Cervical cancer - Complications of cervical cancer

Complications of cervical cancer can occur as a side effect of treatment or as the result of advanced cervical cancer.

These are described in more detail below.

Side effects

Early menopause

If your ovaries are surgically removed or they're damaged during treatment with radiotherapy, it will trigger an early menopause (if you haven't already had it). Most women experience the menopause in their early fifties.

The menopause is caused when your ovaries stop producing the hormones oestrogen and progesterone. This leads to the following symptoms:

you no longer have monthly periods or your periods become much more irregular
hot flushes
vaginal dryness
loss of sex drive
mood changes
stress incontinence (leaking urine when you cough or sneeze)
night sweats
thinning of the bones, which can lead to brittle bones (osteoporosis)

These symptoms can be relieved by taking a number of medications that stimulate the production of oestrogen and progesterone. This treatment is known as hormone replacement therapy (HRT).

Narrowing of the vagina

Radiotherapy to treat cervical cancer can often cause your vagina to become narrower. This can make having sex painful or difficult.

There are two main treatment options if you have a narrowed vagina. The first is to apply hormonal cream to your vagina. This should increase moisture within your vagina and make having sex easier.

The second is to use a vaginal dilator, which is a tampon-shaped device made of plastic. You insert it into your vagina and it is designed to help make it more supple. It is usually recommended that you insert the dilator for five to 10 minutes at a time on a regular basis during the day over the course of six to 12 months.

Many women find discussing the use of a vaginal dilator embarrassing, but it's a standard and well-recognised treatment for narrowing of the vagina. Your specialist cancer nurse or radiographers in the radiotherapy department should be able to give you more information and advice.

You may find that the more times you have sex, the less painful it becomes. However, it may be several months before you feel emotionally ready to be intimate with a sexual partner.

You can read more about sexuality and cancer on the Macmillan Cancer Support website.

Lymphoedema

If the lymph nodes in your pelvis are removed, it can sometimes disrupt the normal workings of your lymphatic system.

One of the functions of the lymphatic system is to drain away excess fluid from the body's tissue. A disruption can cause a build-up of fluid in the tissue. This can lead to certain body parts becoming swollen, but usually the legs in cases of cervical cancer. This is known as lymphoedema.

There are a number of exercises and massage techniques that can reduce the swelling. Wearing specially designed bandages and compression garments can also help.

Emotional impact

The emotional impact of living with cervical cancer can be significant. Many people report experiencing a "rollercoaster" effect.

For example, you may feel down when you receive a diagnosis, but feel up when removal of the cancer has been confirmed. Then you may feel down again as you try to come to terms with the after-effects of your treatment.

This type of emotional disruption can sometimes trigger depression. Signs that you may be depressed include feeling down or hopeless during the past month and no longer taking pleasure in the things that you enjoy.

Contact your GP for advice if you think you may be depressed. There are a range of effective treatments available, including antidepressant medication and talking therapies such as cognitive behavioural therapy (CBT).

You may also find Jo's Cervical Cancer Trust website a useful resource. It's the UK's only charity dedicated to women affected by cervical cancer.

There may also be local support groups in your area for women affected by cancer. Your specialist cancer nurse should be able to provide contact details.

Advanced cervical cancer

Some of the complications that can occur in cases of advanced cervical cancer are discussed below.

Pain

If the cancer spreads into your nerve endings, bones or muscles, it can often cause severe pain.

However, a number of effective painkilling medications can usually be used to control the pain. Depending on the levels of pain, they can range from paracetamol and non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, to more powerful opiate-based painkillers such as codeine and morphine.

If the painkillers you are prescribed aren't effective in reducing your pain, you should tell your care team as you may need to be prescribed a stronger medication. A short course of radiotherapy can also be effective in controlling the pain.

Macmillan nurses, who work both in hospitals and in the community, can also provide expert advice about pain relief.

Kidney failure

Your kidneys remove waste material from your blood. The waste is passed out of your body in urine through tubes called the ureters. Kidney function can be monitored by a simple blood test called serum creatinine level.

In some cases of advanced cervical cancer, the cancerous tumour can press against the ureters, blocking the flow of urine out of the kidneys. The build-up of urine inside the kidneys is known as hydronephrosis and can cause the kidneys to become swollen and stretched.

Severe cases of hydronephrosis can cause the kidneys to become scarred, which can lead to loss of most or all of the kidneys' functions. This is known as kidney failure.

Kidney failure can cause a wide range of symptoms, including:

tiredness
swollen ankles, feet or hands caused by water retention
shortness of breath
feeling sick
blood in your urine (haematuria)

Treatment options for kidney failure associated with cervical cancer include draining urine out of the kidneys using a tube inserted through the skin and into each kidney (percutaneous nephrostomy). Another option is to widen each of the ureters by placing a small metal tube called a stent inside them.

Blood clots

Cervical cancer, like any other cancer, can make the blood more "sticky" and more prone to forming clots. Bed rest after surgery and chemotherapy can also increase the risk of developing a clot.

Large tumours can press on the veins in the pelvis, which slows the flow of blood and can lead to a blood clot developing in the legs.

Symptoms of a blood clot in your legs include:

pain, swelling and tenderness in one of your legs (usually your calf)
a heavy ache in the affected area
warm skin in the area of the clot
redness of the skin, particularly at the back of your leg, below the knee

A major concern in these cases is that the blood clot from the leg vein will travel up to the lungs and block the supply of blood to the lungs. This is known as a pulmonary embolism and can be fatal.

Blood clots in the legs are usually treated by using a combination of blood-thinning medication, such as heparin or warfarin, and compression garments designed to help encourage the flow of blood through the limbs.

Read more about treating deep vein thrombosis.

Bleeding

If the cancer spreads into your vagina, bowel or bladder, it can cause significant damage resulting in bleeding. Bleeding can occur in your vagina or rectum (back passage), or you may pass blood when you urinate.

Minor bleeding can often be treated using a medication called tranexamic acid, which encourages the blood to clot and stop the bleeding. Radiotherapy can also be highly effective in controlling bleeding caused by cancer.

Major bleeding can be treated using a combination of medications designed to lower blood pressure. This should help to stem the flow of blood.

Fistula

A fistula is an uncommon but distressing complication that occurs in around 1 in 50 cases of advanced cervical cancer.

A fistula is an abnormal channel that develops between two sections of the body. In most cases involving cervical cancer, the fistula develops between the bladder and the vagina. This can lead to a persistent discharge of fluid from the vagina. Sometimes a fistula develops between the vagina and rectum.

Surgery is usually required to repair a fistula, although it's often not possible in women with advanced cervical cancer because they're usually too frail to withstand the effects of surgery.

In such cases, treatment often involves using medication, creams and lotions to reduce the amount of discharge and protect the vagina and surrounding tissue from damage and irritation.

Vaginal discharge

Another uncommon but distressing complication of advanced cervical cancer is an unpleasant smelling discharge from your vagina.

The discharge can occur for a number of reasons, such as the breakdown of tissue, the leakage of bladder or bowel contents out of the vagina, or a bacterial infection of the vagina.

Treatment options for vaginal discharge include an antibacterial gel called metronidazole and wearing clothing that contains charcoal. Charcoal is a chemical compound that's very effective in absorbing unpleasant smells.

Palliative care

If your doctors can't do any more to treat your cancer, your care will focus on controlling your symptoms and helping you to be as comfortable as possible. This is called palliative care.

Palliative care also includes psychological, social and spiritual support for you and your family or carers.

There are different options for terminal care in the late stages of cancer. You may want to think about whether you would like to be cared for in hospital, in a hospice or at home, and discuss these issues with your doctor. Some organisations who provide care for people with cancer include:

Macmillan Cancer Support has specially trained nurses who help look after people with cancer at home. To be referred to a Macmillan nurse, ask your hospital doctor or GP, or call 0808 808 00 00.
Marie Curie Cancer Care have specially trained nurses who help look after people with cancer at home. They also run hospices for people with cancer.
Help the Hospices has information about hospice care and how to find a hospice.