Side effects of treating uterine cancer

Wednesday 1 March, 2017

Download PDF Order FREE booklet

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


It will take some time to recover from the physical and emotional changes caused by treatment. Treatment side effects can vary – some women experience many side effects, while others have few.

Side effects may last from a few weeks to a few months or, in some cases, years or permanently. This section includes ways to reduce or manage the discomfort that side effects may cause.

For more information see Living Well After Cancer or call Cancer Council 13 11 20.

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 and you will 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. If you have not already entered menopause, these treatments will cause sudden menopause. If you have already been through menopause, the symptoms of menopause may come back.

Menopausal symptoms include hot flushes, dry or itchy skin, mood swings, trouble sleeping (insomnia), tiredness and vaginal dryness. The symptoms are usually more severe than during a natural menopause because the body hasn't had time to get used to the gradual decrease in hormone levels.

While hormone replacement therapy (HRT) can help reduce symptoms of menopause, this treatment is not usually used in women with uterine cancer because oestrogen may cause the cancer to grow. 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.

Tips for managing the symptoms of menopause

  • Vaginal moisturisers available over-the-counter from chemists can help with vaginal discomfort and dryness.
  • You may need to avoid products containing oestrogen. Talk to your doctor about nonhormonal medicines that may help you deal with menopausal symptoms such as hot flushes and night sweats.
  • A loss of oestrogen at menopause may cause bones to weaken and break more easily. Talk to your doctor about having a bone density test or taking medicine to prevent your bones from becoming weak. Regular exercise will also help keep your bones strong. For more information see Osteoporosis Australia (call 1800 242 141 or visit osteoporosis.org.au).
  • Cholesterol levels can change after menopause and this can increase your risk of heart disease. Regular exercise and a balanced diet may help improve cholesterol levels. If not, talk to your doctor about cholesterollowering medicines.
  • Meditation and relaxation techniques may help reduce stress and lessen some of the symptoms associated with menopause.

Fatigue

It is common to feel very tired and lack energy during and after treatment. This 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. Your tiredness may continue for a while after treatment has finished.

Fatigue may impact on your ability to continue to work during your treatment or care for your home and family. It may help to talk with your family and friends about how you feel, and discuss ways they can help you.

Tips for managing fatigue

  • Plan your day. Set small, manageable goals so you can rest regularly.
  • Ask for and accept offers of help from family and friends, e.g. with shopping, housework and driving.
  • Learn to recognise signs of tiredness before you feel exhausted.
  • Leave plenty of time to get to appointments.
  • Try not to feel you must please others all the time.
  • Talk to your employer about taking time off, reducing your hours or working from home.
  • Do some light exercise, with the approval of your doctor. Even a walk around the block can boost your energy levels.
  • Eat nutritious foods to keep your energy levels up and limit your alcohol intake.
  • Sit down whenever you can.
  • Do some things that you enjoy.

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. There may be options available in certain cases to preserve the uterus so you can still have children. If appropriate, your doctor will discuss the risks and benefits of these options with you.

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 an oncology nurse about your feelings and individual situation can be very beneficial. You can also call Cancer Council 13 11 20 or see Fertility and Cancer.

Call Cancer Council for information about wig services in your area. If you have private health insurance, check with your provider whether you are entitled to a rebate on a wig for hair loss associated with chemotherapy.

Vaginal narrowing and dryness

Radiotherapy to the pelvic area can cause vaginal tissue to lose its elasticity and shrink, narrowing the vagina (vaginal stenosis). If your ovaries were removed, your vagina may also become very dry. These side effects may make vaginal examination by a doctor difficult or uncomfortable, and may make it painful to have sex.

If you experience any of these problems, talk to your health care team as the symptoms can usually be relieved. They may advise you to use a device called a vaginal dilator to expand the vagina or a vaginal moisturiser or lubricant. Vaginal moisturisers are available over-the-counter from pharmacies or can be bought online.

Tips for using vaginal dilators

  • Vaginal dilators can help keep the vaginal walls open and supple, and prevent vaginal narrowing, particularly if you are no longer sexually active.
  • They are tube-shaped devices made from plastic or rubber.
  • They come in different sizes.
  • Begin with the smallest dilator and progress to larger ones as each size becomes more comfortable.
  • Find a quiet, private place.
  • Start using 4–6 weeks after you've finished radiotherapy, once any inflammation has settled down.
  • Use a water-based lubricant and slowly insert a dilator into the vagina. Leave it there for 5–10 minutes.
  • You will need to do this 3–5 times a week, usually for many months.
  • Talk to your health care team for more detailed instructions.

Bladder problems

Urinary incontinence

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 to the hospital continence nurse or women's health physiotherapist. They may suggest exercises to strengthen your pelvic floor muscles. You could also visit the Australian Government's bladder and bowel website at bladderbowel.gov.au or contact the Continence Foundation of Australia at continence.org.au or on 1800 33 00 66.

Cystitis

Radiotherapy can irritate the lining of the bladder causing a burning sensation when you urinate and the need to pass urine more often than usual. This is called cystitis. Try to drink plenty of water to make your urine less concentrated. Over-the-counter urinary alkalisers (e.g. Ural) can help by making the urine less acidic. Your doctor may also prescribe medicine to treat cystitis.

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.

Bowel problems

After surgery and radiotherapy, some women notice bowel changes. You may experience constipation or diarrhoea, faecal incontinence, or feel pain in your lower abdomen. If you experience any of these problems, talk to your GP, specialist doctor, dietician or women's health physiotherapist, as they may be able to help with these issues.

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. Talk to your dietitian or doctor about making changes to your diet or taking medicines if you are experiencing constipation.

Tips that may reduce constipation

  • Drink more water – aim for at least 8 glasses during the day.
  • Eat regular meals throughout the day.
  • Try to eat more fibre-rich foods, e.g. wholegrain breads and cereals, legumes such as beans and lentils, vegetables, fruit, nuts and seeds.
  • Do some gentle exercise like walking.
  • Reduce your alcohol intake.
  • Cut down on sweets, soft drinks, takeaway food, fried foods, potato chips and other savoury snacks.
  • Limit foods containing added sugars and salts.
  • Take medicines as directed by your doctor.

Diarrhoea

Diarrhoea is the frequent passing of loose, watery stools (faeces) from the bowels. A dietitian can suggest changes to your diet to reduce the frequency of your bowel movements. Once your bowels have returned to normal you should resume a balanced diet that includes fresh fruits, vegetables, dairy foods and wholegrain cereals.

Tips to help you manage diarrhoea

  • Drink plenty of fluids such as water, herbal teas, sports drinks and electrolytereplacing fluids. Avoid alcohol.
  • Eat fewer high-fibre foods such as wholegrain breads and cereals, raw fruits and vegetables, and legumes.
  • Cut down on caffeine drinks.
  • Choose low lactose or soy-based dairy products; small amounts of cheese and yoghurt are usually okay.
  • Ask your doctor about suitable medicines. Take as directed.

Lymphoedema and cellulitis

Lymphoedema is a swelling of part of the body, usually a leg in the case of uterine cancer. If lymph nodes have been damaged during surgery or removed in a lymphadenectomy, it may prevent lymph fluid from draining properly. This causes fluid build-up and swelling. Sometimes the swelling can take months or years to develop and some women who are at risk never develop lymphoedema. Though lymphoedema may be permanent, it can usually be managed.

The skin of the legs is more susceptible to infection after removal of the lymph glands. This inflammation 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 for a referral to a specialist physiotherapist or nurse; download a copy of Cancer Australia's booklet Lymphoedema – what you need to know or call Cancer Council 13 11 20.

How to prevent and/or manage lymphoedema

  • Keep the skin healthy and unbroken to reduce the risk of infection.
  • Gently massage the swollen leg towards your heart to move the fluid to other lymph channels. Elevate your legs when resting.
  • Avoid cuts, scratches, burns, insect bites, sunburn and injections in your legs.
  • Do leg exercises to move fluid out of the affected area and into other lymph channels.
  • Talk to a lymphoedema practitioner about wearing compression bandages or stockings, or other ways to improve the circulation of lymphatic fluid. Visit lymphoedema.org.au to find a practitioner and to learn more about lymphoedema.
  • Moisturise your skin to prevent dryness and irritation. Use sunscreen to protect your skin from sunburn.
  • Keep your feet clean and dry, especially between the toes, to avoid fungal infections.

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.
  • 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.
  • 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. There are ways to reduce the discomfort of vaginal narrowing and dryness.
  • Bladder control may change after treatment. There are ways to manage or prevent accidental or involuntary loss of urine (urinary incontinence). You may also be more prone to bladder infections (cystitis).
  • After surgery, some women experience constipation, diarrhoea or pain in the lower abdomen. These can often be managed with changes to your diet.
  • 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, swelling and fever.

Reviewed by:A/Prof Sam Saidi, Senior Staff Specialist, Gynaecological Oncology Group, Chris O’Brien Lifehouse, NSW; Lauren Atkins, Accredited Practising Dietitian, Peter MacCallum Cancer Centre, VIC; Dr Scott Carruthers, Radiation Oncologist, Royal Adelaide Hospital, SA; Prof Michael Friedlander, Medical Oncologist, Royal Hospital for Women Sydney, NSW; Roslyn McAullay, Social Worker, Women and Newborn Health Service, King Edward Memorial Hospital, WA; Anne Mellon, Clinical Nurse Consultant, Hunter New England Centre for Gynaecological Cancer, NSW; Christine O’Bryan, Consumer; Deb Roffe, 13 11 20 Consultant, Cancer Council SA; Department of Physiotherapy, King Edward Memorial Hospital for Women, WA.
Updated: 01 Mar, 2017