Managing side effects


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.

See more information about nutrition and cancer or call Cancer Council 13 11 20.

Tiredness

Many women who are treated for cervical cancer find that tiredness 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. See information about support services.

Tips for coping with tiredness

  • Plan to do things at the time of day when you feel less tired. Keep a journal to track your "good times".
  • Limit daytime naps to 30 minutes so they don't make it hard to sleep at night.
  • 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.
  • See living well after cancer of call Cancer Council 13 11 20.

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 find a guide to exercising the pelvic floor muscles in exercise for people living with cancer – call Cancer Council 13 11 20 for more information. You can also ask your doctor to refer you to a continence nurse or physiotherapist, 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 radiotherapy. 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.

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. For more information see 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 information 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.

How to manage effects of menopause

Osteoporosis

  • Eat 3–5 serves of calcium- rich food daily (e.g. yoghurt, milk, tofu, green vegetables).
  • Vitamin D helps the body absorb calcium. The sun is a good source of vitamin D. Download the SunSmart app for safe times to go out in the sun. Ask your GP whether a calcium or vitamin D supplement might help you.
  • Do weight-bearing exercise, such as walking, dancing or team sports. Ask your GP what is suitable for you.

Heart disease

  • Ask your doctor to check your cholesterol levels. If they are high, ask about medication and/or dietary changes.
  • Eat lots of fruit, vegetables and fibre.
  • Reduce your saturated fat intake by limiting processed meats and takeaway foods.
  • Exercise regularly. Your doctor can suggest exercises that are suitable for you.
  • If you smoke, talk to your doctor about quitting or call the Quitline on 13 7848.

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. See below for ways to keep your vagina open and more elastic.

See more information about sexuality issues or call Cancer Council 13 11 20.

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.

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 list 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.

See more information on fertility and cancer or call Cancer Council 13 11 20.

Key points

  • Many women experience side effects following treatment. There are ways to reduce or manage the discomfort that side effects may cause.
  • Bowel and bladder problems may occur after treatment. Your doctor can refer you to a continence nurse or physiotherapist to help you manage these problems.
  • Tiredness is a common side effect. Try to plan activities around your energy levels, and talk to your family and friends about ways they can help you.
  • If fluid builds up in the legs (lymphoedema), try gentle exercise, compression stockings or visit lymphoedema.org.au to find a specialised practitioner.
  • Surgery or radiotherapy to the ovaries can cause menopause. Chemotherapy may also cause temporary or permanent menopause. The symptoms of menopause include hot flushes, mood swings and insomnia. Talk to your doctor about ways to help reduce these symptoms.
  • Menopause increases the risk of osteoporosis and heart disease. Ask your doctor for advice on reducing your risk or ways to manage these issues. Making some changes to your diet and lifestyle can help.
  • Sexuality issues following treatment are common. Addressing any challenges early can help you adjust. It can be helpful to talk to a counsellor.
  • If you are unable to have children as a result of treatment (infertility), you may feel very distressed. If you would like to have children, speak to your doctor before treatment starts about options for preserving your fertility.

Expert content reviewers:

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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