Supportive care for cervical cancer

Supportive care helps women meet the physical, practical, emotional and spiritual challenges of cervical cancer. It is an important part of cancer care. There are many programs and services available to help meet the needs and improve the quality of life of people living with cancer and their loved ones, especially after treatment has ended.

Recovering from cervical cancer and adjusting to life after treatment is different for each woman, depending on the stage of the cancer, the organs and tissues removed during surgery, the type of treatment and many other factors. The end of cancer treatment may bring mixed emotions. Even though treatment has ended, there may be other issues to deal with, such as coping with long-term side effects. A woman who has been treated for cervical cancer may have the following concerns.

How a person feels about themselves is called self-esteem. Body image is how a person sees their own body. Cervical cancer and its treatments can affect a woman’s self-esteem and body image. Often this is because cancer or cancer treatments may result in body changes, such as:

• scars
• hair loss
• changes in body weight
• sexual problems
• having an ostomy
• urinary or bowel problems

Some of these changes can be temporary. Others can last for a long time or be permanent.

For many women, body image and how they think other people see them is closely linked to self-esteem. It may be a real concern for them and can cause considerable distress. They may feel angry or upset, afraid to go out or afraid others will reject them, even if the effects of treatment may not show on the outside of the body.

Find out more about how to cope with problems of self-esteem and body image.

Many women continue to have strong, supportive relationships and a satisfying sex life after cervical cancer. If sexual problems happen because of cervical cancer treatment, there are ways to manage them.

Some of the side effects of cancer treatment that can make sex painful or difficult include:

• vaginal dryness caused by cancer treatments such as radiation therapy or surgery
• vaginal narrowing caused by scarring after radiation therapy to the pelvic area or some vaginal cancer surgeries
• treatment-induced menopause caused by cancer treatments such as radiation therapy or surgery

Some women may lose interest in having sex. It is common to have a decreased interest in sex around the time of diagnosis and treatment.

When a woman first starts having sex after treatment, she may be afraid that it will be painful or that she will not have an orgasm. The first attempts at being intimate with a partner may be disappointing. It may take time for the couple to feel comfortable with each other again. Some women and their partners may need counselling to help them cope with these feelings and the effects of cancer treatments on their ability to have sex.

Find out more about sexuality and cancer, sexual problems for women and treatment-induced menopause.

Fertility problems can happen after treatment with radiation therapy or chemotherapy for cervical cancer. Women who have had a hysterectomy will not be able to become pregnant.

Treatments for early stage cervical cancer may be considered to preserve fertility in women who still wish to have children. Before you start any treatment for cervical cancer, talk to your healthcare team about side effects that may affect your ability to have children after treatment and what you can do about them.

Find out more about how you can manage fertility problems.

Lymphedema is a type of swelling that happens when lymph fluid builds up in tissues. It usually happens in parts of the body where large numbers of lymph nodes have been removed.

You may have lymphedema in your legs if lymph nodes were removed from your pelvis or groin. Lymphedema is more likely to happen if you were also given radiation therapy to the pelvis.

If you develop lymphedema, your healthcare team can suggest ways to reduce swelling and pain as much as possible and to help prevent more fluid from building up. Ways to manage lymphedema include propping up the limb so that fluid can drain more easily, exercise, compression stockings and regular physiotherapy. You can also ask for a referral to a healthcare professional who specializes in managing lymphedema.

Find out more about lymphedema.

An ostomy connects an internal cavity to an opening (stoma) on the abdomen. People who have a pelvic exenteration will have the bladder, rectum or both removed. A urostomy allows urine to pass out of the body and a colostomy allows stool to pass out of the body. People who have the bladder and rectum removed will have 2 ostomies.

Many people can adapt to an ostomy and live normally with it, although they have to learn new skills and how to care for it. Specially trained healthcare professionals (called enterostomal therapists) teach people how to care for their ostomies.

Find out more about colostomies and urinary diversions, including urostomies.

Many women who are treated for cervical cancer worry that the cancer will come back (recur). It is important to learn how to deal with these fears to maintain a good quality of life.

A mental health professional, such as a social worker or counsellor, can help you learn how to cope and live with a diagnosis of cervical cancer. Other members of your healthcare team may also offer support.

Although uncommon, a different (second) cancer may develop after radiation therapy or chemotherapy treatment for cervical cancer. While the possibility of developing a second cancer is frightening, the benefit of treating cervical cancer with chemotherapy or radiation therapy usually far outweighs the risk of developing another cancer. Whether or not a second cancer develops depends on the type and dose of chemotherapy drugs given and if radiation therapy was also given. The combination of chemotherapy and radiation therapy (chemoradiation) increases the risk of second cancers.

Women who have radiation therapy to the pelvis have a small risk of developing a second cancer in the area treated with radiation. This area can include the colon, rectum, anus or bladder.

Women who have chemotherapy for cervical cancer can develop a second cancer at any time, but it usually happens up to 10 years after treatment. The most common cancer that develops in women treated with chemotherapy for cervical cancer is acute myelogenous leukemia (AML).

Living a healthy lifestyle and working with your healthcare team to develop a wellness plan for staying healthy may help lower the risk of second cancers. Routine screening to find a second cancer early, being aware of changes in your health and reporting problems to your doctor are also important parts of follow-up care after cancer treatment.

Some women with cervical cancer are very anxious or depressed during or after treatment. Levels of anxiety and depression appear to be related to physical symptoms and how much support you think you have from people close to you, including your caregivers.

You can speak with a social worker or counsellor on your healthcare team or ask to be referred to another mental health professional.

To make decisions that are right for you, ask your healthcare team questions about supportive care.