Complications of cervical cancer can occur as a side effect of treatment or as the result of advanced cervical cancer.
If your ovaries are surgically removed or are damaged during treatment with radiotherapy, it will trigger an early menopause if you haven't 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
- leaking urine when you cough or sneeze (stress incontinence)
- 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 the hormones 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, which 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 and make having sex easier.
The second is to use vaginal dilators, sometimes called vaginal trainers. These are tampon-shaped plastic tubes that come in many different sizes. You insert one into your vagina, usually starting with the smallest size.
Dilators are designed to help stretch the vagina and make it more supple. As you get used to the smaller sizes, you can work your way up to slightly larger ones.
It's usually recommended to use dilators for 5 to 10 minutes at a time on a regular basis during the day over the course of 6 to 12 months.
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.
Macmillan has more information about sexuality and cancer.
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 to this process can lead to a build-up of fluid in the tissue, called lymphoedema. This can cause certain body parts to become swollen – usually the legs, in cases of cervical cancer.
There are exercises and massage techniques that can reduce the swelling. Wearing specially designed bandages and compression garments can also help.
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 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 and hopeless, and losing interest in things you used to enjoy.
Contact your GP 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).
Read more about coping with cancer.
Advanced cervical cancer
Some of the complications that can occur in advanced cervical cancer are discussed in the following sections.
If the cancer spreads into your nerve endings, bones or muscles, it can often cause severe pain, which can usually be controlled with painkilling medications.
These painkillers 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, depending on pain levels.
Tell your care team if the painkillers you're prescribed aren't effective. You may need to be prescribed a stronger medication. A short course of radiotherapy may 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.
In some cases of advanced cervical cancer, the tumour can cause a build-up of urine inside the kidneys (hydronephrosis), which can lead to loss of most or all of the kidneys' functions. This is called kidney failure.
Kidney failure can cause a wide range of symptoms, including:
- swollen ankles, feet or hands, caused by water retention
- shortness of breath
- feeling sick
- blood in your pee (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, or widening the ureters by placing a small metal tube, called a stent, inside them.
As with other types of cancer, cervical cancer 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 and 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 a combination of blood-thinning medication, such as heparin or warfarin, and compression garments designed to help encourage blood flow through the limbs.
Read more about treating deep vein thrombosis.
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 back passage (rectum), or you may pass blood when you pee.
Minor bleeding can often be treated using a medication called tranexamic acid that encourages the blood to clot and stop the bleeding. Radiotherapy can also be highly effective in controlling bleeding caused by cancer.
Major bleeding may be temporarily treated by using gauze to stem the bleeding and, later, by surgery, radiotherapy or cutting off blood supply to the cervix.
A fistula is a rare but distressing complication of advanced cervical cancer.
In most cases involving cervical cancer, 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 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.
If your doctors can't do any more to treat your cancer, your care will focus on controlling your symptoms and helping you 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 palliative care in the late stages of cancer. You may want to think about whether you'd like to be cared for in hospital, in a hospice or at home, and discuss these issues with your doctor.