information has been prepared to help you understand more about
cervical cancer (cancer of the cervix).
Many women feel understandably shocked and upset when they are
told that they have or may have cervical cancer. This booklet is
intended to help you to understand the diagnosis and treatment
of cervical cancer. We also include information about available
We cannot advise you about the best treatment for you. You need
to discuss this with your doctors. However, we hope this
information will answer some of your questions and help you
think about the questions you want to ask your doctors.
What is Cancer?
Cancer is a disease of the body’s cells. It starts in our genes.
Our bodies are constantly making new cells; to enable us to
grow, to replace worn out cells, or to heal damaged cells after
Certain genes control this process.
All cancers are caused by damage to these genes.
This damage usually happens during our lifetime, although
a small number of people inherit a damaged gene from a parent
when they are born.
Normally, cells grow and multiply in an orderly way.
damaged genes can cause them to behave abnormally.
They may grow into a lump, which is called a tumour.
Tumours can be benign (not cancerous) or malignant (cancerous).
Benign tumours do not spread outside their normal boundary to
other parts of the body.
malignant tumour is made up of cancer cells. When it first
develops, this malignant tumour may be confined to its original
site, a cancer in situ (or carcinoma
HOW CANCER SPREADS
If left untreated they may spread beyond their normal boundaries
and into surrounding tissues (invasive cancer).
For a cancer to grow bigger than the head of a pin, it must grow
its own blood vessels. This is called angiogenesis.
cells move away from the original (primary) cancer and invade
other organs. When these cells reach a new site they may
continue to grow and form another tumour at that site. This is
called a secondary cancer or metastasis.
In some cancers, it is the body's blood cells,
which multiply abnormally. These cancers are called leukaemia,
myeloma and lymphoma.
The cervix is at the lower part of the uterus (womb), which
protrudes into the vagina.
sometimes called the neck of the womb.
There is a small opening in the cervix, the cervical
canal, which leads through the cervix into the main part of the
The cervix has several important functions. It produces some of
the moistness that helps lubricate the vagina. It also produces
the mucus that helps sperm travel up to the Fallopian tubes in
an effort to fertilise an egg from the ovary. The cervix holds
the developing baby in the uterus during a pregnancy. During
labour the cervix opens to allow the baby to be born.
The cervix is covered by two different kinds of cells.
Squamous cells cover the outer part. Endocervical cells cover
the inner part.
Cervical cancer develops in stages. This is why regular Pap
tests are so valuable: they can detect abnormal cells that may
one day become cancerous.
Atypia refers to minor changes to the cells,
which can be detected in a Pap test. These changes may worsen or
return to normal. If a Pap test picks up atypical changes, the
woman will be advised to have another test in six months to see
whether the changes have disappeared.
Dysplasia (also known as CIN or SIL)
Dysplasia is a type of abnormal change in the cells of the
cervix. It is also called cervical intraepithelial neoplasia
(CIN) and squamous intraepitheliallesion (SIL). CIN is graded
into CIN I CIN II and CIN III, that is, mild, moderate and
severe cervical cell changes. These conditions are not cancer
but could later develop into cancer if left untreated; the term
carcinoma in situ is sometimes still used to describe abnormal
cell changes in the cervix. It is the same as CIN III.
There are two main types of cervical cancer. These are squamous
cell carcinoma and adenocarcinoma. Squamous cell carcinoma, the
most common type of cervical cancer, starts in the squamous or
skin-like cells of the cervix. Adenocarcinoma is a less common
type of cervical cancer. It starts in the glandular cells. In
addition cervical cancer may be either microinvasive or
This is when cancer
cells have just broken through the bottom layer of the skin of
the cervix. At this stage, the cells have not spread more than
five millimetres into the tissues of the cervix.
In this, the cancer
cells have spread from the surface skin of the cervix into the
deeper tissues of the cervix. The cancer may also have spread to
part of the vagina or to the lymph nodes and other tissues
surrounding the cervix, within the pelvis, or beyond
the genital and pelvic areas into
How common is
Generally, cervical cancer takes a long time to develop and this
is one reason why it is more common in women over the age of 40.
However, as with all types of cancer, cervical cancer
occasionally develops very quickly and is sometimes diagnosed in
Causes of cervical
Some factors seem to put some women at a higher risk. These
- Human Papilloma or
wart virus (HPV). Almost everyone is infected with HPV at
some stage in his or her life. Most cases of HPV resolve
themselves and have no ill effects. Many women have HPV and
don't ever show signs of abnormal cell changes. The exact
link between HPV infection and cervical cancer is unclear.
It remains the subject of research.
- Daughters of women
who used the drug diethylstilboestrol (DES) during pregnancy
to prevent a miscarriage. The use of this drug has declined
since the 1940s and 1950s.
- Smoking, which
increases the risk of cervical cancer fourfold.
women with abnormal cell changes feel well and have no symptoms
at all. Some women
may have irregular bleeding.
Discomfort or bleeding during or after intercourse,
unusual vaginal discharge, pelvic pain, excessive tiredness,
swollen legs or backache can be signs of cervical cancer.
These symptoms can also be due to other more common problems,
but you should still have them checked by your doctor. You may
need to be referred to a specialist for further diagnosis and
What doctors and
other health professionals will I see?
Your general practitioner will refer you for initial tests to
confirm whether or not you have cancer. He or she may later
refer you to a specialist who will advise you about treatment
Specialists and other health professionals who care for people
with cervical cancer include:
oncologists: diagnose and treat people with cervical cancer
- medical oncologists:
responsible for chemotherapy
oncologists: responsible for radiotherapy
responsible for some biopsies and other surgical
recommend the best diets to follow while you are in
treatment and recovery
- nurses: assist you
through all stages of your hospitalisation and cancer
The Pap test is used to detect abnormal cell changes in the
cervix before cancer develops.
Cell samples from the
surface of the cervix are sent to a pathologist for analysis
under a microscope.
Results are usually available within a week of the test.
The test can be
uncomfortable but is not painful. You will be asked to remove
your trousers/ skirt and underwear and lie on the examination
table with your feet together and legs apart, or on your side.
The doctor will insert a speculum into your vagina. This
holds the vaginal walls apart so that he or she can see your
cervix. The doctor will use an instrument like a spatula to take
the cells from your cervix. The test usually takes no more than
a couple of minutes.
Sometimes there is a
little bleeding after a Pap test.
Regular Pap tests pick up
most abnormal cell changes that could become cancerous.
It is recommended that women have a Pap test once every
two years. Women who have had abnormal changes diagnosed may
need to have more frequent Pap test.
Your doctor may do
a pelvic examination, feeling the uterus, vagina, ovaries,
Fallopian tubes, bladder and rectum for abnormalities in their
shape or size.
Diagnosis of dysplasia and cervical cancer
If cervical cancer is suspected or diagnosed, you will need to
be referred to a doctor who specialises in treating women with
cervical cancer, a gynaecological oncologist.
tests are used to detect dysplasia or cervical cancer. The tests
provide information about the condition and allow the doctor to
make decisions about further tests or treatment. When discussing
these tests with your doctor, make sure you understand what is
being discussed and what will happen.
may not be very pleasant but are designed to be as quick and
painless as possible. Some women may feel uncomfortable about
having them. It helps to understand exactly what the tests
involve. Having a partner or friend with you can give you
extra support at this time.
Colposcopy gives a
magnified view of the cervix. It uses an instrument called a
colposcope, which is like a microscope on a stand. As with a Pap
test, the doctor puts a speculum into your vagina to hold the
walls slightly apart.
colposcopy can be done in the doctor's room and takes only a few
minutes. The specialist looks at your cervix through the
colposcope. The doctor may coat the cervix with an iodine
solution. This causes healthy cells to turn brown and abnormal
cells to turn white. Some colposcopes have a special TV screen
so you can watch the procedure if you wish.
If you are pregnant a colposcopy is quite safe. However, you
should always tell your doctor if you are or think you may be
pregnant as this may mean you would need different treatment.
it is necessary to have a punch or target biopsy taken at the
Punch or target
In a punch or target biopsy, a small piece of tissue is removed
with a special instrument and sent to a laboratory for
examination. The doctor uses the colposcope to see the area that
needs to be removed. You may feel a little pain when the biopsy
is taken: ask the doctor to tell you when this might happen.
your cervix to heal after a punch biopsy, your specialist will
advise you about whether and for how long you should avoid
sexual intercourse and the use of tampons.
or target biopsy can cause some bleeding or other discharge, but
it will usually heal quickly. Women also often experience some
pain afterwards, similar to menstrual cramping, which can be
relieved with painkillers.
definite diagnosis can usually be made until the results of the
biopsy are received. This may take several days, sometimes
If the punch or target biopsy shows abnormal cells on the
surface of the cervix, it may be necessary to have a cone
biopsy, which removes a larger and deeper area of tissue from
the cervix. (It is called a cone biopsy because a cone-shaped
area of tissue is taken from the inner base of the cervix).
Sometimes this procedure removes all of the abnormal cells and
no further treatment is needed. In other cases, it shows that
the cells have spread into the cervix, and further treatment
will be necessary.
have a general anaesthetic. You may be treated as a day patient
or stay overnight in hospital. You may have some bleeding or
cramping for a short while after the cone biopsy.
Sexual intercourse and tampons should be avoided for two
to three weeks. This allows time for your cervix to heal.
women do not experience any problems after a cone biopsy,
although occasionally some women have difficulty with their
cervix will be weaker after a cone biopsy. You can still become
pregnant but may be at more risk of having a miscarriage. Having
some supportive stitches put in early in the pregnancy can help
this; these stitches are removed before the baby is due. If you
want to become pregnant in the future, you should discuss this
and possible side effects with your doctor before you have a
These procedures are done while you are under anaesthetic. They
check whether the cancer has spread to other organs in your
A cystoscope is a thin, lighted instrument
that is used to examine your bladder. A proctosigmoidoscope is a
thin-lighted instrument that is used to examine the rectum and
lower part of the large intestine.
This is an x-ray of
your kidneys, bladder and ureters (the tubes that connect the
kidneys to the bladder). An IVP can be done in hospital x-ray
department or at a special clinic.
You may be asked to go on a low fibre diet and take something to
help empty your bowels before you have the IVP. Before the test,
a dye that shows up on x-ray is injected into a vein in your
arm. This dye concentrates in your kidneys, ureters and bladder
so that the x-rays can show any problems. An IVP should not
cause any side effects.
Instead of an IVP, some specialists may recommend that you have
an ultrasound to check your kidneys.
tomography (CT) scan is usually done at a hospital or a special
clinic. You do not need to be admitted to hospital and you
should have no side effects.
In a CT scan, x-rays are taken at different positions. This
allows a two and three-dimensional image of the body to be built
the scan you will be asked to drink some fluid that shows up on
x-rays. This makes it easier for abnormalities to be detected.
You may also be asked to put a tampon into your vagina before
the scan; this also makes it easier to detect any problems.
This test is
similar to a CT scan but it uses magnetic fields instead of
x-rays to build up a series of very clear and detailed images.
You may be admitted to hospital, usually as a day patient, for
an extensive physical examination. While you are under
anaesthetic, your gynaecological oncologist will examine your
bladder, bowel, vagina and pelvic area very carefully. A punch
biopsy of your cervix may also be performed at this time.
urine tests are also usually done.
If you are
diagnosed with dysplasia, you may need treatment to remove the
abnormal cells from the cervix.
In mild cases, all that may be needed is regular Pap tests.
In more severe cases, the abnormal cells may be removed using
cryosurgery (freezing), cauterisation (burning) or laser
surgery. These procedures destroy the abnormal cells without
harming normal tissue. A punch or cone biopsy may also remove
all the abnormal cells.
Treatment for microinvasive cancer is usually by cone biopsy,
although hysterectomy may occasionally be required.
These treatments can cause temporary cramping or other pain,
bleeding or a watery discharge.
it is not cervical cancer, the diagnosis and treatment of
dysplasia may still be a shock and it may take you some time to
recover emotionally. Talking with friends, partners or relatives
Treatment of cervical cancer
your test results are available, your doctor will be able to
discuss with you the best treatment for you.
Sometimes there will be a choice or combination of
or choices of treatment will vary with different women. This
depends on whether the cancer is at an early stage or has
spread, your age and general health. It is important to
understand what the treatments will involve so that you can make
the best decision for you.
have a lot of questions to ask your doctor at this stage. Making
a list can help you remember them. A list of possible questions
is included at the end.
Treatments for cervical cancer include surgery, radiotherapy,
chemotherapy or a combination of these treatments.
earlier, some very early cervical cancers may be treated with
cone biopsy. However, great care is needed to ensure that all
the cancer cells are removed, so the margins of the tissue
removed are carefully examined. Most women who have a cone
biopsy will not have any long-term side effects.
This is also known as lymphadanectomy. It is a surgical
procedure in which some lymph nodes near the site of the cancer
are removed and examined to see if they contain cancer cells.
Lymph node removal is usually performed at the time of radical
hysterectomy. Leg swelling (lymphoedema) may result. Talk with
your doctor about this.
A hysterectomy is the removal of the uterus by surgery.
There are two kinds of hysterectomy. In a total hysterectomy,
the uterus including the cervix is removed. In a radical
hysterectomy, the cervix, support ligaments and top part of the
vagina are removed. The ovaries are usually not removed in women
who are still having periods. Lymph node dissection may also be
done during a radical hysterectomy for cervical cancer.
For both types of hysterectomy, you will need a general
anaesthetic. A radical hysterectomy is a longer operation and it
may take you longer to recover.
When you wake up from the operation, you will find that you have
several tubes in place. You will have an intravenous drip which
will give you fluid and drugs. Sometimes you may have a drain
tube in your pelvis for a little while. You will also have a
catheter inserted into your bladder to drain away urine. As you
improve after the operation, these tubes will gradually be
As with all major operations, you will have some discomfort or
pain. Painkillers can be taken to control this. They may be
given through an intravenous drip or through an epidural tube
into your spine. The epidural pain relief is similar to that
given to women during childbirth. Let the doctor or nurse know
when you are starting to feel uncomfortable--don't wait until
the pain becomes severe.
hysterectomy is a major operation. You may be in hospital for
five to seven days for a total hysterectomy. If you have a
radical hysterectomy you will need to be in hospital for about
recovery time will depend on different factors. Don't expect to
get back to your normal activities too quickly. For some women,
it may take six weeks or even longer. During this time heavy
work or lifting should be avoided. It may take some time before
you feel completely well.
you go home from hospital, discuss with your doctor about what
you can do and what you should avoid for a while, for example,
when you can start to be sexually active again.
many books about hysterectomy,
which may be helpful.
effects of treatment for cervical cancer are also discussed.
Radiotherapy is the
use of radiation to destroy cancer cells. Radiotherapy may be
advised if you are not well enough for a major operation. It may
also be advised if the tumour has spread into the tissues around
the cervix, as this would be difficult to sure by surgery alone.
Radiotherapy may also be used after surgery or combined with
Radiotherapy can be given in two ways: from
outside or onside the body. In external radiotherapy, the
radiation is directed from a machine at the cancer and
surrounding tissue. In internal radiotherapy, radioactive
material is put in thin tubes into your body, on or near the
cancer. Usually both external and internal radiotherapy is used
to treat cervical cancer.
radiotherapy is advised, a doctor who specialises in
radiotherapy treatment for women with cervical cancer will treat
you. This doctor works closely with your gynaecological
In external radiotherapy, special rays from a large machine are
directed at the part of the body needing treatment. For women
with cervical cancer, this is the pelvic area.
Radiotherapy is usually given as an outpatient, five days a week
for four to six weeks. The actual treatment takes two to three
minutes each time. However the waiting and preparation time is
longer. Like a normal x-ray, radiotherapy does not cause pain or
discomfort as it is being given.
Currently, chemotherapy is given once a week with the external
In internal radiotherapy, a radioactive implant is placed inside
your body as close to the tumour as possible. You will be given
a general anaesthetic so that the implant can be inserted
through your vagina. You will need to be admitted to hospital
for a few days. The implant is left in place for up to 72 hours.
The exact dose of radiotherapy given and the length of time the
implant is left in position are very carefully measured.
be in a room of your own while the implant is in place. This is
because the implant is radioactive. Some pre- cautions will need
to be taken by the hospital staff as well as by your family to
protect themselves from unnecessary radiation.
nursing staff will explain these precautions to you and your
family before the implant is inserted. Make sure that you and
your family understand what you need to do.
Side effects of
Radiotherapy may cause a number of side effects that are
temporary and can be controlled. These include tiredness,
depression, loss of appetite, diarrhoea, pain when passing urine
and skin problems. The skin between your buttocks may feel sore,
like the feeling you get from sunburn.
cream can be used to relieve this burning feeling. If you have
not been through menopause, radiotherapy will affect your
ovaries and reduce their ability to produce normal hormones.
This may cause infertility and symptoms of menopause.
undergoing radiotherapy, you should allow plenty of time to
rest. Remember to drink lots of water and have small but
frequent meals. Ask the doctor or nurse about how to manage any
Chemotherapy is the treatment of cancer using anti-cancer drugs.
The aim is to kill cancer cells while doing the least possible
damage to normal cells. The drugs work by stopping the cancer
cells from growing and reproducing.
Chemotherapy is usually given to women with more advanced
cervical cancer or together with radiotherapy. Chemotherapy is
usually given through a vein. You may need to stay in hospital
overnight or you may be treated as a day patient. This depends
on the drugs you are given and how you are feeling. A number of
chemotherapy treatments, usually six, may be given every three
to four weeks over several months. This depends on the disease
and other treatments being used. Blood tests are taken before
your next treatment to make sure your body's normal cells have
had time to recover.
Side effects of
The side effects of chemotherapy vary according to the
particular drugs used. They may include feeling sick, vomiting,
depression, feeling off colour and tired, and some thinning or
loss of hair from your body and head. These side effects are
temporary, and measures can be taken to prevent or reduce them.
Chemotherapy may also cause a temporary suspension of
menstruation, or premature menopause.
radiotherapy and chemotherapy
A combination of radiotherapy and chemotherapy is being used
increasingly to treat cervical cancer. US trials found recently
that women with invasive cervical cancer have better rates of
survival when they receive chemotherapy that includes the drug
cisplatin along with radiotherapy.
radiotherapy and chemotherapy causes more severe side effects
than radiotherapy alone. The side effects include leucopoenia,
nausea and vomiting. These effects are temporary and can be
If the cancer has spread and it is not possible to cure it, then
your doctor will discuss various treatments for specific
problems caused by the cancer.
Palliative treatment is
treatment that relieves or soothes pain and other symptoms of
illness. Palliative care is available for all people who
experience pain and distress associated with cancer, whatever
their stage of cancer treatment. It is a particularly important
type of treatment for people with advanced cancer, who cannot be
cured but can expect to live without undue pain and distress.
Palliative care includes pain relief using painkilling drugs and
other measures. Pain is usually well controlled with oral
medication. If pain is particularly severe or difficult to
control, then you may have injections of pain-relieving
practitioners, specialists and specialist palliative care teams
in hospital all play important roles in palliative treatment for
people with early and advanced cancer. For further information
contact The Resource and Wellness Centre.
Cervical cancer can be effectively treated when it is found
early. The vast majority of women with early cervical cancer
will be cured.
For women with more advanced disease, a cure may still be
possible. For other women treatment can keep the disease under
control for long periods of time.
For information about your own prognosis, you should talk with
your doctor who is familiar with your full medical history.
Even if your cancer is curable you may find that you often need
reassurance from your specialist. This is normal as you may feel
that you can no longer trust your body. Over time you will find
that your confidence builds up again.
Making decisions about treatment
Sometimes it is difficult to make decisions about what is the
right treatment for you.
You may feel that everything is happening so fast that
you do not have time to think things through. Some people find
that waiting for test results and for treatment to begin is very
some women feel they are overwhelmed with information, others
may feel that they don’t have enough.
You need to make sure that you understand enough about
your illness, the treatment and its side effects to make your
decisions. Don’t be
hurried into making a decision.
Waiting a few extra days will not make a difference to
the success of your treatment.
are offered a choice of treatments, you will need to weigh the
advantages and disadvantages of each treatment.
If only one type of treatment is recommended, ask your
doctor to explain why other treatment choices are not advised.
majority of women, cervical cancer can be cured.
However, treatment may
make it more difficult or impossible for you to become pregnant.
This may be a blow for many women even if they already
have a family. For
other women who have not yet had children, it can be
Taking time over your decisions is even more important in this
For a few
women with more advanced cervical cancer, treatment may be aimed
at controlling symptoms rather than curing the cancer. Some
women in this situation will choose treatment, even if it only
offers a small chance of cure.
Others want to make sure that the benefits of treatment
will outweigh any side effects. Still others will choose the
treatment they consider offers them the best quality of life.
You may want to see your doctor a few times before making a
final decision on treatment. It is often difficult to take
everything in, and you may need to ask the same questions more
than once. You
always have the right to find out what a suggested treatment
means for you and the right to accept or refuse it.
you see the doctor, it may help to write down your questions. At
the end of this there is a list of questions that may assist
you. Taking notes
during the session can also help.
Many people like to have a family member or friend go
with them, to take part in the discussion, take notes, or simply
listen. Some people
find it is helpful to tape record the discussion.
Talking with others
Once you have discussed treatment options with your doctor,
you may want to talk
them over with family or friends, nursing staff, the hospital
social worker or your own religious or spiritual adviser.
Talking it over can help to sort out what course of action is
right for you.
A second opinion
You may want to ask for a second opinion from another specialist
This is understandable and may be a valuable part of your
decision making process Your specialist or local doctor can
refer you to another specialist and you can ask for your records
to be sent to the second opinion doctor You can still ask for a
second opinion even if you have already started treatment or
still want to be treated by your first specialist.
Taking part in a clinical trial
Your doctor may suggest that you consider taking part in a
trials are a vital part of the search to find better treatments
for cancer. Doctors
conduct clinical trials to test new or modify treatments and see
if they are better than existing treatments.
Many people all over the world have taken part in
clinical trials that have resulted in improvements to cancer
the decision to take part in a clinical trial is always yours.
doctor asks you to take part in a clinical trial, make sure that
you fully understand the reasons for the trial and what it means
for you. Before
deciding whether or not to join the trial, you may wish to ask
· What treatments are being
tested and why?
· What tests are involved?
· What are the possible risks or
· How long will the trial last?
· Will I need to go into
hospital for treatment?
· What will I do if any problems
occur while I am in the trial?
decide to join a randomised clinical trial, you will be given
the best existing treatment or a promising treatment.
You will be chosen at random to receive one treatment or
other, but it will always be at least the best treatment
If you do
join the clinical trial, you have the right to withdraw at any
time, doing so will not jeopardise your treatment for cancer.
always your decision to take part in a clinical trial. If you do
not want to take part, your doctor will discuss the best current
treatment choices with you.
After the completion of your treatment, you will need to have
regular checkups. Your doctor will decide how often you will
need checkups, as everyone is different. They will gradually
become less frequent if you have no further problems.
disease flares up, or relapses, it can often be treated
successfully. The treatment used for the relapse is often
different from the first treatment.
normal to feel a range of intense emotions for some time after
your diagnosis and treatment. You may feel sad, depressed, angry
or frustrated. It is
important to acknowledge these reactions and understand that it
may take some time before you feel well again.
It may be helpful to talk about your feelings with your
partner, family members or friends, or with a hospital
counsellor, social worker, psychologist or your religious or
you may find that your friends and family do not know what to
say to you: they may have difficulty with their feelings as
well. Some people
may feel so uncomfortable that they avoid you.
They may expect you to ‘lead the way’ and tell them what
you need. You may
prefer to ask a close family member or a friend to talk with
other people for you.
fertility can be difficult for many women to cope with, even if
they already have a child or children, or have chosen not to
have children. You,
with or without your partner, may need to seek help to cope with
your grief. This may
be through a social worker, psychologist and psychiatrist or
through other support services.
Permanent care or adoption of a child may be a choice for
some women. This
requires dedication and perseverance and not all couples who
wish to adopt a child are able to do so.
nutritious diet will help you keep as well as possible and cope
with the cancer and any side effects treatment. Depending on the
kind of treatment you have had, you may have special dietary
needs. A dietician may help plan the best foods for your
particular situation; ones that you find tempting, easy to eat
will probably find it helpful
to stay active and to exercise regularly if you can. The amount
and type of exercise you do will depend upon what you are used
to and how well you feel.
with your doctor what is likely to be best for you.
Some women find relaxation or meditation techniques helpful.
The Resource and Wellness Centre conduct relaxation and
The diagnosis and treatment of cervical cancer may affect how
you feel about
yourself and your relationships. It is a time when
you will need support
as your relationships may change. Current or new partners may
also have difficulty adjusting and may need reassurance.
find it helpful to share your feelings with each other. However,
this is not always possible as with all crises, some
relationships suffer under the strain. You may both need to seek
need radiotherapy you are usually able to continue being
sexually active during treatment, as long as it is comfortable
for you and you feel like it. Everyone is different and you
should be guided by how you feel. You may find that,
particularly near the end of treatment, you don't feel like
have vaginal dryness, a gel such as KY Jelly can be helpful.
This can be bought from a chemist or supermarket. Some women may
bleed after sexual intercourse when they are having
radiotherapy. Don't be worried but let your doctor or nurse know
have had your check-up following surgery you will be able to
recommence sexual activity. However, some women find that it
takes time before they feel both physically and emotionally well
It may be
some time until you feel you are ready for sex. You may need to
build up your confidence first. Sharing affection with your
partner through kissing, caressing and touching can give you
both much pleasure.
Talking about your needs together is important to help you feel
more confident and to reduce any fears.
are resuming vaginal intercourse, you may wish to proceed
slowly. As your
vagina may be a little shorter after treatment, you may find it
better to try different positions for intercourse.
You may want to choose a position where you have more
control and there is less pressure to your pelvic area. If you
have difficulty you may need expert advice.
are some special aids to help you gradually stretch your vagina
after surgery or radiotherapy.
These are called vaginal dilators and are available from
your gynaecological oncologist or from specialist services like
family planning clinics.
find that you are having difficulty resuming your sexual
relationship, you may need specialist help and advice.
You may want to talk with your doctor about this or ask
for advice on where you can get help.
Remember, it is normal not to feel like sex after being
treated for cancer.
Coping with side
It may take some time to recover from the various types of
treatment. You will find that there are physical changes as well
as many emotional changes to cope with. It is important that
you, your partner, family and employer are prepared for this.
Ovaries produce the
hormones oestrogen and progesterone. If your ovaries are
surgically removed or damaged by radiotherapy, they will no
longer produce these hormones. This means that you
will have premature menopause. Your body will have lower
levels of these hormones circulating in the blood, which can
cause symptoms such as hot flushes and palpitations. Oestrogen s
an important protection against osteoporosis and heart disease,
so premature menopause may increase your risk of these diseases.
replacement therapy (HRT) can be taken to reduce or prevent
symptoms of menopause. HRT is a combination of oestrogen and
progesterone, taken in tablets.
need to discuss with your doctor, and evaluate for yourself, the
benefits and possible risks of taking HRT. There are also many
useful books about menopause, which may help you with your
Bladder sensations or control may change after treatment. Some
women find they need to go to the toilet more often; others find
that they need to go in a hurry and sometimes don't get there in
time. Others find that they pass urine when they cough or
sneeze. While these problems may improve, even a small loss of
bladder control can be upsetting.
bladder control is a problem for you, you should seek help. Your
specialist will be able to suggest ways to help with bladder
control. These may include special exercises to strengthen the
muscles of your pelvic floor. You should also be visited in
hospital by a physiotherapist who can teach you about these
exercises, or you can contact The Resource and Wellness Centre.
After surgery some women may have problems with their bowels for
a while. This may be wind pain that can be helped by sucking
strong peppermints. Other women find that they become
constipated or suffer from diarrhoea and may need to make
adjustments to their diet or take medication. Talk with your
doctor if your bowel problems or pain do not improve.
Lymphoedema is swelling of part of the body, usually the legs or
arms. It may occur after treatment for cervical cancer if you
have had the lymph nodes in your pelvis removed (a
lymphadenectomy). Removal of the nodes may prevent normal
draining of the fluid from the legs. As a result fluid can build
up in one or both legs causing swelling. This usually does not
occur until some time after the original treatment.
It is not
possible to predict whether you will have problems with
lymphoedema. If you begin to have problems seek immediate help,
as symptoms are better managed if treated early. Seek advice
from your specialist or nurse. You may be given special
stockings to wear after your operation.
hospitals have specialist physiotherapists who can advise you on
how you may be able to reduce your risk of developing
lymphoedema. They also help you if lymphoedema does occur in the
further information about lymphoedema, contact the Resource and
Caring for someone
Caring for someone with cancer can be very stressful;
particularly when it is someone you care about very much. Look
after yourself during this time. Give yourself some time out,
and share your worries and concerns with someone outside.
have to make many decisions. You will probably have to attend
many appointments with doctors, support services and hospitals.
Many people have found it helpful to take with them another
member of the family or a close friend. It also helps to write
down questions beforehand, and to take notes during the
What type of cancer do I have?
2. How extensive is my
3. What treatment do you
advise for my cancer and why?
4. Will my treatment (and surgery) be performed by a doctor who
specialises in cervical cancer?
5. Are there other treatment choices for me? If not, why not?
What are the risks and
possible side effects of each treatment?
7. Will I have to stay in hospital, or will I be treated as an
8. How long will the
treatment take? How much will it affect what I can do?
9. How much will it cost?
10. Will I have a lot of pain with the operation? What will be
done about this?
11. If I need further treatment, what will it be like and when
will it begin?
12. Will the treatment affect my sexual relationships?
13. How frequent will my
check-ups be and what will they involve?
14. Are there any problems
I should watch out for?
15. I would like to have a
second opinion. Can you refer me to someone else?
16. Is my cancer hereditary?
are answers you do not understand, feel comfortable to say 'can
you explain that again' or 'I am not sure what you mean by ...'
Most of the words listed
here are used on this web page, others are words you are likely
to hear used by doctors and other health professionals who will
be working with you.
A cancer that has arisen in glandular cells.
A drug given to stop a person feeling pain. A 'local'
anaesthetic numbs part of the body; a 'general' anaesthetic
cause temporary loss of consciousness.
The formation of new blood vessels to support tissue.
Angiogenesis enables tumours to develop their own blood supply,
which helps them to survive and grow.
Not cancerous. Benign cells are not able to spread like cancer
The removal of a small sample of tissue from the body, for
examination under a microscope, to help diagnose a disease.
carcinoma in situ
Cancer that involves only the cells in which it began and has
not spread to nearby tissues.
A flexible tube inserted into a narrow opening so that fluids
can be introduced or removed.
The 'building blocks' of the body. A human is made of millions
of cells, which are adapted for different functions. Cells are
to reproduce themselves exactly, unless they are a abnormal or
damaged, as are cancer cells.
The lower part of the uterus, which extends into the vagina
The use of special (cytotoxic) drugs to treat cancer by killing
cancer cells or slowing their growth.
The examination of the vagina and cervix with a magnifying
instrument, called a colposcope, to check these tissues for
tomography (CT) scan
The technique for constructing pictures from cross sections of
the body, by x-raying the part of the body to be examined from
many different angles.
The removal of a cone-shaped piece of the cervix. It may be used
to both diagnose and treat a problem.
An alteration in size, shape and arrangement of normal cells.
Dysplastic cells are abnormal but are not cancerous. They
may progress into cancer.
The cells lining the inside of the cervix.
The tiny factors that govern the way the body's cells grow and
behave. Each person has a set of many thousands of genes
inherited from both parents. These genes are found in every cell
of the body.
A doctor who specialises in treating women diagnosed with cancer
of the reproductive organs.
hormone replacement therapy (HRT)
Female hormones (oestrogen and progesterone) which can be taken
by women to relieve symptoms of menopause.
The removal of a woman's uterus by surgery.
Into a vein. An intravenous drip gives drugs directly into a
A reduction in the number of white blood cells in the blood
Removal of the lymph nodes from a particular part of the body
Also called lymph glands. Small, bean-shaped structures which
form part of the lymphatic system. Lymph is the fluid that flows
through this system and carries cells that help to fight disease
and infection. The lymph nodes filter the lymph to remove
bacteria and other harmful agents, such as cancer cells.
Part of the lymphatic system. The lymphatic system is part of
the immune system, which protects the body against ‘invaders’,
like bacteria and parasites. The lymphatic system is a network
of small lymph nodes connected by very thin lymph vessels, which
branch into every part of the body.
Swelling of a part of the body, usually the legs or arms. Caused
by the blockage or removal of the lymph nodes so causing fluid
(lymph) to accumulate.
Cancerous. Malignant cells can spread (metastasise) and can
eventually cause death if they cannot be treated.
The natural cessation of a woman's periods or menstruation. This
is the main event marking a woman's transition from when having
children is possible to the post-reproductive years. Usually
occurs between the ages of 45 and 55 years.
Also known as 'secondaries'. Tumours or masses of cells that
develop when cancer cells break away from the original (primary)
cancer and are carried by the lymphatic and blood systems to
other parts of the body.
A test that can detect changes in cervical cells. Some cells are
scraped off the cervix and sent to a laboratory for examination
under a microscope.
An assessment of the course and likely outcome of a person's
The use of radiation to kill cancer cells. Radiation can be
directed at a tumour from outside the body, or a radioactive
source may be implanted into a tumour and the surrounding
A cancer that arises in the squamous or skin-like cells of the
A new or abnormal growth of tissue on or in the body.
is the sound waves of a very high frequency (higher than human
can hear). If ultrasound is directed at the body it is reflected
back differently by different types of the tissue. In an
ultrasound scan, these differences are measures and used to
build up pictures of structures in the body.
Ultra sound pictures are usually taken by an ultrasound
technician, who guides the scanning by watching the images on a
screen like a television.