outside of the pelvis, you will probably have a drug called cisplatin. Sometimes you may have another drug or a combination of drugs.

Read about chemotherapy drugs >

The length of treatment depends on the chemotherapy drug or drugs you are having:

• You may have chemotherapy once a week for 5 weeks. This happens at the same time you are having radiotherapy for 5 weeks. 
• You may have chemotherapy every 2 or 3 weeks.

Your treatment shouldn’t last more than 8 weeks.

You will usually have brachytherapy after chemotherapy and external radiotherapy.  

You might have treatment in the radiotherapy department as an outpatient or you might stay in hospital to have it. This depends on the type of brachytherapy you are having.

Read about brachytherapy >

It can take a long time to recover and feel like yourself again after radiotherapy. The exact time will depend on:

• the side effects you have
• your general health. 

It usually takes a few months to recover from chemoradiation. It is important to recognise that the combination of treatments may make you feel more unwell and need a longer recovery time than if you had a single treatment. You must let your healthcare team know if you are struggling with any side effects during or after treatment. They can assess your needs and give you support or medication to help.

You will need to rest to help your recovery. Try to limit your normal activities until you start feeling better, as these can take a lot of energy. Remember to be kind and gentle to yourself.

Read about recovering from treatment > 

If you are struggling with your emotions before, during or after chemoradiation, you are not alone. We know that lots of women and people who have had a cervical cancer diagnosis or treatment feel sad, down or depressed. Sometimes this can last a long time after treatment has finished.  

Read about mental health and cervical cancer >

Once the chemoradiation is finished, you should be given a treatment summary. This is a document by your healthcare team that explains:

• what treatments you have had
• any side effects you might have
• signs and symptoms to look out for 
• a plan that has been made for your long-term care and support.   

This treatment summary should also be sent to your GP surgery, so they know how to support you too. You might want to check that the hospital have sent it to them.

You will also have check-ups with your healthcare team. You might see or speak to your consultant oncologist, clinical oncologist, or clinical nurse specialist (CNS). 

How often you have check-ups will depend on the exact treatment you have had and your individual situation. You will usually have check-ups:

• 6 to 8 weeks after your treatment has finished
• every 3 to 6 months for first 2 years
• every 6 to 12 months for the next 3 years.

These check-ups will:

• check how well treatment has worked
• monitor any side effects 
• provide you with support.

These check-ups may be at the hospital, or by phone or video call. The COVID-19 pandemic means it is more likely you will be offered a phone or video call check-up, as your healthcare team will be following safety rules put in place by the hospital. However, if you or your healthcare team would prefer that you go into the hospital, they will arrange this for you.  

You might have physical examinations during your check-ups. These may include:

• a pelvic examination – where your healthcare professional feels your stomach and may put gloved fingers inside your vagina 
• a speculum or visual examination – where your healthcare professional uses a speculum (plastic tube) to gently open your vagina and look at your vagina or cervix, if you still have one.

If you had chemoradiation for locally advanced cervical cancer, you may have an MRI scan 12 weeks after starting treatment. But if you are having chemoradiation after surgery or for advanced cancer, you won’t usually have scans at check-up appointments, unless your healthcare team think you should have it. They might suggest it if you are having new symptoms. If you would feel more comfortable having a scan, it is important to ask for one.   

Cervical screening after treatment

If you have radiotherapy or brachytherapy as part of chemoradiation, you will not need to go for cervical screening anymore. This is because the radiotherapy causes changes to the cells in your cervix, which may make them difficult to see under a microscope or more likely to give an incorrect result. Instead, your healthcare team will do the checks we talk about above.   

Your healthcare team should let your GP surgery know that you no longer need cervical screening. Your GP surgery will then tell the national Cervical Screening Programme, so you no longer get automatic invitations. If you still get an invite after radiotherapy, contact your healthcare team at the hospital so they can sort it out.