Making treatment decisions
Sometimes it is difficult to decide on the type of treatment to have. You may feel that everything is happening too fast, or you might be anxious to get started. Check with your specialist how soon treatment should begin, as it may not affect the success of the treatment to wait a short time. Ask them to explain the options, and take as much time as you can before making a decision.
Know your options
Understanding the disease, the available treatments, possible side effects and any extra costs can help you weigh up the options and make a well-informed decision. Check if the specialist is part of a multidisciplinary team (see above) and if the treatment centre is the most appropriate one for you – you may be able to have treatment closer to home, or it might be worth travelling to a centre that specialises in a particular treatment.
Record the details
When your doctor first tells you that you have cancer, you may not remember everything you are told. Taking notes or recording the discussion can help. It is a good idea to have a family member or friend go with you to appointments to join in the discussion, write notes or simply listen.
Ask questions
If you are confused or want to check anything, it is important to ask your specialist questions. Try to prepare a list before appointments (see page 63 for suggestions). If you have a lot of questions, you could talk to a cancer care coordinator or nurse.
Consider a second opinion
You may want to get a second opinion from another specialist to confirm or clarify your specialist’s recommendations or reassure you that you have explored all options.
Specialists are used to people doing this. Your GP or specialist can refer you to another specialist and send your initial results to that person. You can get a second opinion even if you have started treatment or still want to be treated by your first doctor. You might decide you would prefer to be treated by the second specialist.
It’s your decision
Adults have the right to accept or refuse any treatment that they are offered. For example, some people with advanced cancer choose treatment that has significant side effects even if it gives only a small benefit for a short period of time. Others decide to focus their treatment on quality of life. You may want to discuss your decision with the treatment team, GP, family and friends.
Should I join a clinical trial?
Your doctor or nurse may suggest you take part in a clinical trial. Doctors run clinical trials to test new or modified treatments and ways of diagnosing disease to see if they are better than current methods. For example, if you join a randomised trial for a new treatment, you will be chosen at random to receive either the best existing treatment or the modified new treatment. Over the years, trials have improved treatments and led to better outcomes for people diagnosed with cancer.
You may find it helpful to talk to your specialist, clinical trials nurse or GP, or to get a second opinion. If you decide to take part in a clinical trial, you can withdraw at any time. For more information, visit australiancancertrials.gov.au.
Cervical cancer treatment
The most common treatment for cervical cancer is surgery and/or a combination of radiation therapy and chemotherapy (chemoradiation). When cervical cancer has spread beyond the cervix, targeted therapy may also be used.
Your medical team will recommend treatment based on the results of your tests; the location of the cancer and whether it has spread; your age and general health; and whether you would like to have children in the future.
If becoming a parent is important to you, talk to your doctor before starting treatment and ask for a referral to a fertility specialist. For more information about fertility options, see below.
Surgery
For some women, surgery may be the only treatment needed. Surgery is usually recommended for women who have a tumour that is in the cervix only. The type of surgery you have will depend on how far within the cervix the cancer has spread. Your surgeon will talk to you about the most appropriate surgery for you, as well as the risks and any possible complications (in both the short and long term).
The main type of surgery is called a hysterectomy, which is done under general anaesthetic. A hysterectomy is an operation to remove the uterus (womb) and cervix. The surgeon may also remove other organs of the reproductive system (see pages 30–31) or the lymph glands on the side wall of the pelvis (see page 33).
Types of surgery to treat cervical cancer
Depending on how far the cancer has spread and your age, you may have one or more of the procedures listed below.
Cone biopsy
Removes a cone of tissue around the cancer, including a margin of healthy tissue. This is used to treat very early cervical cancers, particularly for young women who would like to have children.
Trachelectomy
Removes part or all of the cervix, along with the upper part of the vagina. The uterus, fallopian tubes and ovaries are left in place. This is not a common procedure, but it may be used in young women with early-stage cervical cancer who would like to have children.
Total hysterectomy
Removes the uterus and cervix. Can be suitable for early cervical cancers. The fallopian tubes are also commonly removed. Some premenopausal women are able to keep their ovaries.
Radical hysterectomy
Removes the uterus, cervix, and soft tissue around the cervix and top of the vagina. This is the standard operation for most cervical cancers treated with surgery. The fallopian tubes are also commonly removed (see below). Some premenopausal women are able to keep their ovaries.
Bilateral salpingectomy
Removes both fallopian tubes. This is commonly recommended for women having a hysterectomy performed through the abdomen (open surgery). Your doctor will talk to you about the risks and benefits removing the fallopian tubes.
Bilateral salpingo-oophorectomy
Removes both fallopian tubes and ovaries. This is considered when your doctor is concerned that the cancer may have spread to the ovaries, or for women approaching the menopause or of menopausal age.
How the surgery is done
The surgery will be performed under a general anaesthetic. The hysterectomy can be done in two different ways.
Open surgery (laparotomy)
The surgery is performed through the abdomen. A cut is usually made from the pubic area to the bellybutton. Sometimes the cut is made along the pubic line instead. The uterus and other organs are then removed. Research has shown that open surgery is the better option for most cervical cancers.
Keyhole surgery (laparoscopy or robotic surgery)
These methods use thin cameras and instruments that are inserted through small cuts into the abdomen. The uterus and other organs are removed through the vagina. Laparoscopic surgery may be used for small, early-stage tumours.
Treatment of lymph nodes
Cancer cells can spread from the cervix to the lymph nodes in the pelvis. You may have one of the following procedures:
Sentinel lymph node biopsy
This test helps to identify the lymph node that the cancer is most likely to spread to first (the sentinel lymph node). While you are under anaesthetic, your doctor will inject a dye into the cervix. The dye will flow to the sentinel lymph node, and the surgeon will remove it for testing. If it contains cancer cells, the remaining nodes in the area may be removed in a procedure called a lymphadenectomy.
Alternatively, your doctors may decide you need other treatments such as chemoradiation (see page 37). A sentinel lymph node biopsy can help the doctor avoid removing more lymph nodes than necessary and minimise side effects such as lymphoedema (see page 49). This procedure may be used for some women with early cervical cancer and is only available in some treatment centres. Research into its role in treating cervical cancer is ongoing.
Lymphadenectomy (lymph node dissection)
The surgeon will remove an area of lymph nodes from the pelvic and/or abdominal areas to see if the cancer has spread beyond the cervix. If cancer is found in the lymph nodes, your doctor may recommend you have additional treatment, such as radiation therapy (see pages 37–41).
What to expect after surgery
When you wake up from surgery, you will be in a recovery room near the operating theatre. Once you are fully conscious, you will be taken to your bed on the hospital ward.
Tubes and drips
You may have an intravenous (IV) drip to give you fluid and medicine, a tube in your abdomen to drain fluid from the operation site, and a small plastic tube (catheter) in your bladder to drain urine. These tubes will be removed before you go home.
After the catheter is removed from your bladder, the nurses will perform a test to check that your bladder is emptying properly. This is done by measuring the amount of urine you pass each time you go to the toilet, then using an ultrasound scan to check that your bladder is empty. It is a quick, painless test that is done on the hospital ward.
Pain and discomfort
After a major operation it is common to feel some pain. You will be given pain medicine as a tablet, through a drip (intravenously) or through a catheter inserted in the spaces in the spine (epidural). If you still have pain, let your doctor or nurse know so they can change your medicine to one that provides more relief.
Moving your legs
While you are in bed, you may have to wear compression stockings or “calf compressors” around your lower legs. These help the blood in your legs circulate and prevent blood clots forming in the deep veins of the legs or pelvis (deep vein thrombosis). You will be encouraged to walk around as soon as you can.
Recovery
You will spend 3–5 days in hospital after a hysterectomy. The recovery time depends on the type of surgery and your fitness. You will be able to go home when the medical team is satisfied with your recovery and the results of your bladder function tests.
Side effects of surgery
After surgery for cervical cancer, you may experience some of the following side effects. See below for more information on managing these side effects.
Problems with bladder or bowel function
If some of the nerves to the bladder were removed during the hysterectomy, you may feel that you’re not able to empty your bladder completely, or that you’re emptying your bladder or bowel too slowly. These problems improve with time. Some women experience accidental leakage of urine after surgery. This is called urinary incontinence.
Lymphoedema
Sometimes the removal of lymph nodes in the pelvis can stop or slow the natural flow of lymphatic fluid. This may cause lymphoedema, which is excess fluid in the legs. Symptoms of lymphoedema may appear immediately or years after surgery.
Menopause
If your ovaries are removed and you have not been through menopause, removal will cause sudden menopause. After menopause you will not be able to become pregnant.
Impact on sexuality
The physical and emotional changes you experience after surgery may affect how you feel about sex, but surgery doesn’t change the ability to have sex or feel pleasure.
Internal scar tissue (adhesions)
Tissues in the pelvis may stick together. Sometimes adhesions to the bowel or bladder may cause abdominal pain or discomfort. Rarely, adhesions may need to be treated with surgery.
Taking care of yourself at home
Your recovery time after a hysterectomy will depend on the type of surgery you had, your age and general health. Most women say they feel better within six weeks.
Rest Take things easy for the first few weeks and only do what is comfortable. Ask family or friends to help you with chores so you can rest as much as you need to.
Work Depending on the nature of your work, you will probably need 6 weeks leave from work.
Exercise Walk regularly if your doctors say it is okay to do so. Gentle exercise can help speed up recovery. Speak to your doctor about when it is suitable to start more vigorous exercise.
Sex You’ll need to avoid sexual intercourse for at least 6 weeks to give the vaginal wound time to heal properly.
Diet Drink plenty of water and eat lots of fresh vegetables and fruit to avoid becoming constipated.
Bathing Take showers instead of baths and avoid swimming for 4–6 weeks after surgery.
Lifting Avoid heavy lifting for about a month, although this will depend on the type of surgery you had.
Radiation therapy
Also called radiotherapy, radiation therapy uses x-rays to kill or damage cancer cells. The radiation is targeted at the parts of the body with cancer or areas the cancer cells might have spread to. Treatment is carefully planned to do as little harm as possible to healthy tissues.
You may have radiation therapy on its own as the main treatment for cervical cancer, or you may have it after surgery to help get rid of any remaining cancer cells. Women with cervical cancer that has spread to the tissues or lymph nodes surrounding the cervix will usually have radiation therapy in combination with chemotherapy (chemoradiation) to reduce the chance of the cancer coming back.
There are two main ways of delivering radiation therapy: externally or internally. Most women who have radiation therapy for cervical cancer will have both types.
What is Chemoradiation?
When radiation therapy is combined with chemotherapy, it is known as chemoradiation. The chemotherapy drugs make the cancer cells more sensitive to radiation therapy.
If you have chemoradiation, you will usually receive chemotherapy once a week a few hours before the radiation therapy appointment.
Side effects of chemoradiation include fatigue; diarrhoea; needing to pass urine more often or in a hurry; cystitis; dry and itchy skin in the treatment area; nausea; and low blood counts. Low numbers of bloods cells may cause anaemia, infections or bleeding problems. Talk to your treatment team about ways to manage the side effects of chemoradiation.
External beam radiation therapy
In external beam radiation therapy, a machine precisely directs radiation beams from outside the body to the cervix, lymph nodes and other organs that need treatment. The initial planning session will include a CT scan to work out where to direct the radiation beams, and may take up to 45 minutes. The actual treatment takes only a few minutes each time.
You will probably have external radiation therapy as daily treatments, Monday to Friday, over 4–6 weeks as an outpatient. You will lie on
a table under the radiation therapy machine. Before the machine is turned on, the radiation therapist will leave the room, but they will be able to talk to you through an intercom and they will watch you on a screen while you have treatment. The treatment itself is painless.
Internal radiation therapy
Internal radiation therapy is known as brachytherapy. It is a way of delivering radiation therapy from inside your body directly to the tumour, while reducing the amount of radiation delivered to nearby organs such as the bowel and bladder. The main type of internal radiation therapy used for cervical cancer is high-dose-rate (HDR) brachytherapy. With HDR, bigger doses are given in a few treatments.
During treatment
You will probably have 3–4 sessions over 2–4 weeks. You will be given a general or spinal anaesthetic at each brachytherapy session.
Applicators are used to deliver the radiation source to the cancer. They are available in different sizes and your radiation oncologist will examine you to choose a suitable applicator for your situation. The applicator is placed into the cervix under the guidance of an ultrasound to make sure it is in the right place.
To hold the applicator in place, you may have gauze padding put into your vagina, and a stitch or two in the area between the vulva and the anus (perineum). You will also have a small tube (catheter) inserted to empty your bladder of urine during treatment.
You will have a CT or MRI scan to check the position of the applicator. This scan helps your doctor deliver the brachytherapy to the correct area. Once your doctor has completed the treatment plan, the radiation source will be placed into the applicator for 10–20 minutes. If you have a general anaesthetic, this will happen while you are asleep.
If you’ve had surgery to remove the cervix and uterus (hysterectomy), your doctor may want to deliver some extra radiation to the top of the vagina. An applicator will be placed into your vagina. You will not need to have a general anaesthetic or gauze padding.
After treatment
The applicator is taken out after the radiation dose is delivered. If several sessions are needed, the applicator will be reinserted each time.
External beam radiation therapy and HDR brachytherapy will not make you radioactive. It is safe for you to be with both adults and children after your treatment sessions.
Side effects of radiation therapy
The side effects you experience will vary depending on the dose of radiation and the length of the treatment. Many will be short-term side effects that occur during treatment or within a few weeks of finishing.
Short-term side effects
Fatigue
Your body uses a lot of energy dealing with the effects of radiation on healthy cells. Tiredness usually builds up slowly during the course of the treatment, particularly near the end. It may last for some time after treatment ends.
Bladder and bowel problems
You may pass urine more often or with more urgency, or with a burning sensation. Try to drink plenty of water to make your urine less concentrated. Bowel motions may be more frequent, urgent or loose (diarrhoea), or you may pass more wind than normal. Less commonly, there may be some blood in the stools. Your treatment team will prescribe medicines to reduce these side effects.
Skin redness, soreness and swelling
Radiation therapy may make the skin in the treatment area dry and itchy. Occasionally, your skin may look red and peel, like sunburn. The treatment team will recommend creams to use to make you more comfortable.
Hair loss
If radiation therapy is aimed at your pelvic area, you may lose your pubic hair. This hair may grow back after the treatment ends, but it will usually be thinner. The radiation therapy will not cause you to lose hair from your head or other parts of your body.
Vaginal discharge
Radiation therapy may cause or increase vaginal discharge. Let your treatment team know if it smells bad or has blood in it. Do not wash inside the vagina with douches as this may cause infection.
Long-term or late effects
Side effects can take several weeks to get better, though some may continue longer. Some side effects from radiation therapy may not show up until many months or years after treatment. These are called late effects.
Lymphoedema
Radiation can scar the lymph nodes and vessels and stop them draining lymph fluid properly from the legs. This may lead to swelling of the legs. This can occur months or years after radiation therapy.
Bladder and bowel problems
Bladder and bowel changes can also be late effects, appearing months or years after radiation therapy finishes. You may pass urine more often or need to go in a hurry. The movement of waste through the large bowel can become faster, meaning you need to go to the toilet more urgently and more often. It is important to let your doctor know if you have any bleeding or if you have pain in the abdomen and cannot open your bowels.
Narrowing of the vagina
The vagina may become drier, shorter and narrower (vaginal stenosis), which may make sex and follow-up pelvic examinations uncomfortable or difficult. Your treatment team will suggest strategies to prevent this.
Menopause
If your ovaries have not been removed, radiation therapy can stop the ovaries producing hormones, which leads to early menopause. Your periods will stop, you will no longer be able to become pregnant and you may have menopausal symptoms.
Pelvic fracture
In rare cases, radiation therapy to the pelvic area can weaken the bones and cause a fracture. Pelvic fractures are the most common. This may not occur for 2–4 years after treatment.
Chemotherapy
Chemotherapy uses drugs to kill cancer cells or slow their growth while causing the least possible damage to healthy cells. Chemotherapy may be given if the cervical cancer is advanced or returns after treatment, and may be combined with radiation therapy.
The drugs are usually given through a vein (intravenously) and most women have treatment as an outpatient. The number of chemotherapy sessions you have depends on the type of cervical cancer and any other treatments you may be having. If you have chemotherapy without radiation therapy, you are likely to have six sessions, scheduled every 3–4 weeks over several months.
Side effects of chemotherapy
The side effects of chemotherapy vary according to the drugs given, how often you have treatment, your general health and fitness, and whether you have chemotherapy alone, or as part of chemoradiation. You may experience nausea or vomiting, feel tired, or lose some hair from your body or head. Chemotherapy can also cause temporary or permanent menopause (see below).
Chemotherapy may reduce the number of blood cells in your body. Depending on the type of blood cells affected, you may feel very tired and be more prone to infections. If your temperature rises to 38°C
or above, seek urgent medical attention. You will have regular blood tests during treatment to monitor the levels of blood cells.
Most side effects are temporary, and your treatment team can help you to prevent or reduce them.
Targeted therapy
Targeted therapy drugs affect specific molecules within cells to block cell growth. They are used to treat some women with cervical cancer that has spread to other parts of the body or has come back and cannot be treated by surgery or radiation therapy.
Cancers develop their own blood vessels to help them grow. This process is called angiogenesis. Some targeted therapy drugs known as angiogenesis inhibitors are designed to stop this process.
Bevacizumab is an angiogenesis inhibitor that can be used to treat advanced cervical cancer. It is given with chemotherapy every three weeks through a drip into a vein (infusion). The total number of infusions you receive will depend on how you respond to treatment.
Side effects of targeted therapy
The most common side effects experienced by women taking bevacizumab include high blood pressure, feeling tired and loss of appetite. Less common side effects include bleeding and wound healing problems.
Palliative treatment
Palliative treatment helps to improve people’s quality of life by managing the symptoms of cancer without trying to cure the disease.
Many people think that palliative treatment is for people at the end of their life, but it may be beneficial for people at any stage of advanced cervical cancer. It is about living as long as possible in the most satisfying way you can.
As well as slowing the spread of cancer, palliative treatment can relieve any pain and help manage other symptoms. Treatment may include radiation therapy, chemotherapy, targeted therapy or other medicines such as hormone treatment.
Palliative treatment is one aspect of palliative care, in which a team of health professionals aim to meet your physical, emotional, practical and spiritual needs. The team also provides support to families and carers.
Managing side effects
It will take some time to recover from treatment for cervical cancer. You may find the cancer affects you physically and emotionally. Some women experience many side effects, while others don’t experience any. 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.
Bladder problems
Bladder control may change after surgery or radiation therapy. 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 find a guide to exercising the pelvic floor muscles in our Exercise for People Living with Cancer booklet. Using continence pads can help you manage any leakage and prevent any loss of dignity. A continence nurse or physiotherapist can develop a bladder training program – ask your doctor for a referral, or contact the National Continence Helpline on 1800 33 00 66 or at continence.org.au.
The blood vessels in the bowel and bladder can become more fragile after radiation therapy. This can cause blood to appear in urine or stools, even months or years after treatment. Let your doctor know if this occurs so you can be given the appropriate treatment.
Bowel changes
After surgery or radiation therapy, some women notice changes in their bowel habits. You may experience constipation or diarrhoea, or feel pain in your abdomen from trapped wind.
If radiation therapy has damaged the lining of the rectum, it can cause inflammation and swelling known as radiation proctitis. This can cause a range of symptoms including blood in bowel motions; frequent passing of loose, watery stools (diarrhoea); the need to empty the bowels urgently; and loss of control over the bowels (faecal incontinence). The risk of developing radiation proctitis is low, but you may develop some of these symptoms for other reasons. Talk to your treatment team if you develop any of these symptoms. If you have ongoing bowel problems, they may refer you to a gastroenterologist.
Tips for managing bowel changes
- 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.
- See a women’s health physiotherapist for information about exercises to strengthen your pelvic floor and anal sphincter. These exercises can help you control your bowels.
- Limit spicy and greasy foods, as these can make diarrhoea and constipation worse.
- Talk to your doctor or a dietitian about dietary changes, or to ask about suitable medicines. They may suggest you take a soluble fibre supplement to help avoid constipation, diarrhoea and loss of bowel control.
Fatigue
Many women who are treated for cervical cancer find that tiredness is a major issue, particularly if they have both radiation therapy 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. See below for information about support services.
Tips for managing fatigue
- Plan to do things at the time of day when you feel less tired. Keep a journal to track your “good times”.
- Talk with your family and friends about how you’re feeling and discuss things they can help you with, e.g. housework and shopping.
- Do some light exercise, such as walking or stretching, to
help increase your energy levels. Ask your doctor if these activities are suitable for you. - Limit daytime naps to 30 minutes so they don’t make it hard to sleep at night.
- Don’t expect to be able to instantly do everything you used to do. Your body is still recovering and it will take time for your energy levels to return.
Lymphoedema
After surgery or radiation therapy to the pelvic area, some women may find that one or both legs become swollen. This is known as lymphoedema. Lymphoedema may appear during treatment or 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. Mild lymphoedema is usually managed with exercise, skin care and a compression stocking or sleeve. 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’s website at lymphoedema.org.au.
Menopause
If your ovaries have been damaged by radiation therapy 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. You may also have a decreased interest in sex (low libido).
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 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. Oestrogen-alone hormone replacement therapy (HRT) has been shown to be an effective treatment for menopausal symptoms and to help prevent osteoporosis. For more information about dealing with the symptoms of menopause and whether HRT is right for you, talk to your doctor or ask for a referral to a specialist menopause clinic.
Tips for managing symptoms of menopause
- Talk to your doctor about having a bone density test or taking medicines to prevent osteoporosis.
- Regular exercise will help keep your bones strong. Osteoporosis Australia has more information – visit osteoporosis.org.au or call 1800 242 141.
- Ask your doctor to check your cholesterol levels. If they are high, regular exercise and a balanced diet may help them improve. If not, talk to your doctor about cholesterol- lowering drugs.
- Your doctor can suggest dietary changes and suitable exercises.
- If you smoke, talk to your doctor about quitting or call the Quitline on 13 7848.
- Try meditation and relaxation techniques to help reduce stress and lessen symptoms.
Fertility issues
Surgery or radiation therapy for cervical cancer may mean you are unable to conceive children. Before treatment starts, ask your doctor or a fertility specialist about what options are available to you.
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 extremely upset 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.
Ways to preserve fertility:
- 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.
- Having a trachelectomy, where only the cervix is removed, is an option for some women. 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.
- If you require radiation therapy but your ovaries do not need to be treated, one or both of the ovaries may be surgically moved higher in the abdomen and out of the field of radiation. This is called ovarian transposition or relocation (oophoropexy), and it may help the ovaries keep working properly.
Impact on sexuality and intimacy
Having cervical cancer can affect your sexuality in physical and emotional ways. The impact of these changes depends 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 experience of having cancer and the side 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. See the table opposite for some ways to manage sexual changes.
Vaginal changes
The main side effect of treatment for cervical cancer will be to the vagina. If the ovaries have been affected by surgery or radiation therapy, they will no longer produce oestrogen. This will cause your vagina to become very dry and it may not expand easily during sexual intercourse.
Radiation therapy to the pelvic area can also cause vaginal tissue to lose its elasticity and shrink, narrowing the vagina (vaginal stenosis). These side effects can make sexual penetration difficult or painful, and you may have to explore different ways to orgasm or climax.
See below for ways to keep your vagina open and more elastic. If you need more support resuming sexual activity, ask your doctor for a referral to a sexual therapist or psychologist.
Coping with impact on sexuality
Sexual changes
- Give yourself time to get used to any physical changes.
- Talk to your doctor about ways to manage side effects that change your sex life. This may include using hormone creams and vaginal moisturisers to help with vaginal discomfort and dryness.
- Hormone creams are available on prescription, while vaginal moisturisers are available over the counter from pharmacies.
- Discuss changes to your libido with your partner so they understand how you’re feeling and don’t feel rejected.
- Consider touching, hugging and kissing. This is a chance to feel close to your partner without expectations of sexual penetration.
- Explore other ways to climax, such as caressing the breasts, inner thighs, feet or buttocks.
- Use water- or silicone-based vaginal lubricants without perfumes, oils or glycerines.
Changes to the vagina
- Your doctor may suggest you use a vaginal dilator to help keep the walls of the vagina open and supple.
- Dilators are tube-shaped devices made from plastic or silicone that are designed to gently stretch the vagina. They come in different sizes – it is important to seek advice from a health professional about the correct size for you.
- Make sure any soreness or inflammation has settled before you start using a dilator. This
is usually 2–6 weeks after your last session of radiation therapy. - Used with lubricant, the dilator is inserted into the vagina for short periods of time.
- Using a dilator can be challenging. Your doctor or a physiotherapist can provide practical advice on their use.
- Having regular gentle sexual intercourse can also help widen the vagina. Use a lubricant to prevent discomfort caused by vaginal dryness.
Looking after yourself
Cancer can cause physical and emotional strain, so it’s important to look after your wellbeing. Cancer Council has free booklets and programs to help you during and after treatment. Call 13 11 20 to find out more, or visit your local Cancer Council website.
Eating well
Healthy food can help you cope with treatment and side effects. A dietitian can explain how to manage any special dietary needs or eating problems and choose the best foods for your situation.
Staying active
Physical activity can reduce tiredness, improve circulation and lift mood. The right exercise for you depends on what you are used to, how you feel, and your doctor’s advice.
Complementary therapies
Complementary therapies are designed to be used alongside conventional medical treatments. Therapies such as massage, relaxation, acupuncture and reiki can increase your sense of control, decrease stress and anxiety, and improve your mood. Let your doctor know about any therapies you are using or thinking about trying, as some may not be safe or evidence-based.
Work and money
Cancer can change your financial situation, especially if you have extra medical expenses or need to stop working. Getting professional financial advice and talking to your employer can give you peace of mind. You can also check with a social worker or Cancer Council whether any financial assistance is available to you.
Relationships
Having cancer can affect your relationships with family, friends and colleagues in different ways. Cancer is stressful, tiring and upsetting, and this may strain relationships. It may also result in positive changes to your values, priorities or outlook on life. Give yourself time to adjust to what’s happening, and do the same for those around you. It may help to discuss your feelings with each other.
Contraception and fertility
If you can have sex, you may need to use certain types of contraception to protect your partner or avoid pregnancy for a time. Your doctor will explain what precautions to take. They will also tell you if treatment will affect your fertility permanently or temporarily. If having children is important to you, discuss the options with your doctor before starting treatment.
Body image
Changes to your body can affect the way you feel about yourself (your self-esteem) and make you feel self-conscious. You may feel less confident about who you are and what you can do. Try to see yourself as a whole person (body, mind and personality), instead of focusing on the parts that have changed.
Life after treatment
For most women, the cancer experience doesn’t end on the last day of treatment. Life after cancer treatment can present its own challenges. You may have mixed feelings when treatment ends, and worry that every ache and pain means the cancer is coming back.
Some women say that they feel pressure to return to “normal life”. It is important to allow yourself time to adjust to the physical and emotional changes, and establish a new daily routine at your own pace. Your family and friends may also need time to adjust.
Cancer Council 13 11 20 can help you connect with other women who have had cancer, and provide you with information about the emotional and practical aspects of living well after cancer.
Dealing with feelings of sadness
If you have continued feelings of sadness, have trouble getting up in the morning or have lost motivation to do things that previously gave you pleasure, you may be experiencing depression. This is quite common among people who have had cancer.
Talk to your GP, as counselling or medicine – even for a short time – may help. Some people can get a Medicare rebate for sessions with a psychologist. Ask your doctor if you are eligible. Cancer Council may also run a counselling program in your area.
For information about coping with depression and anxiety, call Beyond Blue on 1300 22 4636 or visit beyondblue.org.au. For 24-hour crisis support, call Lifeline 13 11 14 or visit lifeline.org.au.
Follow-up appointments
After treatment ends, you will have regular appointments to monitor your health, manage any long-term side effects and check that the cancer hasn’t come back or spread.
At these appointments, you will usually have a pelvic examination, and you may have a follow-up HPV test or liquid-based cytology (LBC) test, blood tests, x-rays, a CT scan or PET scan. You will also be able to discuss how you’re feeling and mention any concerns you may have. Your doctor will discuss your follow-up schedule with you.
When a follow-up appointment or test is approaching, many people find that they think more about the cancer and may feel anxious. Talk to your treatment team or call Cancer Council 13 11 20 if you are finding it hard to manage this anxiety.
For the first few years, you will probably have a check-up every 3–6 months. Check-ups will become less frequent if you have no further problems. Let your doctor know immediately if you have any symptoms or health problems between follow-up appointments.
What if cervical cancer returns?
For some women cervical cancer does come back after treatment, which is known as a recurrence. It is important to have regular check-ups so that if cancer does come back, it can be found early. If cervical cancer returns, you will usually be offered treatment with chemotherapy, radiation therapy or surgery. If you had radiation therapy the first time you had treatment, you may not be able to have further radiation therapy.
