Supportive care for cervical cancer

Supportive care helps with the physical, practical, emotional and spiritual challenges of cancer. This important part of cancer care focuses on improving the quality of life of people with cancer and their loved ones, especially after treatment has ended.

Adjusting to life after treatment is different for everyone. Your recovery will depend on many different factors, such as where the cancer was in your body, the stage of the cancer, the organs and tissues removed during surgery, the type of treatment and side effects.

If you have been treated for cervical cancer, you may have the following concerns.

Self-esteem is how you feel about yourself. Body image is how you see your own body. They are often closely linked. Cervical cancer and its treatments can affect your self-esteem and body image. Often this is because cancer or cancer treatments change your body in different ways, such as having:

• scars
• hair loss
• weight loss or weight gain
• sexual problems
• having a stoma or ostomy bag
• bladder problems

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

But treatment can affect your self-esteem or body image even if it doesn’t affect how you look. Other people may not be able to see changes to your body, but you may still worry about how they now see you. This may affect your self-esteem, making you feel angry or upset, afraid to go out or worried that others will reject you.

Find out more about coping with body image and self-esteem worries.

Many people 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 by some vaginal cancer surgeries
• treatment-induced menopause caused by cancer treatments such as radiation therapy or surgery

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

When you first start having sex after treatment, you may be afraid that it will be painful or that you will not have an orgasm. The first attempts at being intimate with a partner may be disappointing. It may take time to feel comfortable with each other again. You and your partner may need counselling to help you cope with these feelings and the effects of cancer treatments on your 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. If you’ve had a hysterectomy, you will not be able to become pregnant.

Certain treatments for early-stage cervical cancer may be considered to preserve fertility if you want to have children in the future. Before you start any treatment for cervical cancer, talk to your healthcare team about side effects that may affect your ability to get pregnant 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). 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. An ostomy bag (or pouch) is attached to the opening (stoma) on the abdomen and collects waste from the body.

Many people can adapt to an ostomy bag 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 people 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.

People 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.

People who have chemotherapy for cervical cancer can develop a second cancer at any time. But if it happens, it usually happens up to 10 years after treatment. The most common cancer that develops in people treated with chemotherapy for cervical cancer is a type of blood cancer called acute myelogenous leukemia.

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 people 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.