Cervical cancer - Complications

Complications of cervical cancer can happen as a side effect of treatment. They can also be a result of advanced cervical cancer.

Side effects of cervical cancer treatments can include:

• early menopause
• narrowing of the vagina
• lymphoedema
• emotional impact

Early menopause

If your ovaries are removed or damaged during radiotherapy, you will have an early menopause. This is if you have not already been through it. Most women experience the menopause naturally in their early fifties.

Symptoms of the menopause include:

• no longer having monthly periods or your periods becoming much more irregular
• hot flushes
• vaginal dryness
• loss of sex drive
• mood changes
• night sweats

Special medication can relieve these symptoms.

These drugs help produce the hormones oestrogen and progesterone. This is known as hormone replacement therapy (HRT).

Narrowing of the vagina

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

There are 2 main treatment options if you have a narrowed vagina.

The first is to apply a hormone cream to your vagina. This should increase moisture within your vagina. It will make having sex easier.

The second is to use vaginal dilators. These are sometimes called vaginal trainers.

Vaginal dilator

Vaginal dilators are tampon-shaped plastic tubes that come in many different sizes. You insert one into your vagina, usually starting with the smallest size.

Dilators help stretch the vagina. They make it more supple. As you get used to the smaller sizes, you can work your way up to larger ones.

It's usually recommended to use dilators for 5 to 10 minutes at a time on a regular basis. 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 be intimate with a sexual partner.

Lymphoedema

The lymph nodes in your pelvis may be removed. This can sometimes disrupt your lymphatic system.

One of the things your lymphatic system does is drain excess fluid from your body's tissue.

A disruption to this process can lead to a build-up of fluid in the tissue. This is called lymphoedema. This can cause certain body parts to become swollen. In cases of cervical cancer, usually your legs will become swollen.

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

Emotional impact

The emotional impact of living with cervical cancer can be significant.

Many report experiencing a 'rollercoaster' effect.

For example, you may feel down when you receive a diagnosis. But you may be happy when removal of the cancer has been confirmed. You may then 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.

Typical signs of depression include:

• feeling sad
• feeling hopeless
• losing interest in things you used to enjoy

Contact your GP if you think you may be depressed.

Complications of advanced cervical cancer

Some of the complications in advanced cervical cancer are:

• pain
• kidney failure
• blood clots
• bleeding
• fistula

Pain

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

• nerve endings
• bones
• muscles

You can usually manage this pain with medication.

The medication 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 aren't working. You may need stronger medication. A short course of radiotherapy may also help.

Kidney failure

In some advanced cancer cases, the tumour can cause a build-up of urine inside the kidneys (hydronephrosis). This can lead to loss of the kidneys' functions. This is called 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 pee (haematuria)

Treatment options for kidney failure include draining urine out of the kidneys. This involves using a tube inserted through the skin and into each kidney.

Another treatment option is widening the ureters. This is done by placing a small metal tube, called a stent, inside them.

Blood clots

All cancers can make the blood 'stickier' 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. This 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)
• the skin of your leg being warm and red

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

Blood clots in the legs are usually treated using medication and compression. You will be given blood-thinning medication, such as heparin or warfarin. You will also be told to use compression garments. These will help encourage blood flow through the limbs.

Bleeding

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

Bleeding can occur in your vagina or back passage (rectum), or you may pass blood when you pee.

Minor bleeding can often be treated using medication. This medicine is called tranexamic acid. It encourages the blood to clot and stop the bleeding. Radiotherapy can also be very effective in controlling bleeding caused by cancer.

Major bleeding may be temporarily treated by using gauze to stem the bleeding. It will later need surgery, radiotherapy or cutting off blood supply to the cervix.

Fistula

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

In most cases, the fistula is a channel that develops between the bladder and the vagina. This can lead to a persistent discharge of fluid from the vagina. A fistula can sometimes develop between the vagina and rectum.

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

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