Side effects of treating uterine cancer

Tuesday 1 April, 2014

Download PDF Order FREE booklet

On this page: Menopause | Tiredness | Infertility | Vaginal narrowing and dryness | Bladder problems | Bowel problems | Lymphoedema and cellulitis | Key points  


It will take some time to recover from treatment. As well as physical changes, you will have to cope with the emotional impact.

Treatment side effects can vary. Some women will have a few side effects; others will have more. Side effects may last from a few weeks to a few months or, in some cases, years or permanently. There are often ways to reduce or manage the discomfort that side effects cause.

Menopause

The ovaries produce the hormones oestrogen and progesterone. If both ovaries have been removed or if you’ve had radiotherapy in the pelvic area, you will no longer produce these hormones. If you are not already menopausal, these treatments will cause sudden menopause (when a woman’s periods stop and she is no longer able to become pregnant).

Menopausal symptoms include hot flushes, trouble sleeping and vaginal dryness. The symptoms are usually more severe than a natural menopause because the body hasn’t had time to get used to the gradual decrease in hormone levels.

If you have already been through menopause and have had surgery to remove your ovaries and/or radiation treatment for uterine cancer, the symptoms of menopause may come back.

While hormone replacement therapy (HRT) can help reduce symptoms of menopause, this treatment is not usually used in women with uterine cancer because there is a risk the hormones may make the cancer worse. If your menopausal symptoms are severe, talk to your gynaecological oncologist about the risks and benefits of taking HRT. If you were already on HRT when the cancer was diagnosed, you may need to consider stopping its use.

Menopause can also increase the risk of some other health conditions. These include:

  • Osteoporosis – a loss of oestrogen at menopause may cause bones to weaken and break more easily.
  • Heart disease – cholesterol levels can change after menopause and this can increase your risk of heart disease.

Tiredness

It is common to feel tired or fatigued during and after treatment. Feeling tired is not only a side effect of the treatment itself. Travelling to hospitals and clinics for treatment and appointments can be exhausting. Dealing with your emotions can also cause fatigue. If you work during your treatment or if you have a home and a family to care for, fatigue may be a problem.

Your tiredness may continue for a while after treatment has finished. You might need to plan your activities during the day so you can rest regularly. It may help to talk with your family and friends about how you feel and discuss ways they can help you.

See our pages on fatigue and how to cope with fatigue for more information.

Coping with the side effects of treatment
  • Plan your day. Set small, manageable goals.
  • Ask for and accept offers of help from family and friends.
  • Learn to recognise signs of tiredness before you are exhausted.
  • Leave plenty of time to get to appointments.
  • Sit down whenever you can.
  • Try not to feel you must please others all the time.
  • Exercise, with the approval of your doctor. Even just a walk around the block can boost your energy levels.
  • Eat nutritious foods to keep your energy levels up.
  • Take time out to do things that you enjoy, for example, listen to music or watch a movie.
  • Smoking reduces your energy. If you smoke, talk with your doctor about trying to quit, or call the Quitline on 13 7848.

Infertility

Surgery or radiotherapy for uterine cancer will mean you are unable to have children. Although most women are older and postmenopausal when they are diagnosed with uterine cancer, it does occasionally affect younger, premenopausal women.

If fertility is a concern for you, it is important to discuss this with your doctor before your treatment starts.

Learning that your reproductive organs will be removed or will no longer function and that you won’t be able to have children can be devastating. Even if your family is complete or you did not want children, you may still experience a sense of loss and grief. These reactions are not unusual. Speaking to a counsellor or a gynaecological oncology nurse about your feelings and individual situation can be very beneficial. You can also call 13 11 20  or see our Fertility and Cancer section.

Vaginal narrowing and dryness

Radiotherapy to the pelvic area can cause vaginal tissue to shrink, narrowing the vagina. If you have had surgery to remove your ovaries, your vagina may also become very dry. This may make vaginal examination by a doctor difficult or painful. It may also make it painful to have sex.

If you experience any of these problems, talk to your GP, specialist doctor or oncology nurse, as the symptoms can usually be relieved. They may advise you to use vaginal lubricant or a device to expand the vagina (vaginal dilator).

Vaginal dilators

Your doctor may suggest you use a vaginal dilator to help keep the walls of the vagina open and supple, particularly if you are no longer sexually active. Used with lubricant, the dilator is usually inserted into your vagina for short periods of time, by yourself or with the help of a partner. Treatment staff can show you how to do this.

Bladder problems

Bladder control may change after treatment. Some women find they need to pass urine more often, or feel that they need to go in a hurry. Others may leak urine when they cough, sneeze, strain or lift.

For ways to manage accidental or involuntary loss of urine (urinary incontinence), talk with your GP or a physiotherapist. You could also contact the Continence Foundation of Australia on 1800 33 00 66.

Bowel problems

After surgery and radiotherapy, some women notice bowel changes. You may experience constipation or diarrhoea, or feel pain in your lower abdomen.

Constipation

Constipation is when you have difficulty passing a bowel motion regularly or often. It is important to avoid constipation, especially in the days after surgery, because it may lead to more discomfort or cause you to strain when you’re sitting on the toilet. 

The blood vessels in the bowel and bladder can become more fragile after radiotherapy. This can cause blood to appear in your urine or bowel movements, even months or years after treatment. Always seek advice from your specialist or GP if you notice new or unusual bleeding. Keep in mind that it may not be related to your treatment.

How to improve bowel symptoms

You may be able to make simple changes to your lifestyle to reduce constipation or diarrhoea. Talk to your dietitian or doctor about making changes to your diet or taking medication if you are experiencing bowel problems. 

  • Cut down on sweets, soft drink, takeaway food, fried foods, potato chips and other savoury snacks.
  • Limit intake of foods containing added sugars and salts.
  • Reduce alcohol intake. Drink more water.
  • Unless you have diarrhoea, try to eat more fibre-rich foods, such as bread, cereals, legumes, fruit and vegetables.
  • Do some gentle exercise like walking.
Diarrhoea

Diarrhoea is when you are passing frequent, loose stools from the bowels. If you have diarrhoea, drink plenty of water to replace lost fluid and prevent dehydration.

Try to avoid high-fibre foods, for example, wholegrain bread and cereals, nuts and legumes (such as beans and lentils). Fatty foods, alcohol, caffeine and spicy foods can also worsen the symptoms of diarrhoea. Some people who have radiotherapy find that they cannot have dairy products for a short time after treatment.

Ask a dietitian for suggestions on reducing the number of bowel movements. You can also talk with your doctor about medications that may help to reduce your symptoms. 

Lymphoedema

Lymphoedema is a swelling of part of the body, usually a leg or arm. If lymph nodes have been damaged or removed, it may prevent lymph fluid from draining properly. This causes fluid build-up and swelling.

The skin of the legs is more susceptible to infection after removal of the lymph glands. This is called cellulitis.

Signs of cellulitis include redness, painful swelling in the legs, warm skin and fever. If you have any of these symptoms, you should see your GP as soon as possible. Symptoms are better managed if treated early.

For more information on managing lymphoedema and cellulitis, ask your health care team for a referral to a specialist physiotherapist or nurse.

Download a copy Cancer Australia's booklet Lymphoedema – what you need to know, or call Cancer Council 13 11 20 for more information about lymphoedema.

Preventing lymphoedema and cellulitis
  • Gently massage the swollen leg to move fluid to other lymph channels.
  • Wear special bandages, stockings or a compression garment to help reduce the build-up of fluid in your legs. Check if you are entitled to a rebate for these from your health fund.
  • Wear sunscreen to avoid sunburn.
  • If you shave your legs, use an electric razor to avoid cuts, which may become infected.
  • Keep your feet clean and dry, especially between the toes.
  • Check your feet regularly for fungal infections.
  • Wear shoes when outdoors.
  • If you have symptoms of cellulitis (infection of the skin of the legs), see your GP as soon as possible. 

Key points

  • Every woman will experience side effects differently. Some will have none and others will have several. There are often ways to reduce or manage side effects.
  • If you are not already menopausal, having surgery or radiotherapy will mean your periods will stop.
  • If fertility is a concern for you, discuss this with your doctor before treatment starts. After surgery or radiotherapy you will be unable to have children.
  • Radiotherapy can cause your vagina to narrow and become dry, which can make vaginal examinations by a doctor and sexual intercourse difficult or painful.
  • Tiredness is common during and after treatment. Plan your daily activities and ask family and friends for help around the house so you can rest regularly.
  • Bladder control may change after treatment. There are ways to manage or prevent accidental or involuntary loss of urine (urinary incontinence).
  • After surgery, some women experience constipation, diarrhoea or pain in the lower abdomen. There are things you can do to reduce these side effects.
  • You may experience swelling in your legs (lymphoedema). Exercises or compression stockings may help to reduce the swelling. See your doctor as soon as possible if you have symptoms of an infection in your legs, such as redness and fever.

Reviewed by: Dr Sam Saidi, Senior Staff Specialist, Department of Gynaecological Oncology, Chris O’Brien Lifehouse, NSW; Sharon Ellis, Consumer; Anne Finch, Accredited Practising Dietitian, Campaign Project Officer, Cancer Council WA; Harrison Hills, Accredited Practising Dietitian, Nutrition and Physical Activity Project Officer, Cancer Council WA; Suparna Karpe, Clinical Psychologist, Department of Gynaecological Oncology, Westmead Hospital, NSW; Dr Pearly Khaw, Consultant Radiation Oncologist, Peter MacCallum Cancer Centre, VIC; Rosalind Robertson, Senior Psychologist, Gynaecological Cancer Centre, The Royal Hospital for Women, NSW; Deb Roffe, 13 11 20 Consultant, Cancer Council SA, Gynaecological Cancer Research Nurse, QIMR Berghofer Medical Research Institute, SA; Kylie Tilbury, Acting Gynaecology, Brain and CNS Cancer Nurse Care Coordinator, The Canberra Hospital, ACT. 
Updated: 01 Apr, 2014