Cervical and Ovarian Cancer Treatment

Overview

Cervical cancer and ovarian cancer are both cancers of the female reproductive organs, and both are treated by gynaecologic oncologists (surgeons who specialise in these cancers). That is where the likeness ends. They start in different places, are found in different ways, and are treated differently. This page covers them in two clearly separate parts so you can read the one that applies to you.

Cervical cancer starts in the cervix, the neck of the womb. Almost all cases are linked to long term infection with HPV (human papillomavirus). Early cancer is often treated with surgery, and cancer that has grown beyond the cervix is treated with radiation and chemotherapy together.

Ovarian cancer starts in the ovaries, or in the fallopian tubes or the lining of the abdomen. It often causes vague symptoms such as bloating and is commonly found at a later stage. Treatment usually combines major surgery with chemotherapy.

Some women want a female doctor, female interpreter or female nurse present. Tell your coordinator, and we pass the request to each hospital when asking for quotes.

Who needs it

Cervical cancer

Cervical cancer is often found after an abnormal smear or HPV test, or because of bleeding after sex, between periods or after menopause. Doctors stage it from an examination, a biopsy and scans, usually an MRI of the pelvis and often a PET-CT. Very small early cancers may need only a cone biopsy (removal of a cone of tissue from the cervix) or a simple hysterectomy. Larger cancers still confined to the cervix are usually treated by surgery. Cancer that has spread into the surrounding tissue, the upper vagina or the lymph nodes is usually called locally advanced, and is treated with chemoradiation.

Ovarian cancer

Ovarian cancer is often suspected from symptoms like bloating, pelvic pain, feeling full quickly or needing to pass urine often, together with an ultrasound and a CA-125 blood test (a marker that can be raised in ovarian cancer). A CT scan of the chest, abdomen and pelvis shows how far it has spread. The plan depends on the stage, the type of tumour and how fit you are for a long operation.

For a quote, hospitals generally ask for the biopsy or pathology report, the scan images on a disc or download link with their reports, recent blood results including CA-125 for ovarian cancer, and details of any treatment already given. You can name the country you prefer on the quote form, or ask hospitals in several countries to quote.

How it is done

Cervical cancer: surgery for early stage

The standard operation is a radical hysterectomy. This removes the womb and cervix together with the tissue around the cervix and the top of the vagina, along with lymph nodes from the pelvis. A large trial published in 2018 found better results with open surgery than with keyhole surgery for this operation, so many surgeons now prefer an open approach. Ask your surgeon which approach they plan and why. The ovaries can often be kept in younger women, which avoids an early menopause.

Cervical cancer: chemoradiation and brachytherapy

For locally advanced cancer, external beam radiation is given every weekday for about five weeks, usually with a weekly dose of the chemotherapy drug cisplatin, which makes the radiation more effective. Brachytherapy, internal radiation, follows. A small applicator is placed in the vagina and womb under anaesthetic or sedation, and a radiation source sits inside it for a short time before it is removed. Most women have three to five brachytherapy sessions. Brachytherapy is an essential part of this treatment, so we check that the hospitals quoting for you provide it on site.

Ovarian cancer: surgery

The main operation is cytoreductive or debulking surgery, done by a gynaecologic oncologist. The aim is to remove all visible cancer. This usually means removing the womb, both ovaries and tubes, the omentum (a fatty apron of tissue in the abdomen) and any other deposits, which can include part of the bowel. Some women have surgery first. Others have three cycles of chemotherapy to shrink the cancer, then surgery, then more chemotherapy.

Some centres offer HIPEC (heated chemotherapy washed through the abdomen during surgery) for selected patients. It is not offered everywhere and is not suitable for everyone, so ask whether it applies to you.

Ovarian cancer: chemotherapy and BRCA testing

The usual chemotherapy is carboplatin with paclitaxel, given by drip every three weeks for six cycles in total. Hospitals test for changes in the BRCA1 and BRCA2 genes, and often for a related tumour feature called HRD. Women with these changes may be offered PARP inhibitors, tablets taken daily at home after chemotherapy to help keep the cancer from returning. Another drug, bevacizumab, is sometimes added.

Fertility-sparing options

For small early cervical cancer, a radical trachelectomy removes the cervix but leaves the womb, so pregnancy may still be possible. For some early ovarian cancers in young women, the surgeon may remove only the affected ovary and tube. These operations suit only some cancers, and egg or embryo freezing needs planning before treatment begins.

Recovery and how long you stay

After a radical hysterectomy, most women spend three to six days in hospital. A urinary catheter may stay in for some days while the bladder recovers its normal feeling. Plan for about three weeks in your destination, including tests, surgery and the post-operative review, and avoid lifting for about six weeks.

Debulking surgery is a bigger operation. A hospital stay of five to ten days is common, sometimes with a short time in intensive care. Most women stay abroad for four to six weeks, often until the first cycle of chemotherapy has been given after surgery. Later cycles can often continue at home if the same drugs are available.

Chemoradiation for cervical cancer takes about seven to eight weeks including planning. Tiredness, loose bowels and bladder irritation are common towards the end. Afterwards the team usually advises using a vaginal dilator, a smooth device that keeps the vagina from narrowing. Radiation to the pelvis also brings on menopause in women who have not yet reached it.

Questions to ask your doctor

Write your questions down, and give a copy to the interpreter before the appointment.

• What is the stage and type of my cancer?
• Do you recommend surgery, chemoradiation or chemotherapy first, and why?
• Will the operation be open or keyhole?
• Can my ovaries be kept, and can my fertility be protected?
• Has BRCA or HRD testing been done, and when will the results be ready?
• Is brachytherapy done at this hospital?
• Will I need treatment after surgery, and can it continue in my country?
• Which follow up checks will I need, and how often?

Ask the coordinator before you travel which of these the hospital can answer from your reports. Some answers arrive with the quote, which saves time later.