Kathmandu
Cancer Center
Kathmandu
Cancer Center
"The bleeding will stop on its own." It may — but if you haven't been screened in years and the bleeding is new, that sentence has cost too many Nepali women their lives.
Cervical cancer is the most commonly diagnosed cancer in women in Nepal — and among the most preventable and treatable cancers in all of oncology. HPV vaccination prevents it. Screening catches it before it becomes cancer. And when treatment is needed, KCC provides the complete pathway: radical surgery, concurrent chemoradiation, and Nepal's first and most experienced IGBT brachytherapy programme.
Medically reviewed by: The Gynaecological Oncology Team, Kathmandu Cancer Center — Gynaecological Surgery · Radiation Oncology · Medical Oncology. Educational content — not personal medical advice. Last updated: 2025.
The most dangerous feature of early cervical cancer is that it often causes no symptoms at all. By the time symptoms appear, the cancer is frequently at a more advanced stage. The symptoms below — particularly postcoital bleeding — are serious signals that require evaluation.
Any of the above: Call KCC: 01-6634300 or book a gynaecological evaluation.
Many Nepali women delay seeking evaluation for vaginal bleeding because of embarrassment, normalisation ("it's just irregular periods"), or fear of the diagnosis. If your wife, mother, or sister has reported postcoital bleeding or unusual discharge and hasn't seen a gynaecologist: please help her make that appointment. Early cervical cancer is almost always curable. The window for curative treatment is real — and it closes with delay.
Early cervical cancer — found through screening before symptoms develop — is treated with surgery alone and has survival rates above 90%. Locally advanced cervical cancer (the stage at which most Nepali women present) requires chemoradiation + brachytherapy and has cure rates of 60–75% with modern treatment. Late-stage disease at diagnosis is the single greatest preventable tragedy in cervical cancer — and it is prevented by screening.
Book Cervical Screening at KCCCervical cancer is unique among cancers: it has a long, detectable pre-invasive phase (CIN — cervical intraepithelial neoplasia) that takes 10–20 years to progress to invasive cancer. Screening finds these pre-cancerous changes and treats them before cancer ever develops. This makes cervical cancer screening one of the most impactful public health interventions in oncology.
Cells scraped from the cervix examined under microscope for abnormalities. Recommended every 3 years from age 21 (or within 3 years of sexual debut). High sensitivity for HSIL (high-grade pre-cancerous changes).
Tests for high-risk HPV strains (16, 18, and 12 others) directly. More sensitive than Pap smear alone. Preferred primary screening test in women 30+. A negative HPV test provides reassurance for 5 years.
Acetic acid applied to the cervix; abnormal areas turn white and are visible to the naked eye. Inexpensive, immediate result, no laboratory required. Effective for resource-appropriate screening in Nepal.
When Pap, HPV test, or VIA is abnormal, colposcopy (magnified inspection of the cervix) with directed biopsy identifies the extent of CIN. CIN 2–3 is treated with LEEP/LLETZ to prevent cancer development.
Gardasil-9 protects against HPV 16, 18 (cause 70% of cervical cancers) and 5 other high-risk types. Recommended for girls 9–14 (2 doses, 6 months apart). Catch-up vaccination up to age 26 (3 doses).
All sexually active women from age 21, or within 3 years of first sexual intercourse. Women 30–65: every 5 years with co-testing (Pap + HPV). After hysterectomy for benign disease: screening can stop. Never screened at any age: start now.
KCC's cancer screening programme offers Pap smear, HPV DNA testing, VIA, colposcopy, and HPV vaccination at one visit. If you or a family member has not had a cervical screen in the past 3 years — or has never been screened — book a screening appointment at KCC today. Women from Kathmandu, Bhaktapur, Lalitpur, Pokhara, Chitwan and across Nepal are seen.
Speculum examination visualises the cervix. Visible tumours are biopsied directly (punch biopsy). A cone biopsy (LEEP/LLETZ or cold knife) may be needed to assess depth of invasion in Stage IA disease. Biopsy results confirm cancer, histotype (squamous vs. adenocarcinoma), and grade — all factors that affect treatment planning.
High-resolution MRI of the pelvis is the most important imaging investigation for cervical cancer staging. It measures tumour size (critical for Stage IB classification), assesses parametrial invasion (IIB), vaginal involvement (IIA/IIIA), bladder and rectal involvement (IVA), and lymph node enlargement. MRI findings directly determine whether surgery or chemoradiation is the appropriate primary treatment. Available at KCC radiology.
Radiology at KCCCT chest/abdomen/pelvis assesses para-aortic lymph nodes (involved in Stage IIIC2) and detects distant metastases (lung, liver — Stage IVB). For high-risk stages, PET-CT is the most sensitive staging tool and changes management in 15–25% of cases by detecting unsuspected nodal or distant disease not visible on CT alone.
Pathology review with IHC determines p16 and Ki-67 positivity (confirms HPV-related aetiology), and p53 status (relevant for some adenocarcinomas). For recurrent or metastatic disease: PD-L1 testing (CPS score for pembrolizumab eligibility), MSI/MMR testing, and HER2 testing in adenocarcinomas. KCC performs all relevant biomarker testing on-site.
In selected cases with large or unclear tumours, an examination under anaesthesia (EUA) with cystoscopy and proctoscopy allows definitive clinical staging, particularly to assess bladder (IVA) and rectal (IVA) involvement when imaging is equivocal. Used in combination with MRI findings to confirm FIGO stage before finalising the treatment plan.
Every confirmed cervical cancer case at KCC is presented at a formal gynaecological oncology MDT. Gynaecological surgeon, radiation oncologist, medical oncologist, radiologist, and pathologist review the case together. For cases where surgery vs. chemoradiation is genuinely equipoise (e.g., Stage IB2), the MDT discusses both options and the patient's preference is central to the decision.
Cervical cancer is staged using the FIGO 2018 system. Stage determines whether surgery or chemoradiation is the primary treatment — this is the most important decision in cervical cancer management.
For Stage IA2–IB2 (tumour ≤4 cm, no parametrial invasion), radical hysterectomy and chemoradiation + IGBT brachytherapy have equivalent long-term cure rates in randomised trials. Surgery is preferred in younger women (avoids radiation effects on ovaries — allows ovarian transposition to preserve hormonal function), and when pathological staging information is desired. Chemoradiation is preferred for larger tumours (IB3+), parametrial involvement (IIB+), and in women unfit for major surgery. For Stage IB3 and above, chemoradiation + IGBT is the standard of care worldwide — and at KCC.
KCC's gynaecological surgical oncology team performs the full range of cervical cancer operations — from fertility-sparing trachelectomy for young women with early disease to radical hysterectomy for localised disease.
Removal of the uterus, cervix, upper vagina, parametrial tissue, and utero-sacral ligaments —
plus pelvic lymph node dissection. The extent of resection (Querleu-Morrow classification B2/C1/C2)
is tailored to the clinical stage.
Laparoscopic or robotic-assisted approach is preferred for Stage IA2–IB1 —
smaller incisions, less blood loss, faster recovery. Open (abdominal) Wertheim's for larger IB2 tumours
where laparoscopic access may compromise surgical radicality.
Ovarian conservation is discussed in younger premenopausal women with squamous cell carcinoma (low risk of ovarian metastasis).
For women with Stage IA1 (with LVSI), IA2, or IB1 (≤2 cm) who wish to preserve
their ability to have children, radical trachelectomy removes the cervix and upper vagina
while leaving the uterus intact. A permanent cerclage suture (permanent stitch) supports the
lower uterine segment.
After recovery, natural conception or IVF is possible. Pregnancy is carried and delivered by
planned caesarean section. Fertility-sparing trachelectomy requires strict patient selection:
no lymph node involvement confirmed intraoperatively, no high-risk histology (clear cell, small cell),
and tumour entirely confined to the cervix.
If you want to preserve fertility, tell us at your first consultation.
This changes the surgical planning significantly.
For Stage IA2–IB2 disease, sentinel lymph node mapping (injection of ICG or blue dye at the cervix, identified by fluorescence imaging) allows targeted removal of the first-echelon draining nodes rather than full pelvic lymphadenectomy. Equivalent nodal staging with less morbidity (lower risk of lymphoedema, shorter operation). Frozen section analysis allows intraoperative decision-making — if nodes are positive, the procedure is modified accordingly.
For premenopausal women who will require pelvic radiotherapy (Stage IB3 and above), laparoscopic ovarian transposition (surgically moving the ovaries out of the radiation field — typically to the paracolic gutters, above the iliac crest) before starting radiotherapy can preserve ovarian function and avoid surgical menopause. Success in preserving ovarian function: approximately 50–90% depending on para-aortic field extent and radiation scatter.
For Stage IB3–IVA cervical cancer, concurrent cisplatin-based chemoradiation followed by IGBT brachytherapy is the international standard of care — established in five landmark randomised trials and adopted in NCCN, ESMO, and FIGO guidelines. KCC delivers this protocol in full at Bhaktapur.
45–50.4 Gy in 25–28 fractions (Monday–Friday, 5–6 weeks). IMRT (Intensity-Modulated Radiotherapy)
shapes the dose to the pelvic target volume while sparing the rectum, bladder, bowel, and femoral heads.
Daily cone-beam CT image guidance verifies target position before each fraction.
Para-aortic nodal irradiation (extended-field RT) is added for Stage IIIC2 or
confirmed para-aortic lymph node involvement — up to 45–54 Gy to the para-aortic region
with IMRT dose shaping to protect kidneys and spinal cord.
Weekly cisplatin 40 mg/m² IV, given concurrently with each week of external beam radiotherapy (5–6 doses).
Cisplatin sensitises tumour cells to radiation — the combination is significantly more effective
than radiation alone, with a 6–8% improvement in 5-year survival across all stages.
Cisplatin requires adequate renal function. Carboplatin is substituted for patients with
impaired renal function or cisplatin intolerance. Pre-hydration and anti-emetics are given
with each cycle. Delivered in KCC's Day Care chemotherapy unit on the same day as radiotherapy.
Weeks 1–5/6: Daily EBRT (Mon–Fri) + weekly cisplatin. Each radiation session takes
approximately 15–20 minutes; cisplatin infusion 1–2 hours.
Weeks 6–8: IGBT brachytherapy — 3–5 sessions over 1–2 weeks, immediately
following completion of EBRT (or interspersed in the final 2 weeks). Total treatment duration:
approximately 7–8 weeks.
Most patients remain in Kathmandu throughout treatment; daily transport from home to KCC is feasible for most.
During treatment: Diarrhoea / bowel frequency (acute proctitis), urinary frequency
and urgency (acute cystitis), nausea (from cisplatin), fatigue. Managed with anti-diarrhoeals,
anti-emetics, bladder relaxants, dietary modification.
Long-term: Vaginal stenosis (preventable with vaginal dilators — KCC provides
instruction), bowel irregularity, risk of late cystitis or proctitis (reduced significantly by
IGBT vs old brachytherapy). Premature menopause if ovaries not transposed. All discussed in
detail before treatment begins.
Brachytherapy — internal radiation delivered directly to the cervical tumour — is an essential and irreplaceable component of curative-intent radiotherapy for locally advanced cervical cancer. Without brachytherapy, external beam radiation alone cannot deliver sufficient dose to the tumour without unacceptable damage to surrounding organs. No brachytherapy means no cure for most locally advanced cervical cancers — and IGBT is the modern standard.
IGBT is performed under spinal or general anaesthesia. An intracavitary applicator (typically a tandem inserted into the uterus and ring or ovoid placed in the vaginal fornices) is positioned in the uterine cavity and vagina. MRI or CT imaging is then performed with the applicator in place — giving the radiation team a precise 3D map of the residual cervical tumour and the bladder, rectum, and sigmoid colon. Using this imaging, the brachytherapy treatment planning system calculates a dose distribution that maximises dose to the tumour (high-risk CTV) while keeping bladder and rectal doses within internationally agreed safety limits (EMBRACE constraints). The prescribed dose is then delivered by a remote-controlled afterloader in approximately 5–15 minutes. 3–5 IGBT sessions are given over 1–2 weeks.
KCC introduced IGBT to Nepal in 2022. The programme is conducted by radiation oncologists trained in IGBT technique, and outcomes have been published in international peer-reviewed oncology journals. Every IGBT plan is reviewed against EMBRACE study dose constraints.
For Stage IVB or recurrent cervical cancer after primary treatment, systemic therapy offers meaningful disease control. The treatment landscape has changed significantly with the addition of immunotherapy.
Standard first-line chemotherapy for metastatic or recurrent cervical cancer. Cisplatin + paclitaxel (or carboplatin + paclitaxel for cisplatin-ineligible patients) every 3 weeks. Bevacizumab (anti-VEGF, 15 mg/kg) added to doublet chemotherapy for eligible patients — the GOG 240 trial showed bevacizumab + chemotherapy significantly improved overall survival (17 months vs 13.3 months) vs chemotherapy alone. Bevacizumab requires monitoring for hypertension, proteinuria, and fistula risk (higher in previously irradiated patients).
Chemotherapy at KCC
The KEYNOTE-826 trial established pembrolizumab (Keytruda, anti-PD-1) as a standard addition to
first-line chemotherapy ± bevacizumab in recurrent/metastatic cervical cancer with PD-L1
CPS ≥1 (approximately 90% of cases). Adding pembrolizumab to chemotherapy improved median
overall survival to 24 months vs 16.3 months with chemotherapy alone — a landmark result.
All recurrent/metastatic cervical cancer patients at KCC are tested for PD-L1 expression (CPS).
Pembrolizumab is administered as 200 mg IV every 3 weeks, concurrent with chemotherapy,
and continued as maintenance for up to 2 years.
For isolated local recurrence after primary surgery (vaginal vault recurrence),
salvage chemoradiation + IGBT can achieve cure in a proportion of patients —
particularly those with small-volume, central recurrence who have not previously
received pelvic radiation.
For metastatic disease causing specific symptoms (bone pain, bleeding, pelvic pressure),
short-course palliative radiotherapy (8 Gy × 1 or 20 Gy × 5) provides effective
symptom control. KCC's palliative radiation oncology service is an integral part of
advanced disease management.
KCC's palliative care team is integrated into the cervical cancer service for patients with advanced or recurrent disease. This includes pain management, lymphoedema care (from pelvic node involvement), fistula management, psychological support, and end-of-life planning when appropriate. KCC's palliative care service prioritises quality of life alongside disease management at every stage.
Palliative Care at KCCWhether you have a recent diagnosis, an abnormal smear, or symptoms that need investigating, here is exactly what your journey at KCC looks like.
Call KCC, WhatsApp your reports, or book a cervical cancer screening or oncology appointment. Our team will guide you through everything — from the first phone call.
गर्भाशय ग्रीवाको क्यान्सर (Cervical Cancer) नेपालमा महिलाहरूमा सबैभन्दा बढी देखिने क्यान्सर हो। यो HPV (Human Papillomavirus) भाइरसबाट हुन्छ। राम्रो खबर: यो क्यान्सर रोक्न सकिन्छ — HPV खोप र नियमित स्क्रिनिङले। र प्रारम्भमा पत्ता लाग्यो भने पूर्ण रूपमा निको हुन्छ।
IGBT एउटा आधुनिक रेडियोथेरापी विधि हो जसमा MRI वा CT scan बाट ट्युमरको सटीक नक्सा बनाइन्छ र त्यही अनुसार विकिरण दिइन्छ। परम्परागत brachytherapy भन्दा १०–१५% बढी क्यान्सर नियन्त्रण र मूत्राशय / आन्द्राका दुष्प्रभावमा ~५०% कमी। यो विधि नेपालमा पहिलो पटक KCC मा २०२२ मा सुरु भयो — र अन्तर्राष्ट्रिय जर्नलमा प्रकाशित भएको छ।
KCC, सूर्यबिनायक, भक्तपुर — गर्भाशय ग्रीवाको क्यान्सरको सम्पूर्ण उपचार नेपालमै। भारत जानु पर्दैन। फोन: 01-6634300 | स्क्रिनिङ बुक गर्नुहोस् | WhatsApp