Cervical Cancer

Cervix

The lower part of the womb; most cancers start where two types of cells meet, called the transformation zone.

Parametrium

Supportive tissue beside the cervix; involvement makes a cancer stage IIB.

Vagina

Which part of the vagina is affected helps determine the stage and the area to treat with radiotherapy.

Bladder and rectum

Cancer growing into the inner lining of the bladder or rectum is stage IVA. Treatment planning also aims to protect these organs.

Ureters

Tubes that carry urine from the kidneys to the bladder. A tumour blocking a ureter can make a kidney swell (hydronephrosis) or stop working; this can make the cancer stage IIIB.

Bleeding after sex

Arrange a pelvic examination; repeated bleeding needs assessment.

Bleeding between periods or after menopause

Seek prompt medical review. Heavy or ongoing bleeding may need urgent care.

Watery, blood-stained or foul-smelling discharge

Report a new persistent change, especially with bleeding or pain.

Pelvic or lower back pain

Assess if persistent, worsening, associated with bleeding, leg swelling or urinary symptoms.

Pain during sex

Discuss openly; examination can identify cancer and many non-cancer causes.

Leg swelling, pain near the kidneys or reduced urine

These can be signs of blocked lymph-fluid drainage or a blocked ureter and need urgent assessment.

Histology

Histology means the type of cancer seen under the microscope. Squamous cell carcinoma starts in flat surface cells; adenocarcinoma starts in glandular cells; adenosquamous carcinoma has features of both. Their treatment often follows similar stage-based pathways.

Neuroendocrine carcinoma

A rare cancer with features of hormone-producing and nerve-like cells. It can grow quickly and usually needs specialist care combining platinum-based chemotherapy and etoposide with other treatments.

Grade

Describes how abnormal the cells look; stage and other risk features usually guide treatment more strongly.

Depth and horizontal extent

The depth of growth determines microscopic stage IA1 or IA2. The International Federation of Gynecology and Obstetrics (FIGO) staging system no longer uses horizontal width to assign a stage, although tumour measurements still help plan care.

LVSI

Cancer cells in lymphatic or blood spaces raise the risk of lymph-node spread and influence node assessment and postoperative treatment.

Margins

A positive margin means cancer reaches a cut edge and may require further surgery or chemoradiation.

Stromal invasion

This means growth into the supporting tissue of the cervix. The depth, together with other findings, helps decide whether treatment is needed after surgery.

Nodes and parametrium

Cancer in lymph nodes or the parametrium raises the risk of cancer returning after radical surgery, which removes the womb, cervix and surrounding tissue.

Pelvic MRI

Measures the tumour and shows nearby tissues to help plan treatment

Very small lesions and microscopic spread may not be visible

PET-CT

Checks pelvic and para-aortic nodes and distant organs; helps plan the radiotherapy area

Uses a radioactive sugar tracer called fluorodeoxyglucose (FDG). Inflammation can also take up the tracer; very small cancer deposits may be missed

CT with contrast dye

Checks the chest, abdomen and pelvis when PET-CT is unavailable or during follow-up

Less detailed than MRI for local cervical anatomy

Kidney imaging

Checks for a swollen kidney or blocked urine flow and assesses kidney function

May involve ultrasound or CT; a blockage may need a procedure to drain urine

Cystoscopy / proctoscopy

Looks directly at the inner lining of the bladder or rectum if cancer involvement is suspected

Not routinely required for every patient

Treatment goal

Whether the aim is cure, cancer control, symptom relief or a combination

Primary local treatment

Whether surgery or chemoradiation is preferred, and why

Lymph nodes

How suspicious pelvic and para-aortic nodes will be confirmed or treated

Brachytherapy access

Where treatment will be given and whether the centre can use needles or small tubes in the tissue if needed

Additional medicine treatment

Whether chemotherapy before chemoradiation or pembrolizumab with chemoradiation is appropriate

Fertility and ovarian function

Your wishes, whether preservation is safe, and whether there is time before treatment

Other health conditions

Kidney function, hearing, nerve symptoms, HIV care, nutrition and anaesthetic safety

Practical arrangements

Start date, treatment duration, travel, accommodation, possible transfusions and costs

IA1, clear cone margins, no LVSI

Follow-up after a cone biopsy that has removed the cancer, if preserving fertility is important; otherwise, a simple hysterectomy may be offered

IA1 with LVSI / IA2

Surgery that preserves the womb, or hysterectomy with assessment of sentinel or other pelvic nodes, depending on risk

Small low-risk IA2-IB1

Less extensive surgery with lymph-node assessment may be possible after specialist review

IB1 suitable for fertility preservation

Cone biopsy or radical trachelectomy with lymph-node assessment, depending on tumour size and other findings

IB1-IB2, fertility not required

Hysterectomy with the extent of surgery tailored to the cancer, plus lymph-node assessment; radiotherapy-based treatment if surgery is unsuitable

IB3 or large IIA2

Usually chemoradiation and brachytherapy with the aim of cure; alternatives require specialist assessment

Cone biopsy

Cone of cervix including transformation zone

May be the only treatment needed for IA1 or selected very low-risk cancers if the tissue edges are clear

Simple trachelectomy

Cervix only

For selected low-risk cancers; lymph nodes are also assessed when needed

Radical trachelectomy

Cervix, parametrial tissue and upper vagina; uterus retained

For selected IA2–IB1 cancers, commonly under 2 cm, after checking that lymph nodes are clear

Ovarian preservation

Ovaries left in place

Keeps the ovaries’ hormone production, but cannot preserve the ability to carry a pregnancy if the womb is removed or treated with radiotherapy

Simple / type A hysterectomy

Very early or selected low-risk IA2-IB1 disease

Pregnancy no longer possible; ovaries may be preserved

Modified radical / type B

Selected early cancers where more surrounding tissue needs to be removed

Bladder and sexual effects generally less than type C

Radical / type C1 hysterectomy

Many operable IB and selected IIA tumours

Difficulty emptying the bladder, swelling from poor lymph drainage (lymphoedema), and sexual changes; protecting nearby nerves may help

Sentinel-node mapping

Identifies the first draining pelvic nodes

Detailed microscope testing can find tiny cancer deposits. If mapping does not find the sentinel nodes, other pelvic nodes on that side may need to be removed

Removal of pelvic lymph nodes

When sentinel-node assessment is unsuitable or more lymph-node information is needed

A collection of lymph fluid (lymphocele), infection, blood-vessel or nerve injury, and leg lymphoedema

Negative nodes, margins and parametrium; low-risk features

Regular follow-up without immediate further cancer treatment

Intermediate-risk combination

Radiotherapy to the pelvis may be recommended based on tumour size, LVSI and depth of growth into cervical tissue

Positive pelvic node

Chemoradiation after surgery; the treatment area depends on which lymph nodes are affected

Positive para-aortic node

Chemoradiation covering a wider area may be considered

Positive surgical margin

Chemoradiation; brachytherapy or an additional dose to the affected area may be considered

Parametrial involvement

Postoperative chemoradiation

Planning session

A planning CT and positioning supports, plus bladder and bowel instructions. MRI or PET-CT images may be combined with the planning scan

Target coverage, bowel, bladder, rectum, kidneys and bone marrow

Daily EBRT

Short weekday sessions; treatment itself is painless

Position and internal organ changes using image guidance

Weekly cisplatin

Fluids through a vein (intravenous, or IV), anti-sickness medicines and chemotherapy during radiotherapy

Kidney function, blood salts such as magnesium and potassium, blood counts, hearing and nerve symptoms

Extra dose to affected lymph nodes

Extra dose to involved nodes within or after the pelvic plan

Radiation dose to the bowel and other nearby healthy organs

Treatment review

Regular radiation and oncology visits

Diarrhoea, urinary symptoms, bleeding, pain, weight and hydration

Inside the womb and vagina (intracavitary)

Special applicators, such as a tandem with a ring or ovoids, are placed through the vagina into the womb and against the cervix to guide the radiation source

Within the tissue (interstitial)

Needles or small tubes are placed in the tumour or nearby tissue when extra coverage is needed because of its size, shape, location or remaining tumour after initial treatment

A combination (hybrid)

Combines intracavitary applicators with interstitial needles

Image-guided

MRI and/or CT define residual tumour and organs at risk for each application

High dose-rate

Several short treatment sessions; anaesthesia or deep sedation is often used to place the applicators

Pembrolizumab with chemoradiation

Pembrolizumab, an immunotherapy that helps the immune system attack cancer, may be added for FIGO 2014 stage III–IVA disease. It continues for a planned period after chemoradiation. Eligibility uses the 2014 stage definitions, which differ from the 2018 staging explained above

Possible immune-related inflammation. The team checks autoimmune conditions, previous organ transplant, steroid use, and thyroid, liver and kidney function. Benefit was less clear in the lower-stage, node-positive group in the initial KEYNOTE-A18 trial analysis

Chemotherapy before chemoradiation

Six weekly cycles of carboplatin and paclitaxel before chemoradiation may be considered for suitable patients with locally advanced cancer. In the INTERLACE trial, this improved five-year survival and the time without cancer worsening

Chemoradiation must start promptly afterwards. Blood counts, nerve symptoms, general health, brachytherapy appointments and travel arrangements all need checking

Pelvic recurrence after surgery, no previous radiation

Curative chemoradiation plus brachytherapy when feasible; surgery in selected cases

Central recurrence after prior radiation

Pelvic exenteration, a major operation explained below, may offer cure in carefully selected patients without distant spread or cancer in the pelvic sidewall that cannot be removed

Small accessible recurrence after radiation

Surgery, highly focused radiotherapy or repeat radiotherapy may be considered by an experienced specialist team for selected patients

Cancer in the pelvis that cannot be removed

Medicines to treat cancer throughout the body (systemic therapy), individually planned radiotherapy, procedures for bleeding or urine problems, pain relief and clinical trials

Recurrence plus distant metastases

Cancer medicines are the main treatment; treatment to individual areas may relieve symptoms or control a small number of sites

Protein score for immunotherapy

Programmed death-ligand 1 (PD-L1) is a protein measured using a combined positive score (CPS). A CPS of 1 or higher can support pembrolizumab with initial platinum-based and taxane chemotherapy, with or without bevacizumab. After chemotherapy, pembrolizumab alone may be an option if it has not already been used

Mismatch repair (MMR) / microsatellite instability (MSI)

These tests look for problems with the cells’ repair of genetic material. Deficient MMR (dMMR) or high MSI (MSI-high) may support immunotherapy under indications that cover several cancer types; previous treatment and other eligibility criteria matter

Tumour mutational burden (TMB)

The number of genetic changes in cancer cells. A high result may support pembrolizumab for selected patients after previous treatment, under an indication that covers several cancer types

Human epidermal growth factor receptor 2 (HER2)

A protein that can be measured by tissue staining, called immunohistochemistry (IHC). A strongly positive result (IHC 3+) may support an antibody–drug conjugate (ADC), a medicine that links an antibody to a cancer-killing drug, after prior treatment. Suitability and access need review

NTRK / RET gene fusions

NTRK and RET are gene names. Rare changes that join one of these genes to another gene (fusions) may allow targeted treatment. The exact fusion and treatment criteria must be confirmed

Next-generation sequencing (NGS)

A test that checks many genes at once. It may find uncommon treatment targets or clinical trials, but many results do not have a proven treatment

PD-L1 CPS 1 or higher

Pembrolizumab plus paclitaxel with cisplatin or carboplatin; bevacizumab may be added when safe

PD-L1 CPS below 1 or unknown

Platinum-based chemotherapy with a taxane, often with bevacizumab if safe. If PD-L1 has not been tested, arrange the test promptly

Previous cisplatin with curative radiation

Carboplatin is often chosen; the earlier treatment and time since it was given matter

Bevacizumab unsuitable

Platinum-based chemotherapy and a taxane with pembrolizumab for PD-L1-positive cancer, or chemotherapy alone for PD-L1-negative cancer

Frailty or reduced organ function

A gentler treatment plan tailored to your health, treatment to relieve symptoms in particular areas, supportive care or a clinical trial

Tisotumab vedotin

An established option after chemotherapy for cervical cancer that has returned or spread

Eye injury, neuropathy and bleeding; preventive eye care and examinations are mandatory

Immunotherapy

Pembrolizumab may be an option after chemotherapy for PD-L1-positive, MSI-high/dMMR or TMB-high cancer if it has not already been given and the relevant treatment criteria are met.

Cemiplimab is an option when cancer has returned or spread and worsens during or after platinum chemotherapy, regardless of PD-L1. Earlier immunotherapy affects the choice.

Immune inflammation of thyroid, lung, liver, bowel, kidney, skin and other organs

Other chemotherapy

Clinician-selected agents when preferred options are unavailable or unsuitable

Responses may be limited. Blood counts, kidney function, nerve symptoms and symptoms from cancer help guide the choice

HER2-directed ADC

An option for selected previously treated cancers with HER2 IHC 3+ results, under an indication covering several cancer types

Lung inflammation (interstitial lung disease), nausea and reduced blood-cell production

Fusion-targeted therapy

Rare confirmed NTRK or RET fusion

Medicine-specific risks to the liver, nerves, heart or circulation, and interactions with other medicines

Clinical trial

May be considered at any treatment stage, especially after immunotherapy or an ADC

Eligibility, travel, extra testing and uncertain benefit

Established treatment marker

Linked to an established treatment for this type and stage of cancer

Check suitability, previous treatment and safety

Marker shared across cancer types

Linked to a treatment across cancer types

Check the test threshold, evidence in cervical cancer and treatment availability

Trial-only marker

Promising but not established standard care

Look for a trial matched to the test result

Uncertain variant

The meaning of the genetic change or its effect on treatment is not known

Do not choose treatment based on this result outside a clinical trial

No result that guides treatment

This is common and does not mean the test was done incorrectly

Use established treatments that do not need a matching biomarker, or consider a clinical trial

Diarrhoea

A temporary low-fibre diet if advised, fluids to drink and prescribed medicines for diarrhoea

Dizziness, very little urine, blood in stools, fever or inability to drink

Nausea / vomiting

Take anti-sickness medicines as prescribed; try small, frequent meals and drinks

Repeated vomiting or missed fluids/medicines

Urinary burning

Urine test; hydration; pain relief; antibiotics only if indicated

Fever, pain near the kidneys or inability to pass urine

Bleeding

Track pads and clots; report any increase

Bleeding that soaks pads, faintness, breathlessness or low blood pressure

Anaemia

Check CBC; treat the cause; transfusion when clinically indicated

Chest pain, fainting, severe breathlessness

Low white cells

Check temperature and follow your team’s advice about blood tests and treatment

Fever 38°C (100.4°F) or higher, shaking chills

Skin / vulval soreness

Gentle care, prescribed creams, loose clothing

Blistering, infection or uncontrolled pain

Heavy vaginal bleeding

Packing to control vaginal bleeding, medicines that help stop bleeding, transfusion, urgent radiotherapy, a procedure to block bleeding blood vessels (embolisation), or surgery

Stabilise circulation and control the bleeding source

Blocked ureter / hydronephrosis

A ureteric stent or a nephrostomy tube to drain urine

Drain the kidney, relieve infection or pain and protect kidney function

Painful bone metastasis

Pain medicines, radiotherapy for symptom relief, procedures to support the bone, or bone-strengthening treatment when appropriate

Reduce pain and fracture or spinal-cord risk

Bowel obstruction

Fluids, a tube to relieve pressure, medicines, a stent, surgery to redirect the bowel or another operation

Relieve vomiting and pain; restore passage when feasible

Fistula

Treatment of infection, wound and skin care, rerouting urine or stool, or surgery in selected patients

Control leakage, infection, odour and skin damage

Fluid around the lung

Drainage, a longer-term drainage tube, or a procedure to seal the space where fluid collects (pleurodesis)

Relieve breathlessness

Hydration

Sip regularly; use oral rehydration when diarrhoea or vomiting is significant; follow fluid restrictions if you have heart or kidney disease

Protein

Include dal, beans, eggs, dairy, fish, chicken, soy, nut pastes or supplements according to preference and tolerance

Energy

Use small frequent meals; enrich food with oil, ghee, milk powder or nut paste when weight is falling and clinically appropriate

Diarrhoea

If diarrhoea worsens, your team may advise temporarily reducing rough fibre, very fatty or spicy foods, or lactose (milk sugar). Gradually broaden your diet as symptoms settle

Anaemia

Do not assume low red blood cells mean iron deficiency. Bleeding, inflammation, treatment effects on blood-cell production and nutrition can all contribute. Check the cause before taking iron

Food safety

Use safe water, freshly cooked food, refrigeration and hand hygiene, especially if infection-fighting white blood cells are low (neutropenia)

Vaginal dryness or narrowing

Moisturisers, lubricants, vaginal dilators after healing, pelvic-floor therapy and local hormonal treatment when appropriate

Pain or fear with sex

Check for treatable causes, return to intimacy gradually, and consider counselling or sexual-health support

Early menopause

Discuss symptoms, bone and heart health, exercise, calcium and vitamin D needs, and whether menopausal hormone therapy is suitable

Bladder urgency or leakage

Urine test, bladder training, pelvic-floor therapy, medicines or urology referral

Bowel urgency or bleeding

Diet review, medicines and gastroenterology assessment; do not assume all bleeding is radiation damage

Leg or genital lymphoedema

Early lymphoedema therapy, compression, skin care, exercise and infection prevention

Neuropathy

Foot care, fall prevention, physiotherapy and symptom medicines

Years 1-2

Clinical review about every 3-6 months, individualised by risk and treatment

Years 3-5

Clinical review about every 6-12 months

After year 5

Yearly or an agreed survivorship schedule

After chemoradiation

Response imaging commonly at 3-6 months; later imaging for symptoms or specific high-risk findings

After fertility-sparing surgery

More frequent cervical examinations, cell-sample or HPV tests, and pelvic MRI according to your specialist’s plan