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  • Managing the side effects of treatment for cervical cancer

     

    Contents

    It may take time to recover from treatment for cervical cancer. You may find the cancer affects you physically and emotionally.

    Side effects of treatment vary from person to person. Some women may experience a few side effects; others don't experience any side effects. Side effects may last from several weeks to a few months or, less commonly, many years or permanently. Fortunately, there are ways to reduce or manage the discomfort that side effects cause.

    Bowel changes

    After surgery or radiotherapy, some women notice changes in their bowel habits. You may experience constipation or diarrhoea, or feel pain in your abdomen. The following tips may help:

    • drink peppermint or chamomile tea to reduce abdominal or wind pain
    • drink plenty of liquids (except alcohol and caffeinated drinks) to replace fluids lost through diarrhoea or to help soften stools if you are constipated
    • limit spicy and greasy foods, as these can make diarrhoea and constipation worse
    • talk to your doctor or a dietitian about making changes to your diet, or to ask whether taking medicine is an option.

    The blood vessels in the bowel can become more fragile after radiotherapy. This can cause blood to appear in stools, even months or years after treatment. Let your doctor know if this occurs so you can be given the appropriate treatment. 

    For more information, call Cancer Council 13 11 20 or you can download the booklet Nutrition and cancer.

    Fatigue

    Many women who are treated for cervical cancer find that fatigue is a major issue, particularly if they have radiotherapy and chemotherapy. The tiredness may continue for several months, or even a year or two, after treatment has finished.

    Feeling tired is not only a side effect of the treatment itself; travelling to hospitals and clinics for treatment can be exhausting. If you work during your treatment or if you have a family to care for, this can make you feel especially tired.

    It may be frustrating if other people don’t understand how you’re feeling.

    For more information, call Cancer Council 13 11 20 or click here.

    Bladder problems

    Bladder control may change after surgery or radiotherapy. Some women find they need to pass urine more often or in a hurry. Others may experience involuntary loss of urine when they cough, sneeze, laugh, strain or lift. This is called urinary incontinence.

    Strengthening the muscles needed for urinary control can help manage urinary incontinence. You can ask your doctor to refer you to a continence nurse or physiotherapist, or contact the National Continence Helpline on 1800 33 00 66 or visit continence.org.au.

    The blood vessels in the bladder can become more fragile after radiotherapy. This can cause blood to appear in urine, even months or years after treatment. Let your doctor know if this occurs so you can be given the appropriate treatment. 

    For more information, call Cancer Council 13 11 20 or you can download the booklet Exercise for People Living with Cancer which contains a guide to exercising the pelvic floor muscles.

    Lymphoedema

    If lymph nodes have been damaged or removed during surgery, lymph fluid may not drain properly from your legs. This causes the fluid to build up and the legs to swell, which is called lymphoedema. Radiotherapy to the pelvic area may also cause swelling. Lymphoedema can occur during treatment or after treatment has finished, sometimes months or years later.

    It is important to avoid pressure, injury or infection to the lower limbs, and to manage lymphoedema symptoms as soon as possible. Gentle exercise, compression stockings, and a type of massage called manual lymphatic drainage can all help to reduce the swelling. A physiotherapist trained in lymphoedema management will be able to give you further advice.

    To find a practitioner who specialises in the management of lymphoedema, visit the Australasian Lymphology Association website at lymphoedema.org.au/the-register/find-a-practitioner

    For more information call Cancer Council 13 11 20 or you can download the fact sheet Understanding Lymphoedema.

    Menopause

    If your ovaries have been damaged by radiotherapy or chemotherapy, or they’ve been surgically removed, your body will no longer produce the hormones oestrogen and progesterone. When these hormones are no longer made, women stop having periods. This is called menopause. For most women, menopause is a natural and gradual process that starts between the ages of 45 and 55.

    Symptoms of menopause can include hot flushes, mood swings, trouble sleeping (insomnia), tiredness and vaginal dryness. The symptoms of sudden menopause are usually more severe than a natural menopause, because the body hasn’t had time to get used to a gradual decrease in the levels of oestrogen and progesterone.

    For information about dealing with the symptoms of menopause, talk to your doctor or call Cancer Council 13 11 20.

    Osteoporosis and heart disease

    Menopause may cause other changes in the body. For example, over time, your bones may become weak and brittle, and break more easily. This is called osteoporosis. Your cholesterol levels may rise, which can increase your risk of heart disease. The table below outlines ways to help prevent osteoporosis and heart disease. For more information, talk to your doctor, or visit osteoporosis.org.au and heartfoundation.org.au.

    Sexuality issues

    Having cervical cancer can affect your sexuality in physical and emotional ways. The impact of these changes depend on many factors, such as your treatment and its side effects, whether you have a partner, and your overall self-confidence.

    Low libido—a lack of interest in sex or loss of desire is common because of the physical and emotional effects of treatment. If you do not feel like having sexual intercourse, or if you find it uncomfortable, let your partner know. It normally takes some time for sex to be comfortable again. You can also explore other ways to be intimate, such as massage and cuddling.

    Vaginal changes—the main side effect of treatment will be to the vagina. If the ovaries have been affected by surgery or radiotherapy, they will no longer produce oestrogen. This will cause your vagina to become very dry and it may not expand easily during sexual intercourse.

    Radiotherapy to the pelvic area can also cause vaginal tissue to lose its elasticity and shrink, narrowing the vagina (vaginal stenosis). Although vaginal stenosis can make sexual intercourse uncomfortable, it should not affect your ability to reach orgasm.

    Coping with vaginal side effects 

    • Your doctor may suggest you use a vaginal dilator to help keep the walls of the vagina open and supple. A dilator is a tube-shaped device that is designed to gently stretch the vagina. Used with lubricant, it is inserted into the vagina for short periods of time. Ask your nurse or radiation therapist for more information about vaginal dilators.
       
    • Having regular gentle sexual intercourse can also help widen the vagina.
       
    • Ask your doctor about short-term hormone replacement therapy (HRT), which may help with vaginal dryness.

    For more information, call Cancer Council 13 11 20 or you can download the booklet Sexuality, Intimacy and Cancer.

    Fertility issues

    Surgery and radiotherapy for cervical cancer will affect the reproductive organs and cause infertility. This means it is no longer possible to become pregnant.

    Many women experience a sense of loss when they learn that their reproductive organs will be removed or will no longer function. You may feel devastated if you are no longer able to have children, and may worry about the impact of this on your relationship or future relationships. Even if your family is complete or you were not planning to have children, you may feel some distress.

    If you have a partner, talk to them about your feelings. Speaking to a counsellor or gynaecological oncology nurse may also help.

    For some women, there may be options for having children after treatment. Before treatment starts, ask your doctor or a fertility specialist about what options are available to you. 

    Fertility options

    The following outlines some ways you may be able to have children after treatment for cervical cancer:

    If you have not already been through menopause, ask about ways to preserve your fertility. One option may be to store eggs or embryos for use in the future.

    If you require radiotherapy but your ovaries do not need to be treated, one or both of the ovaries may be moved higher in the abdomen and out of the field of radiation. This is called ovarian transposition (oophoropexy), and it may help the ovaries keep working properly.

    Having a trachelectomy, where only the cervix is removed, is an option for some women with early-stage cervical cancer. It will still be possible to become pregnant after this procedure, but you will be at higher risk of having a miscarriage and having the baby prematurely. Your doctor can discuss these risks with you.

    For more information, call Cancer Council 13 11 20 or you can download the booklet Fertility and Cancer.

    This website page was last reviewed and updated December 2017.

    Information reviewed by:  Prof Ian Hammond, Gynaecological Oncologist (retired), WA and Chair, Cancer Council Australia Cervical Cancer Screening Guidelines Working Party, National Cervical Screening Program: Guidelines for the management of screen-detected abnormalities, screening in specific populations and investigation of abnormal vaginal bleeding. Cancer Council Australia, Sydney, 2016; Jennifer Duggan, Clinical Nurse Consultant Gynaecological Oncology, Royal Hospital for Women, NSW; Dr Rhonda Farrell, Gynaecological Oncologist, Royal Hospital for Women, Prince of Wales Private Hospital, St George Hospital, and Conjoint Lecturer, School of Women’s & Children’s Health, University of NSW; Melinda Grant, Consumer; Karen Hall, 13 11 20 Consultant, Cancer Council SA; Dr Pearly Khaw, Consultant Radiation Oncologist, Peter MacCallum Cancer Centre, VIC; Megan Smith, Program Manager – Cervix/HPV and Breast Group, Cancer Research Division, Cancer Council NSW

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