What the diagnosis means
Nearly all cervical cancers are caused by persistent infection with high-risk types of human papillomavirus (HPV). Pre-cancerous changes can be picked up by screening (Pap smear, HPV testing or visual inspection) and treated simply; cancer develops when these go undetected for years. Most cervical cancers are squamous cell carcinomas; some are adenocarcinomas. Staging is clinical and imaging-based (examination, MRI, sometimes PET-CT) and ranges from stage I (confined to the cervix) to stage IV.
Where medical oncology fits
- Early stage (IA–IB1/IB2): surgery by a gynaecological oncologist — sometimes fertility-sparing procedures for very early disease. Chemotherapy is not usually needed unless the surgical pathology shows high-risk features, in which case chemoradiation follows.
- Locally advanced (IB3–IVA): the standard is chemoradiation — external radiation plus internal radiation (brachytherapy) delivered by the radiation oncologist, with weekly chemotherapy given by the medical oncologist to sensitise the tumour. In some higher-risk cases chemotherapy before, or immunotherapy alongside and after, chemoradiation is now used.
- Recurrent or metastatic disease: chemotherapy combinations, often with an anti-angiogenic antibody, and immunotherapy guided by PD-L1 — led by medical oncology.
What to expect
Chemoradiation is delivered over about five to six weeks, usually with a short weekly chemotherapy infusion. Expected effects include tiredness, diarrhoea, bladder irritation, skin changes and lowered blood counts; longer-term, vaginal narrowing and early menopause are discussed before treatment with practical measures to reduce them. Completing the full course on schedule — including brachytherapy — matters for cure, so side effects are managed actively rather than by pausing treatment.
Prevention for your family
HPV vaccination for girls (and, where available, boys) before exposure, and regular screening for women from their thirties, prevent most cervical cancers. A diagnosis in the family is a good moment to make sure daughters, sisters and friends are vaccinated and screened.
Questions to ask
- What is my stage, and is surgery or chemoradiation the right first treatment?
- Will brachytherapy be part of the plan, and where will it be given?
- What role does chemotherapy play in my treatment and how often will it be given?
- How will treatment affect fertility, menopause and sexual health, and what help is available?
- For advanced disease: has PD-L1 been tested, and is immunotherapy an option?
Preparing for your consultation
Bring the biopsy report, MRI and any other scans with reports, previous screening or colposcopy results, and a medicine list. Note whether you may wish to have children in future — it affects options in early disease.