Cervical cancer complications

You may have complications after having a radical hysterectomy.

Short-term complications include:

• infection
• bleeding
• blood clots
• accidental injury to your ureter, bladder or rectum

Long-term complications are more common if you have both a hysterectomy and radiotherapy.

Long-term complications include:

• your vagina becoming shorter and drier - this can make sex painful
• not realising your bladder is full and needing to pee during the night - a small number of women may need a catheter
• swelling of your legs, caused by a build-up of fluid (lymphoedema)
• a build-up of scar tissue in the bowel - this may cause pain and may need surgery
• constipation - you may need to use laxatives long term

Your womb is removed during a hysterectomy. This means you will not be able to get pregnant.

Recovering from a radical hysterectomy

Menopause usually starts between age 45 and 55.

Early menopause is when your periods stop or become irregular before age 45.

Cancer treatment can cause early menopause if your ovaries are:

• removed as part of treatment - your periods stop
• affected by chemotherapy or radiotherapy - your periods may become irregular

Symptoms of early menopause

Treatment for early menopause is often to replace the missing hormones. This is usually the combined contraceptive pill or hormone replacement therapy (HRT).

Treating early menopause

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

The 2 types of treatment for a narrowed vagina are:

• a hormone cream you use on your vagina to increase moisture within your vagina - it will make having sex easier
• a vaginal dilator - these are sometimes called vaginal trainers

Vaginal dilator

Vaginal dilators are tampon-shaped plastic tubes that come in different sizes. Dilators help stretch the vagina. They make it more supple.

You insert one into your vagina, usually starting with the smallest size. As you get used to the smaller sizes, you can work your way up to larger ones.

You use dilators for 5 to 10 minutes at a time regularly. You do this over 6 to 12 months.

Your specialist will give you more information and advice.

You may find that sex becomes less painful over time. But it may take several months before you feel ready to have vaginal sex.

Your legs might swell if the lymph nodes in your pelvis are removed. Lymph nodes are part of your lymphatic system. The lymphatic system drains excess fluid from your body's tissue.

If your lymphatic system is disrupted, a build-up of fluid in the tissue can happen.

This causes certain body parts to swell. In cases of cervical cancer, usually your legs will become swollen. This is called lymphoedema.

Radiotherapy to the pelvis can also cause your pelvis and legs to swell.

There are exercises and massage techniques that can reduce the swelling. Wearing special bandages and compression garments can also help.

Treatment for lymphoedema

You might have severe pain if the cancer spreads into your:

• nerve endings
• bones
• muscles

You can usually manage this pain with medicine.

The medicine you're given will depend on your level of pain.

It may be:

• paracetamol
• non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen
• powerful painkillers such as codeine and morphine

Tell your care team if the painkillers you're prescribed are not working. You may need stronger medicine.

All cancers can make the blood 'stickier' and more likely to form clots. Bed rest after surgery and chemotherapy can increase the risk of clots.

Large tumours can press on the veins in your pelvis. This slows the flow of blood and a blood clot can develop in your legs.

Symptoms of a blood clot in your legs include:

• pain, swelling and tenderness in one of your legs (usually your calf)
• warm and red skin on your leg

A major concern is that the blood clot in your leg will travel up to the lungs. This could block the supply of blood to your lungs. This is called a pulmonary embolism. It can lead to death.

Treating blood clots

Blood clots in the legs are usually treated using medicine and compression. You will be given blood-thinning medicine, such as heparin or warfarin. You will also be told to use compression garments (such as compression stockings or socks). These will help blood flow through your legs.

A fistula is a rare and distressing complication of advanced cervical cancer.

A fistula is when a narrow tunnel develops inside your body and connect 2 areas of your body that are not normally connected.

In most cervical cancer cases, the fistula is between your bladder and your vagina.

You may have a flow of pee and discharge from your vagina that you cannot control.

If the fistula is between your bowel and your vagina, you may have a flow of poo and discharge from your vagina that you cannot control.

Treating a fistula

Surgery is usually needed to repair or divert a fistula. It may not be possible if you have advanced cervical cancer or if tissues have been damaged by radiotherapy.

In these cases, your treatment involves using medicine, creams and lotions. These are used to reduce the amount of discharge. They also protect your vagina and surrounding tissue from damage and irritation.

If the cancer spreads into your vagina, bowel or bladder, it can cause major damage. This can cause bleeding.

Treating minor bleeding

The treatment for minor bleeding is often a medicine that helps the blood to clot and stop the bleeding. Radiotherapy can also control bleeding caused by cancer.

Treating major bleeding

The short-term treatment for major bleeding is to stem the bleeding. A doctor will put a gauze pack into your vagina to put pressure on the cervix.

You may need surgery or radiotherapy to reduce the blood supply to your cervix to stop major bleeding.