Why is my doctor not operating?
What is the benefit of avoiding surgery?
Till what stage can radiotherapy cure cervical cancer?
How many radiation sessions will I receive?
What is brachytherapy?
What side effects can I expect?
“Did I get cervical cancer because of something I did?”
The one question worth asking your doctor
Cervical Cancer Radiotherapy: No Surgery? Yes, It Can Still Be a Curative Treatment
When someone is told, “You need radiotherapy for cervical cancer,” the first questions are often:
“Why aren’t you operating?”
“Does that mean my cancer is too advanced?”
“Can radiation really cure it?”
“How many sessions will I need?”
These are completely reasonable questions. The most important thing to understand is:
In cervical cancer, radiotherapy is not simply a treatment used when surgery fails. For many stages, radiotherapy with chemotherapy and brachytherapy is the standard treatment given with the intention of cure.
Why is my doctor not operating?
We often think, “If there is cancer, just remove it.”
But cancer treatment does not work that way for every stage.
For very early cervical cancers, surgery may be an excellent treatment. However, when the tumour is larger, has reached the tissues around the cervix, or lymph nodes are involved, surgery may not be the best first option.
For stage IIB, stage III and many stage IVA cervical cancers , the standard approach is usually radiotherapy + chemotherapy + brachytherapy , rather than hysterectomy.
So when your doctor says “no operation,” it does not automatically mean “no cure.”
Sometimes it means exactly the opposite: your doctors are choosing the treatment that is considered most appropriate for your stage.
What is the benefit of avoiding surgery?
Suppose a patient undergoes a major operation and the final pathology shows features that require radiotherapy afterward anyway.
She may then have to undergo:
major surgery → recovery → radiotherapy → sometimes chemotherapy
For selected patients, doctors can predict beforehand that radiotherapy will probably be required. In such situations, starting with definitive chemoradiotherapy may avoid unnecessarily combining two major treatments.
Avoiding surgery can also mean avoiding surgical risks such as:
anaesthesia-related problems
bleeding or infection
surgical wound complications
bladder or urinary problems after radical pelvic surgery
a prolonged postoperative recovery period
This does not mean radiotherapy has no side effects. It simply means we try to choose one effective curative strategy rather than expose a patient to unnecessary treatment.
Till what stage can radiotherapy cure cervical cancer?
This surprises many patients:
Radiotherapy can be used with curative intent even in locally advanced cervical cancer.
Radiotherapy may be used in selected stage I and stage II cancers and is a major curative treatment for stage IIB, stage III and selected stage IVA disease .
Stage IVA means the cancer has extended into a nearby organ such as the bladder or rectum. Even at this stage, some patients can still receive treatment with curative intent.
Stage IVB is different. It generally means cancer has spread to distant organs or distant sites. Treatment then depends on where and how much disease has spread and often includes systemic treatment.
So please do not hear “stage III” and automatically translate it to “nothing can be done.”
Stage is important, but tumour size, lymph nodes, general health, response to treatment and whether treatment is completed on time also matter.
How many radiation sessions will I receive?
For definitive cervical-cancer treatment, a commonly used external radiotherapy schedule is:
Around 25 sessions
A frequently used prescription is 45-50 Gy in 25 fractions , usually given Monday to Friday for about 5 weeks . Other schedules may also be appropriate depending on your disease.
If lymph nodes are involved, your radiation oncologist may give them an additional dose.
Many patients also receive a small dose of chemotherapy—most commonly cisplatin once weekly —during radiation. Here, chemotherapy mainly helps make cancer cells more sensitive to radiotherapy.
Your treatment does not necessarily finish after those external radiation sessions.
There is another very important part:
What is brachytherapy?
Brachytherapy is internal radiotherapy.
A special applicator is temporarily placed through the vagina close to the cervix so that a very high radiation dose can be delivered directly to the tumour while limiting dose to nearby organs.
For patients receiving definitive radiotherapy for cervical cancer, brachytherapy is a crucial part of curative treatment— not an optional extra. Modern treatment commonly uses several brachytherapy fractions.
I would give brachytherapy a separate detailed discussion because there is much more to explain about the procedure, anaesthesia, planning and what the patient actually experiences.
What side effects can I expect?
Most patients do not suddenly develop all the side effects after the first radiation session . They usually appear gradually as treatment progresses.
During treatment you may notice:
tiredness
loose motions or diarrhoea
increased frequency of stools
abdominal discomfort or cramps
nausea or reduced appetite
burning while passing urine
passing urine more frequently
vaginal discharge or irritation
mild skin redness or darkening around the treated area
temporary reduction in blood counts, particularly when chemotherapy is also given
These problems can usually be managed with medicines, diet changes, fluids and regular assessment by your treatment team.
What about long-term effects?
Because the pelvis contains the bladder, bowel, vagina, ovaries and bones, some late effects can occur.
These may include:
vaginal dryness
narrowing or reduced elasticity of the vagina
early menopause in younger patients
infertility
persistent bowel or urinary changes in some patients
pelvic bone weakening in some patients
lymphoedema in a minority of patients
Modern techniques such as IMRT/VMAT and image-guided radiotherapy allow us to shape the radiation more precisely and reduce unnecessary exposure to surrounding normal tissues.
If fertility is important to you, please discuss it before treatment starts , not after treatment is completed.
“Did I get cervical cancer because of something I did?”
No one deserves stigma because of cervical cancer.
Most cervical cancers are related to persistent infection with high-risk HPV , an extremely common virus.
HPV can remain in the body silently for years. Therefore, finding HPV cannot tell us when it was acquired, from whom it came, or whether either partner has been unfaithful.
Women should not be blamed.
Men should not be blamed.
Partners should not blame each other.
HPV affects both females and males , and HPV-related cancers can occur in both sexes.
Having cervical cancer is not a reflection of cleanliness, morality, character or sexual behaviour.
And cervical cancer itself is not contagious . You cannot catch someone's cancer by touching them, hugging them, eating with them or caring for them.
The one question worth asking your doctor
Instead of asking only,
“Why aren't you operating?”
ask:
“Is my treatment being given with the intention of cure?”
For many women receiving radiotherapy for cervical cancer, the answer is yes .
Radiotherapy, chemotherapy and brachytherapy are not “second-best” treatments because surgery was not done.
For the appropriate stage of cervical cancer, they are a planned, evidence-based curative treatment strategy.