Breast cancer
Diagnosis
Several tests can be used to find out if changes in the breast are the result of breast cancer.
- a physical examination- the doctor will feel your breasts and the lymph nodes under your arms, take a full medical history and ask about your family history.
- mammogram - this is a low-dose x-ray of the breast. It can find changes that are too small to be felt through physical examination. Both breasts are checked. Your breast is pressed between two x-ray plates, which spread the breast tissue out so clear pictures can be taken. Many women find this procedure uncomfortable, but it’s over in about 20 seconds. Sometimes, a lump that can be felt is not seen on a mammogram and other tests will need to be done.
- Ultrasound - this uses soundwaves to make a picture of your breast. A gel is spread on the breast, and a small device called a transducer is moved over the area. It sends out soundwaves that echo when they meet something dense like an organ or tumour. A computer creates a picture from these echoes. This test is painless and takes 15 to 20 minutes.
- Biopsy - your doctor will suggest a biopsy if an abnormal or unusual area of tissue is found in your breast. You may need one or more biopsies. A biopsy means removing a small amount of breast tissue for testing. There are a few ways of doing this.
- Fine needle aspiration
A thin needle is used to take some cells from the breast lump or abnormal area. Sometimes an ultrasound is used to help guide the needle. The test is a bit uncomfortable, similar to having blood taken for a blood test. It is usually done in a specialist’s rooms, a hospital outpatient department or at a radiology practice.
- Core biopsy
A wider needle is used to remove a small piece of tissue, called a core, from the lump or abnormal area. It is usually done under local anaesthetic. A mammogram or ultrasound is used to help guide the needle. A core biopsy may be uncomfortable and you may experience some pain.
- Surgical biopsy
If the lump is too small to be biopsied using the method above, a surgical biopsy is needed. To help the surgeon find the abnormal tissue, a needle and wire may be put into the breast under local anaesthetic before the biopsy. The biopsy is then done in a separate operation using a general anaesthetic. The lump and a small area of normal breast tissue around the lump are removed, along with the wire. This operation is usually done as day surgery but may mean an overnight stay in hospital. If the surgical biopsy removes all of the cancer, no further treatment is needed.
Further tests can be done to see if the cancer, not only specific to breast cancer has spread to other parts of the body. This is called staging. You may have one or more of these tests. The results will be written in a pathology report which you can ask for a copy of.
- Blood tests- blood samples may be taken to check your general health.
- Chest x-ray- an x-ray may be taken to check the lungs for signs of cancer.
- CT scan - a CT (computerised tomography) scan is a type of x-ray procedure that takes pictures of the inside of your body. It can assess if the cancer has spread to the lymph nodes or to other organs.
This painless procedure takes about 30-40 minutes. To make the scan pictures clearer and easier to read you may have an injection of a special dye into a vein in your arm. You may also be asked to drink a special liquid. It may make you feel hot all over for a few minutes. You will lie flat on a table while the CT scanner, which is large and round like a doughnut, takes pictures.
- Bone scan- a bone scan may be done to see if the breast cancer has spread to your bones.
A small amount of radioactive material is injected into a vein, usually in your arm. This material is attracted to areas of bone where there is cancer. After a few hours, the location is viewed with a scanning machine, which sends pictures to a computer. A bone scan is painless and will not make you radioactive.
- PET scan -a PET (positron emission tomography) scan takes detailed pictures of the body to detect abnormalities in the tissues. A small amount of radioactive material is injected into a vein, usually in the arm. The scan involves you lying on a bed, which moves through a machine containing sensors for the signals from the radioactive material.
- MRI scan- an MRI (magnetic resonance imaging) scan uses both magnetism and radio waves to build up detailed cross-section pictures of the body. This test involves lying on a couch in a metal cylinder – a large magnet – that is open at both ends. A dye may be injected into your veins before a scan. Some people feel anxious lying in the narrow metal cylinder. Talk to your health care team before the scan if you are uncomfortable. It may be helpful to take a mild sedative or talk to the person operating the scan through an intercom. An MRI is painless and is usually over in an hour.
Your general practitioner (GP) is also an important member of your treatment team. GPs can explain information provided by your specialists, help you with treatment decisions and assist you in obtaining practical and emotional support.
Treatment
Treatment for early breast cancer aims to remove the cancer and to reduce the risk of the cancer spreading or coming back. Your doctor will advise you on the best treatment for your cancer. The choice of treatment will depend on your test results, where the cancer is and if it has spread, whether your cancer has oestrogen or progesterone receptor protein, your age and general health, and what you want.
If you talk to other people with breast cancer, remember there are different types of breast cancer and the best treatment for one person may not be the best treatment for another. There are a number of treatment options available.
- Breast conserving surgery
Surgery to remove the breast cancer and some surrounding healthy tissue is called breast conserving surgery. It is also called lumpectomy, complete local excision, partial mastectomy or wide local excision. Breast conserving surgery is offered if the cancer is small compared to the size of the breast. The surgeon removes the smallest amount of breast tissue possible, but this will leave a scar and the breast may change slightly in shape and size.
Radiotherapy is usually given to the breast after surgery to destroy any cancer cells that may be left in the breast or armpit. Some lymph nodes from the armpit may be removed at the time of surgery.
A pathologist examines the removed breast tissue to see if there is an area of healthy cells all around the cancer – this is known as a clear margin.
If cancer cells are found at the edge of the removed tissue, this increases the chance of cancer returning. You may need more tissue removed (re-excision) or a mastectomy may be recommended.
Surgery to remove the whole breast is called mastectomy. Usually the nipple is also removed. The chest muscles are not removed. Some or all of the lymph nodes in the armpit closest to your affected breast may also be removed. This is called axillary surgery. You may be offered a mastectomy if the cancer is large compared to the size of the breast or the cancer is in more than one area of the breast.
While your wound heals, you can wear a soft temporary breast form (prosthesis) inside your bra. You may choose to fitted for a breast form or have your breast surgically reconstructed.
During a breast reconstruction, the breast shape is recreated using either an implant or tissue from another part of your body.
Some surgeons do the reconstruction at the same time as the mastectomy (immediate reconstruction). Others prefer to wait for several months or longer (deferred reconstruction). Talk to your surgeon about what is best for you.
Lymph nodes (glands) are found throughout the body, including the armpit. They are small, bean-shaped collections of lymph cells that protect the body against disease and infection. The lymph nodes are part of the lymphatic system.
The lymph nodes in the armpit (axilla) are often the first place breast cancer cells spread to outside the breast.
To check if breast cancer has spread to the lymph nodes, they are removed. There are two ways of removing the lymph nodes.
This may be done at the same time as your breast surgery or as a separate operation and removes some or all of the lymph nodes. After the lymph nodes are removed they are examined and the results help your doctor recommend further treatment.
The sentinel node is the first lymph node that breast cancer cells may spread to outside the breast. There can be more than one sentinel node. Usually it is in the armpit but it may be found near the breast bone (sternum).
Removing only the sentinel node/s will mean fewer side effects than axillary surgery.
The sentinel node is found using a combination of techniques.A small amount of radioactive substance is injected around the cancer before surgery. A scan is taken to show which sentinel node the substance has travelled to. During surgery, a blue dye is injected around the cancer in your breast. The dye moves into the lymphatic vessels and turns the lymph node blue. The nodes that become blue or radioactive first are known as the sentinel nodes. The surgeon removes only the sentinel nodes so they can be tested to see if they contain cancer cells. If the sentinel nodes are clear, no further surgery is needed. If the nodes do contain cancer cells, axillary surgery will be needed.
There are a number of things to be aware of, if you undergo surgery to remove the cancer.
- You will have several tubes in place after the surgery. An intravenous drip will give you fluid as well as medication. There may also be a tube in your breast to drain away fluid from the surgical site. These tubes are usually removed within 3-5 days. If you have had axillary surgery you will have a drain from this site, which is usually removed in 3-7 days. Some people are discharged with drains still in place, but this will depend on what support they have.
- You may have a dressing covering the wound to keep it clean. It will usually be removed after a week.
- You will be given pain relief by injection or tablets while in hospital. Pain medication will be provided for when you go home.
- Bruising and tissue swelling will be present but will clear up after 2 to 3 weeks.
Helpful tips to remember during the recovery period after surgery
- To help prevent blood clots, move your legs while you are still in bed. As soon as you are able, get out of bed and walk around. Medications may be prescribed to lower the risk of blood clots.
- Recovery time varies. Most people start to feel better after 2 weeks. Take it easy and only do what is comfortable.
- Exercising your arm as soon as possible after surgery will help it get back to normal faster.
- Avoid driving for a couple of weeks after surgery until your arm feels agile.
- Talk to someone. Many people feel grief at the loss of their breast and find talking to someone in a similar position helpful.
- Cancer Council Connect can put you in touch with a person who has had a similar operation, call 13 11 20.
Non-surgical treatment options
Radiotherapy
Radiotherapy uses x-rays to kill cancer cells or stop them from growing.
After breast conserving surgery or a mastectomy radiotherapy is usually recommended to help destroy any cancer cells left in the breast and reduce the risk of the cancer coming back.
Planning treatment
It is carefully planned to do as little harm as possible to your normal body tissues. Before you start treatment, you will have a planning session at the radiotherapy centre. During this visit, special x-rays are taken to pinpoint the area to be treated and marks will be put on your skin so that the radiation oncologist treats the same area each time. These marks are small and may be temporary or permanent.
You will probably have radiotherapy once a day from Monday to Friday for 5 to 6 weeks. Usually you can just go to the radiotherapy centre each day.
Each radiotherapy session will be in a special treatment room. Although you will only get radiation for 1 to 5 minutes, you might be in there for 10 to 30 minutes. Most of the time is spent positioning you and the treatment machine. You will lie on a bed under the radiotherapy machine. Once the machine is turned on, the radiation therapist will leave the room, but you can talk to staff through an intercom. Radiotherapy is not painful but you need to lie still while the treatment is given.
Chemotherapy uses drugs to kill or slow the growth of cancer cells. Chemotherapy may be used if the risk of the cancer returning is high, to try to prevent the breast cancer coming back or spreading to other parts of the body. When cancer returns after surgery or radiotherapy, to gain control of the cancer and to relieve symptoms and if the cancer does not respond to hormone therapy.
Chemotherapy is usually given through a vein (intravenously). Usually you will be treated as a day patient but occasionally an overnight stay may be recommended. You may have a number of chemotherapy sessions, maybe up to 8, every 2-3 weeks over several months. This gives your body time to recover before the next session. How long you have chemotherapy will depend on the type of breast cancer you have and what other treatments you are having.
Hormone therapy, also called endocrine therapy, is for people who have hormone receptors on their breast cancer cells.
The aim of hormone therapy is to slow or stop the growth of hormone receptor positive cancer cells.
Talk to your doctor about which type of hormone therapy is suitable for you. This will depend on your age, the type of breast cancer you have and whether you have reached menopause.
Tamoxifen
Tamoxifen is known as an anti-oestrogen drug. It works by stopping cancer cells responding to oestrogen. It is suitable for women of any age, regardless of whether they have reached menopause. It is taken as a daily tablet over five years. and is usually started after surgery or following radiotherapy or chemotherapy treatment.
Side effects of treatment
Some people will experience a few side effects, others will have more. There are ways to reduce or manage the discomfort the side effects cause. The following list presents common side affects experienced by cancer treatment patients.
Lymphoedema is a swelling of part of the body, usually the legs or the arms. It may occur after surgery to remove lymph nodes from under the arm or radiotherapy to the armpit. Women who have had surgery followed by radiotherapy to the armpit are more at risk. If the lymph nodes have been damaged or removed, this may prevent lymph fluid from draining from the arm, which causes the fluid to build-up and the arm to swell.
Lymphoedema can occur months or years after treatment. Signs to look for include redness, swelling, warmth of the skin, pain in the arm or fever. If you have problems, seek immediate help as symptoms are better managed if treated early.
Lymphoedema is treated by preventing or controlling the swelling. Swelling can be reduced by wearing a professionally fitted elastic sleeve or by massage treatment from a trained lymphoedema drainage therapist, physiotherapist, nurse or occupational therapist.
Infection can make the swelling worse.
To prevent infection:
- keep the skin moist
- avoid sunburn
- avoid cuts, burns and insect bites
- avoid repetitive tasks and heavy lifting with the affected arm
- avoid injections being given in the arm on the side of the surgery.
In many hospitals, a lymphoedema specialist will assess you before surgery. Some hospitals have specialist physiotherapists who can help reduce your risk of developing lymphoedema.
For more information contact the Lymphology Association of Australia at www.lymphoedema.org.au or the Lymphoedema Support Group NSW (02) 9402 5625.
Some treatments for early breast cancer cause your periods to stop (menopause) and can affect your ability to become pregnant (fertility).
Menopause may be temporary or permanent. If your periods stop permanently, this will cause an early menopause. Some of the symptoms of a temporary or permanent menopause include hot flushes and sweats, trouble sleeping, vaginal dryness, passing urine more often, lower sex drive, tiredness, sleeplessness, dry skin, aches and pains, mood swings, poor concentration, weight gain and loss of confidence and memory. Not everyone has every symptom and they can range from very mild to more severe.
Talk to your breast care nurse or your doctor about ways to manage menopausal symptoms. You may be able to change medication if you find symptoms difficult to manage, or you may prefer to take no medication.
If fertility is important to you, talk to your doctor before treatment starts about your risk of infertility and discuss ways it might be preserved. When people learn that they may be permanently infertile they often feel a great sense of loss. You may be devastated that you won’t have your own children or additional children, and you may worry about the impact of this on your relationship. Even if your family is complete, you may experience distress.
Ovarian cancer
Diagnosis
Most ovarian cancer tumours are present for some time before they are discovered. Sometimes ovarian cancer is found unexpectedly during an operation such as a hysterectomy. There are a number of procedures which can be used to diagnose ovarian cancer.
The doctor will check for a mass or lump by feeling your abdomen and doing a vaginal examination.
If there is a build-up of fluid in the abdomen, a fluid sample may be taken by a needle passed through the skin (paracentesis). The fluid is checked under a microscope for cancer cells. You may have a type of surgery called an exploratory laparotomy so the doctor can examine the tissue in your abdomen.
Chemicals that are produced by cancer cells as proteins are found in the blood. They are called tumour markers.
You will have a blood test to check the level of your tumour markers. If your levels of the chemicals rise, you may have ovarian cancer. However, you could have raised markers and not have ovarian cancer, as levels may be higher in women who have common gynaecological conditions, such as endometriosis or fibroids. The most common tumour marker for ovarian cancer is called CA125.
Your doctor may do one of the following scans to see if you have cancer.
- Abdominal ultrasound: a handheld device called a transducer is passed over your abdomen. Echoes from soundwaves are turned into a picture by a computer.
- Transvaginal ultrasound: a transducer is inserted into your vagina and echoes from soundwaves are turned into a picture by a computer. This should not be painful.
- CT scan: uses x-ray beams to take pictures of hte inside of your body. You will be asked not to eat or drink before the scan, and you may have some liquid dye that makes your organs appear white on the scans. You will lie on a table while the scanner, which is large and round like a doughnut, rotates around you.
- MRI scan: uses magnetism and radio waves to build up cross-section pictures of your body. You will lie in a narrow metal cylinder.
- X-ray: you may have chest or abdominal x-rays. A bowel x-ray called a barium enema may also be done. This means a white chalky liquid is put into your bowel through your anus and rectum and x-rays are taken.
Treatment
The treatment options for ovarian cancer depends on what type of cancer you have, the stage, your general health and fitness, your doctors' recommendations and your wishes. Epithelial ovarian cancer is commonly treated with surgery, chemotherapy and/or radiotherapy, borderline tumours are usually treated with surgery and non-epithelial ovarian cancer is usually treated with surgery and/or chemotherapy.
Your doctor will discuss the most appropriate type of surgery with you.
Surgery procedures:
- Laparotomy
- Other types of surgery
- After the operation
- Taking care of yourself at home
Laparotomy
The first treatment for ovarian cancer is usually an operation to look inside the abdomen. This is called a laparotomy.
A cut is made in the lower abdomen from the bellybutton to the pubic bone.
If there is obvious spread of cancer, you will need an operation to remove as much of the cancer as possible. This is called surgical debulking. You may also have one or more of the following procedures:
- total abdominal hysterectomy -- removal of the uterus and cervix
- bilateral salpingo-oophorectomy -- removal of both ovaries and both Fallopian tubes
- omentectomy -- removal of the fatty protective tissue (omentum) covering the abdominal organs
- colectomy -- removal of all or part of the bowel and rejoining of the two ends of the bowel or the creation of a new opening called a stoma (colostomy or ileostomy)
- lymphadenectomy -- removal of the small, bean-shaped organs that help filter toxins from the blood stream (lymph nodes).
The surgeon will also take samples of the tumour and fluid in the abdomen and send them to a lab.
After the operation, you may have several tubes in place:
- a drip into a vein through a tube (intravenous drip) to give you fluid, medications and pain relief
- a small plastic tube (catheter) into your bladder to collect urine in a bag
- a tube down your nose into your stomach (nasogastric tube)
- other tubes to drain fluid from the operation site.
As you recover from the operation, the tubes will be gradually removed over 2-3 days. You will be in hospital about 5-7 days.
You may also have inflatable leg casts to keep your blood circulating. You will probably feel some pain, but this can be controlled with medication. After surgery, your doctor should have test results and will discuss further treatment options with you.
Tips for taking care of yourself after surgery
- Rest -- Recovery time varies from woman to woman. Take things easy and only do what is comfortable.
- Sex -- Penetrative sexual intercourse should be avoided for about six weeks after the operation to give your wound time to heal.
- Driving -- Avoid driving for about six weeks after the operation.
- Lifting and exercise -- Heavy lifting should be avoided for at least six weeks. If you have a partner or children, ask them to do more around the house. Services are also available to help.
Non-surgical treatments
Chemotherapy
Chemotherapy is the treatment of cancer with anti-cancer (cytotoxic) drugs that kill or slow the growth of cancer cells.
Women with epithelial ovarian cancer that has spread outside the ovaries usually receive a combination of two chemotherapy drugs: carboplatin and paclitaxel. However, not everyone has both drugs. One drug may be prescribed for frail or elderly women.
Chemotherapy is usually given through an intravenous drip.Your first treatment may be given while you are recovering from surgery, or a few days after you leave hospital. About 6-8 treatments will be given every 3-4 weeks over about six months. Blood tests will be taken to make sure your body's healthy cells have had time to recover. The tests will also check the amounts of your tumour markers, such as CA125.
Radiotherapy
Radiotherapy uses x-rays to kill cancer cells or injure them so they cannot multiply. It is occasionally used to treat ovarian cancer, especially if the cancer is confined to the pelvic cavity.
You may have radiotherapy to the whole abdomen (called whole abdominal radiotherapy or WART), or to one particular area of your abdomen. You will lie on an examination table and a machine above you will deliver the painless treatment. You will have a number of treatment sessions. Most women have treatment daily, Monday to Friday, for 3-4 weeks. Your doctor will tell you how much treatment you need.
Palliative treatment
Palliative treatment helps to improve people's quality fo life without trying to alleviate symptoms of cancer. It can be used during different stages of cancer.
Often treatment is concerned with pain relief and stopping the spread of cancer, but it can also involve management of other physical and emotional symptoms.
After treatment: Patient follow-up
After your treatment, you will need regular checkups with your specialist to confirm the cancer hasn't come back. You may have scans or tests at your checkups, including physical examinations, blood tests, x-rays, ultrasounds and CT scans. If you have health problems between follow-up appointments, let your doctor know immediately.
If the cancer comes back, this is called a relapse or recurrence. It is likely cancer will come back for women with advanced epithelial ovarian cancer. Usually, the longer the time between the end of the first course of treatment and the relapse, the better the response will be to further treatment. The most common treatment for epithelial ovarian cancer that has come back is more chemotherapy. The drugs used will depend on what drugs you were given, the length of your remission, and the aims of the treatment.
Side effects of treatment
Tiredness is a common side effect. Most women need chemotherapy before they have had time to recover from their operation. Travelling to and from hospitals and clinics for treatment is also very tiring. If you start work again during the treatment, or if you have a home and family to care for, you will be very tired. If you are on your own and have to do everything yourself, fatigue may also be a problem.
Your tiredness may continue for a while even after treatment has finished. Some women find that it takes them up to 1-2 years to feel really well again. It may help to talk with your family and friends about how you feel and discuss ways in which they can help you. You may need to plan your day's activities so that you get regular rest periods.
If you have had your uterus removed, you will no longer have your periods and it will not be possible to become pregnant. If you had both ovaries removed when you were still having periods, you will experience sudden menopause.
Menopausal symptoms include:
- hot flushes
- mood swings
- trouble sleeping
- tiredness
- vaginal dryness.
The symptoms are usually more severe than a natural menopause because the body hasn't had time to get used to the loss of hormones.
Talk to your doctor about medication for relieving the symptoms of menopause.
Younger women and those who hope to have children may feel deeply upset after a hysterectomy.
For some women, having children is a long-held dream. You may feel devastated if you can't have a child naturally. Even if you had not planned to have children, or have finished having a family, the removal of your reproductive organs may make you feel less feminine.
Consider talking to a counsellor or gynaecological oncology nurse, who can listen and provide support.
Sometimes fluid can build up in the abdomen.
Ascites are a collection of fluid in the abdomen. They can be uncomfortable because of swelling and pressure.
A procedure called a paracentesis can drain away the fluid and relieve discomfort. This may require an overnight stay in hospital.
Pleural effusion Fluid that collects in the lining of the lungs. May make you feel short of breath and cause some pain. Draining the fluid using a procedure called a pleural aspiration or a pleural tap can provide relief.
After surgery, some women may have bowel problems such as diarrhoea, cramps or constipation. These can occur for some time after treatment. If you have had a colostomy or ileostomy, you will have a stoma bag, which will take some time to adjust to.
Avoid becoming constipated, as this will put more pressure on the bowel. Talk with your doctor, nurse or the dietitian about ways to prevent constipation and relieve other symptoms.
Surgery may sometimes cause the bowel to become blocked (bowel obstruction). The blockage may also occur because the cancer has come back. If you have symptoms such as feeling sick, vomiting, abdominal discomfort or pain you should see your doctor or specialist as soon as possible.
Tip to prevent bowel problems
Prevent or manage constipation by eating more high-fibre foods, such as wholegrain bread and pasta, bran, fruit and vegetables.
Drink plenty of fluids. This will help loosen the bowels if you are constipated and replace the fluids lost through diarrhoea. Warm and hot drinks work well. Eat small, frequent snacks instead of big meals. If you have a stoma, talk to a stomal therapy nurse who can give you advice and written information.
Removing lymph glands in the pelvic area (lymphadenectomy) may cause one or both of your legs to swell because of build-up of lymph fluid. This may make movement and some activities difficult.
Tip to reducing swelling in the legs
- Gently massage the swollen leg to move the fluid out to other lymph channels.
- Wear special bandages, stockings or a compression garment to help remove fluid. Talk to your health care team for information.
- Avoid infection by caring for your skin and nails.
- Avoid injections in your legs.
- Ask if your hospital has a specialist physiotherapist or nurse who can tell you how you can reduce your risk of developing lymphoedema or give you limb exercises to reduce it
Cervical cancer
Diagnosis
Most abnormal changes in cervical cells are detected with a Papanicolaou test (Pap test or Pap smear). However a PAP test doesn't detect ovarian cancer.
Procedure for a Pap test:
- the doctor uses a brush or small spatula to scrape some cells from the surface of the cervix
- may feel slightly uncomfortable, but usually only takes a few minutes
- cells are examined for abnormalities.
A woman should have a Pap test once every two years, but some women have them more often. About 5 to 7% of Pap tests produce abnomal results, which may include dysplasia. Your doctor will talk to you if you have an abnormal result.
Colposcopy
Is an examination that allows the doctor to see a magnified view of the cervix, vagina and vulva. It can help identify where abnormal cells are.It is done using an instrument called a colposcope, which is like binoculars on a stand. The colposcope doesn't enter the body -- the doctor inserts an instrument called a speculum and views the magnified picture through the colposcope.
Beforehand, the vagina and cervix may be coated with a special solution to highlight abnormalities. It may take 10-15 minutes and can be slightly uncomfortable.
Biopsy
Is a procedure where a small sample of tissue may be taken from an abnormal area on the cervix and sent to a laboratory for examination. Taken in the doctor's rooms or in a clinic, a colposcope will be used to see what area needs to be removed. It may be uncomfortable for a brief period. The results are usually back within a week.
Temporary side effects
- Pain -- similar to menstrual cramping. Ask your doctor for pain-killers.
- Light bleeding -- bleeding or other vaginal discharge may be present, but will gradually disappear.
- Infection -- you should not have sexual intercourse or use tampons for a few days to reduce the risk.
Cone biopsy
Is a procedure used to see if the cancer cells have spread to tissue beneath the surface of the cervix. A cone-shaped piece of tissue containing abnormal cells is removed. The procedure may be put under general anaesthetic and may therefore involve day or overnight admission to hospital. Results are usually back within about a week.
Treatment
Surgery is common for small tumours found only within the cervix. The extent of the cancer in the cervix will determine the type of surgery needed.
Cone biopsy is used if the tumour is very small, a cone biopsy may be the only treatment you need.
Hysterectomy is the surgical removal of the uterus and cervix.
Two main types:
1. Total hysterectomy -- removal of uterus and cervix, with about five days in hospital.
2. Radical hysterectomy -- removal of uterus and about two centimeters of upper vagina and tissues around the cervix. May affect continence. About a seven day hospital stay.
When you have either type of hysterectomy, you may also have:
- Bilateral salpingo oophorectomy -- removal of ovaries and Fallopian tubes.
- Pelvic lymphadenectomy -- lymph nodes in pelvis are removed. May cause leg swelling (lymphoedema).
Radiotherapy
Radiotherapy uses x-rays to kill cancer cells or injure them so they cannot multiply.
Radiotherapy can be given in two ways:
1. From outside the body (external). A machine directs radiation at the cancer and surrounding tissue.
2. From inside the body (internal). Radioactive material is put in thin tubes and implanted into your body on or near the cancer. This is called brachytherapy.
Usually both external and internal radiotherapy is used to treat cervical cancer.
Radiotherapy is usually given if you are not well enough for a major operation or if the tumour has spread into the tissues surrounding the cervix. Radiotherapy may be used after surgery or combined with chemotherapy. It can also treat the lymph nodes in the area of the cancer, in case the cancer has already spread.
External radiotherapy
- x-rays are aimed from a machine at the cervix and surrounding tissue (pelvic area).
- You will lie on a table under the radiotherapy machine.
- You'll be alone in the treatment room, but can talk through an intercom.
- Common to have outpatient treatment from Monday to Friday for four to six weeks.
- After the first visit to plan your treatment, which usually takes up to three hours, the actual treatment only takes a few minutes each time.
- During the treatment you will regularly see the radiation oncologist and have weekly blood tests to make sure you are not becoming anaemic and to monitor your electrolytes.
Internal radiotherapy
Is also called brachytherapy. You are given an anaesthetic and a radioactive implant is placed inside your body directly in and around the cancer (cervix and vagina area). You may have gauze packing and a stitch put in your vaginal lips to keep the implant in place. A small tube (catheter) will be passed into the bladder to take away urine. Depending on where you receive your treatment, the implant may be left in for up to 72 hours. The implant doesn't hurt while inserted but you may find it uncomfortable -- pain relief can help.
During the time the implant is in, you won't be able to sit upright in bed. You'll be in a room on your own but you will be able to talk to the hospital staff through an intercom. Removing the implant can be uncomfortable, but once the implant is removed you will not be radioactive. You will be able to go home after the implant has been removed and you have been monitored for any bleeding.
Chemotherapy
Chemotherapy uses drugs to kill or slow the growth of cancer cells. These drugs are called cytotoxins. Chemotherapy is usually combined with radiotherapy to make the radiotherapy more effective. Chemotherapy may also be used on its own for advanced cervical cancer. You will have a number of chemotherapy treatments, sometimes up to six, every three to four weeks over several months. The length of treatment will depend on your circumstances.
Chemoradiation
Is a combination of chemotherapy and radiotherapy is usually used to treat advanced cervical cancer.
- Can give improved survival rates.
- Causes more intense side effects than either treatment alone.
- Most side effects are temporary.
- Talk to your doctor for more information.
Palliative treatment
Palliative treatment helps improves people's quality of life by alleviating symptoms of cancer. It is particularly important for people with advanced cancer. Treatment may be concerned with pain relief and management of physical and emotional problems.
After treatment: Patient follow-up
After treatment is over, you will need regular checkups. Pap tests, pelvic examinations, chest x-rays and liver function tests may be used to check that the cancer hasn't come back. Checkups are usually every three months following completion of treatment and will become less frequent as the time from diagnosis passes. The period of follow-up is usually five years. Between follow-up appointments, let your doctor know immediately of any health problems or concerns.
After treatment ends, it is normal for you to be concerned about the cancer coming back. You should see your doctor if you have any problems. There are many support services available in the community and you should ask your health professional for guidance.
Side effects of treatment
Some women will have no side effects, others will experience a few.
Menopause
The ovaries produce the hormones oestrogen and progesterone. If you've had surgery or radiotherapy to the pelvic area, your ovaries will no longer produce there hormones. If you are not already menopausal, this will cause sudden, premature menopause.
Symptoms are usually more severe than a natural menopause because the body hasn't had a chance to get used to gradual decrease in hormone levels.
Symptoms include:
- hot flushes
- mood swings
- trouble sleeping
- tiredness
- dryness of the vagina, and loss of elasticity
Tips to manage menopausal symptoms:
- Hormone replacement therapy (HRT) -- can help reduce your symptoms. Using HRT for more than five years causes a small increase in the risk of some diseases like breast cancer, but may decrease other diseases like bowel cancer. Talk to your gynaecological oncologist about HRT.
- Locally applied oestrogen -- contained in creams or pessaries. Can be inserted into the vagina to reduce dryness. Moisturisers without oestrogen can also be used.
- Alternative approaches -- such as herbal remedies, complementary therapies, and changes to diet.
Tell your doctor how you are managing your symptoms.
Menopause may also cause bones to weaken and break more easily (osteoporosis). It can also cause changes to cholesterol balance that increase the risk of hardening or blocking of arteries.
Tips to prevent osteoporosis
- Eat low-fat dairy food and other food high in calcium, and maintain an overall balanced diet.
- Exercise regularly. Walking, dancing and weight training all help reduce the rate of bone loss.
- Don't smoke.
- Maintain a healthy weight.
Talk to your doctor about medication for osteoporosis or heart disease.
Effects on sex life and fertility
You don't need your cervix to have sex but treatment for cervical cancer can affect your sex life. Many of these effects can be prevented or treated. Lack of interest or loss of desire for sex (low libido): This is common during cancer treatment. Sometimes it can be brought on by anxiety and worry about your diagnosis rather than the treatment. Libido usually returns after treatment is over.
During treatment, you can have sex if it feels comfortable. After a hysterectomy you will have to wait several weeks before having sex again. In the meantime, kissing, caressing and touching can also be pleasurable.
The main effect of treatment will be on your vagina. If the ovaries have been affected by surgery or radiotherapy the production of oestrogen will drop or stop. The loss of oestrogen may make your vagina dry and it may not expand as easily during sexual intercourse.
Radiotherapy may also shorten and narrow the vagina. This may make intercourse uncomfortable but it usually does not affect your ability to reach orgasm.
Tips
- Use a plastic tube called a dilator. This is inserted into the vagina several times a week to help maintain the shape of your vagina. Speak to your health carers for more information.
- Apply a water-based lubricant to relieve painful irritation. Avoid Vaseline or oil-based lubricants as they may cause irritation.
- Have regular gentle sex to help widen the vagina, if you are ready and able.
- Ask your doctor about hormone replacement therapy (HRT).
Infertility
Women often feel a sense of loss when they learn their reproductive organs will be removed or no longer function. You may feel upset if you are no longer able to bear children and may worry about the impact of this on your relationship. Even if your family is complete, you may have mixed emotions.
Talking to your partner, a counsellor or a gynaecology oncology health professional may help. There may be ways to preserve your fertility. For example, some women who do not have their uterus removed store eggs or embryos before treatment.
Bowel problems
After surgery and radiotherapy some women have changed bowel habits. You may experience abdominal pain, constipation or diarrhoea. Blood vessels in the bowel may also become more fragile after treatment, which can cause blood to appear in your bowel movements.
Tips to assist with bowel problems
If you're constipated, eat more high-fibre foods, such as wholegrain bread and pasta, bran, fruit and vegetables.
Drink plenty of fluids. This will help loosen the bowels if you have constipation and replace the fluids lost through diarrhoea. Warm and hot drinks work well. Eat small, frequent snacks instead of big meals. Suck on peppermints or drink peppermint tea to reduce abdominal pain. Talk to your doctor about making changes in your diet or medication.
Bladder problems
After surgery or radiotherapy, some nerves or muscles may not work properly and you may have difficulty controlling the flow of urine. Some women find they need to go to the toilet more often or that they frequently need to go in a hurry. Other women may lose a few drops when they cough, sneeze, strain or lift.
Blood vessels in the bladder may also become more fragile after treatment, which can cause blood to appear in your urine.
For most women bladder problems are temporary but for a few they may be permanent.
Lymphoedema
Removing lymph glands in the pelvic area (lymphadenectomy) may cause one or both of your legs to swell. This may make movement and some activities difficult.
Tips
- Gently massage the swollen leg towards your heart to move the fluid out to other lymph channels.
- Wear special bandages, stockings or a compression garment to help remove fluid.
- Avoid infection by caring for your skin and nails.
- Exercise the leg to help move fluid out of the area and into other lymph channels.
- Avoid injections in your legs
Vaginal cancer
Diagnosis
Usually you begin by seeing your GP, who will do a vaginal examination. If there is a chance you have vaginal cancer, you should be referred to a gynaecological oncologist, who diagnoses and treats women with cancer of the reproductive organs. Your doctor may also arrange for you to have a blood test and chest x-ray to check your general health. The following tests are commonly used to diagnose vaginal cancer.
- Internal vaginal examination
At the hospital, the gynaecological oncologist will do a full pelvic examination.
This will include examining the inside of your vagina to check for any lumps or swellings.
The doctor will also feel your groin and pelvic area to check for any swollen glands and may also check your back passage.
You will have a Pap smear to check for early cell changes in the vagina or cervix.
If the cells taken in the smear test are abnormal, your doctor may ask you to have a colposcopy.
This is a closer examination of the vagina using a colposcope, which is a small low-powered microscope that allows the doctor or specialist nurse to see the vagina in more detail.
A small sample of tissue will be taken from any abnormal areas, and examined under a microscope.
Treatment
The treatment for vaginal cancer depends on:
- age
- general health
- stage
- grade
- type of cancer
Radiotherapy
Commonly used treatment for many women with cancer of the vagina. In some younger women, radiotherapy may be combined with chemotherapy. Radiotherapy treats cancer by using x-rays, which destroy the cancer cells, while doing as little harm as possible to normal cells. It is given in the radiotherapy department at the hospital. The dose needed will depend on the exact type of cancer and whether it has spread into surrounding tissue, so you may find that you are having a different radiotherapy treatment from other women you meet at the hospital.
Radiotherapy can be given in two ways:
1. From outside the body (external). A machine directs radiation at the cancer and surrounding tissue.
2. From inside the body (internal). Radioactive material is put in thin tubes into your body on or near the cancer.
Most women have both external and internal radiotherapy.
External radiotherapy
This involves beams of radiation being directed at the cancer from outside the body. It is like having an x-ray.
You will be asked to visit the radiotherapy department for treatment every weekday for 4–6 weeks. Each treatment takes several minutes and is painless.
Internal radiotherapy
An applicator (similar to a tampon) containing a radioactive substance is inserted into your vagina. The treatment may last several hours or a few days. Sometimes, as well as the applicator, tiny radioactive needles may be placed into the area surrounding the vagina. If these are needed, they are put in under general anaesthetic and are removed once the treatment ends.
Surgery
Sometimes the cancer needs to be removed in an operation. The type of surgery you will have depends on the size and position of the cancer. It may be possible to have an operation to remove the cancer together with some of the surrounding normal tissue.
Depending on the amount removed, the remaining vagina may be stretched so that you may still be able to have sexual intercourse.
Vaginectomy
Some women may need a larger operation that removes all of the vagina. Sometimes it is possible to make a new vagina (vaginal reconstruction) using tissue from other parts of the body.
Radical hysterectomy
It may also be necessary to remove the uterus (womb), cervix, ovaries and Fallopian tubes. This is called a radical hysterectomy.
During this operation some of the lymph nodes in the pelvis may also be removed.
Side effects
Radiotherapy for vaginal cancer can cause short-term and long-term side effects. The most common side effects happen during or soon after treatment. The side effects happen because, as well as destroying cancer cells, radiotherapy can also damage the healthy cells nearby.
Short term side effects of radiotheraphy
Radiotherapy may also irritate the bowel and cause some diarrhoea. If diarrhoea is a problem let your doctor know, as drugs can be prescribed to reduce it. Drink plenty of water to replace the fluid lost through diarrhoea.
Radiotherapy can cause hair loss in the area being treated. This may be permanent.
- Shortening and narrowing of the vagina
Radiotherapy to the pelvic area can affect the vagina, which will become tender during the course of radiotherapy and for a few weeks after it ends.
In the long term this irritation can make the vagina drier and can leave scarring that makes the vagina shorter, narrower and less flexible. This may make having sex uncomfortable or difficult.
Tips
- Use a vaginal dilator with a lubricating jelly to keep the vaginal walls open and supple. Ask your doctor or nurse to show you how to use it. If they are not used, the vagina may close over completely.
- Applying a hormone cream to your vagina may help. These are available on prescription from your doctor.
- Regular intercourse may also help to prevent the vagina from shrinking. However, you may not feel ready for intercourse for some time
- Vaginal moisturisers can also help
Long-term side effects
Menopause means that your periods will stop. If you are not already menopausal, radiotherapy for cancer of the vagina affects the ovaries. This brings on menopause, usually about three months after the treatment starts. Side effects of menopause include:
- hot flushes
- dry skin
- possibly loss of concentration
- some women become less interested in sex
- vaginal dryness.
Hormone replacement treatment (HRT) may help to control or minimise menopausal symptoms. Your gynaecologist can start HRT during the radiotherapy treatment or shortly after it has ended.
- Bowel and bladder problems
In a small number of people, radiotherapy may permanently affect the bowel or bladder. If this happens, the increased bowel motions and diarrhoea may continue, or you may need to pass urine more often than before. The blood vessels in the bowel and bladder can become more fragile after radiotherapy treatment and this can cause blood to appear in the urine or bowel movements. This can take many months or years to occur. If you notice any bleeding, it is important to let your doctor know so that tests can be done and appropriate treatment given.
Some people also find that the radiotherapy affects the lymph glands in the pelvic area and can cause swelling of the legs. This is more likely if you have had surgery as well as radiotherapy.
Vulvar cancer
Diagnosis
Going to see your GP for an examination is a way to check if there is a chance you have vulvar cancer> if so, you should be referred to a gynaecological oncologist. An oncologist is a doctor who specialises in the treatment of cancer. A gynaecological oncologist diagnoses and treats women with cancer of the reproductive organs, such as cancer of the vulva. Your doctor may also arrange for you to have a blood test and chest x-ray to check your general health. At the clinic or hospital the gynaecological oncologist will take your medical history and do a full medical examination.
Diagnostic Procedures
The medical examination will include an examination of your vulva. A colposcope may be used to identify any abnormal areas.
The colposcope is like a small microscope with a bright light that can magnify areas so that the cells can be seen more clearly. The colposcope remains outside the body. A biopsy will be taken.
You will also have an internal examination to check your vagina and cervix for any abnormality.
A cervical smear test may be done if you haven’t had one recently. Some women with lichen planus or lichen sclerosus can have narrowing of the vagina so they may need to have the smear under a general anaesthetic.
The doctor may also examine your back passage (anus) to check for any abnormal lumps.
A biopsy is the best way to diagnose cancer of the vulva. Anaesthetic cream is applied to the vulva to numb the area, and an injection of local anaesthetic is given. The doctor takes the biopsy (a small amount of cells) from the abnormal area.
A pathologist examines the biopsy under a microscope.
Treatment
Surgery is the main treatment for cancer of the vulva. It may be used either alone or in combination with radiotherapy and chemotherapy.
Your doctor will talk to you about the most appropriate type of surgery, depending on the stage of your cancer. All operations for cancer of the vulva will remove the area of the skin where the cancer is located.
The cancer will be removed using one of the following operations:
- Wide local excision takes out the cancer and a border (margin) of healthy cells, ideally at least 1cm, all around the cancer.
- Radical local excision takes out the cancer and a larger area of normal tissue all around the cancer. The groin lymph nodes may also be removed (known as lymph node dissection).
- Partial vulvectomy removes part of the vulva.
- Radical vulvectomy removes the entire vulva, including the clitoris, and usually the surrounding lymph nodes.
- Pelvic exenteration is done if the cancer has spread beyond the vulva. The surgeon removes the affected organs (such as the lower bowel, or the bladder and the cervix, uterus and vagina).
Any surgery aims to remove the cancer while preserving as much normal tissue as possible. Usually only a small amount of unaffected skin is removed with the cancer, so it is often possible to stitch the remaining skin neatly together.
However, if it is necessary to remove a large area of skin, you may need a skin graft or skin flaps. To do this, the surgeon may either take a thin piece of skin from another part of the body (usually the thigh or abdomen) and stitch it on to the operation site. It may be possible to move (rotate) flaps of skin in the vulvar area to cover the wound.
Vuvlar cancer can spread to the Lymph glands
The lymph glands in the groin are usually the first place to which vulvar cancer can spread. Lymph glands are part of the lymphatic system, and are found mainly in the groins, neck and armpits. If the cancer is deeper than 1mm, you will usually be advised to have the lymph glands removed from one or both groins. This is done to check whether any cancer cells have spread from the vulva. If your cancer is at the very earliest stage, you will not usually need surgery to your lymph glands.
Non-surgical Treatments
Radiotherapy
Radiotherapy uses x-rays to kill cancer cells or injure them so they cannot multiply.
It can be given externally, where a machine directs radiation at the cancer and surrounding tissue, or internally, where radioactive material is put in thin tubes into your body on or near the cancer.
Radiotherapy may be given to the vulva and the lymph glands after surgery to make sure that any remaining cancer cells are destroyed, and to reduce the risk of the cancer coming back.
Whether you have radiotherapy or not will depend on the stage of your cancer, its size, whether it has spread to the lymph glands and, if so, how many are affected. Sometimes radiotherapy is given before surgery to shrink the cancer and make it easier to remove.
If the cancer is known to have spread to the lymph glands, radiotherapy may be used instead of surgery to treat this area.
In advanced vulvar cancer (where the cancer has come back or spread), radiotherapy may be used to shrink a tumour and reduce symptoms to improve quality of life. This is known as palliative radiotherapy.
External radiotherapy is normally given as a series of short daily treatments in the hospital radiotherapy department. High-energy x-rays are directed from a machine at the area of the cancer.
The number of treatments will depend on the type and size of the cancer but the whole course of treatment for vulvar cancer will usually last a few weeks. Each treatment takes 10-15 minutes. External radiotherapy will not make you radioactive and it is safe for you to be with other people, including children, after your treatment.
Side effects
Side effects can be mild or troublesome, depending on the strength of the radiotherapy dose and the length of your treatment. Your doctor will tell you what to expect.
As the skin in the area of the vulva and groin is very sensitive, radiotherapy will cause soreness. Only use lukewarm water to wash the treatment area and pat the area dry gently with a towel. Talcum powder or perfume may cause irritation, so avoid using these on the treated area. Your radiation therapist or nurse can advise you on skin care.
Radiotherapy to the groin may cause inflammation of the lining of the bladder, which can make you feel that you want to pass urine frequently.
You may also feel a burning sensation when you pass urine. Your doctor can prescribe medicines that can make passing urine more comfortable. It helps to drink plenty of water and other fluids to make your urine more dilute.
Radiotherapy may also irritate the bowel and cause some diarrhoea. If this is a problem let your doctor know, as drugs can be prescribed to reduce it. It helps to drink plenty of water to replace the fluid lost through diarrhoea.
The side effects may continue for several weeks and then gradually disappear once your course of treatment is over. It is important to tell your doctor if they continue.
Radiotherapy can cause hair loss in the area being treated, and this may be permanent.
Internal radiotherapy
Internal radiotherapy, also called brachytherapy, involves putting a radioactive material directly into the cancer.
This type of therapy is given by inserting radioactive needles or wires into the cancer while you are under a general anaesthetic. Over a few days, the needles or wires give a high dose of radiotherapy directly to the tumour from the inside.
You will need to be cared for in a single room in hospital for a few days until the doctor has removed the radioactive needles or wires from your body.
Although it will be safe for your family and close friends to visit you for short periods, children and pregnant women will not be allowed to visit, to avoid any chance of them being exposed to even tiny amounts of radiation.
The safety measures and visiting restrictions might make you feel very isolated, frightened and depressed at a time when you might want people around you. The isolation only lasts while the radioactive wires are in place (usually for a few days).
Side effects
While the needles are in place, the tissues around them will become swollen. This usually settles by the time they are removed. The treated area will become sore about 5-10 days after the needles or wires have been removed, and this may last for several weeks. Your doctor can prescribe painkillers to help relieve the discomfort.
Chemotherapy
Chemotherapy uses anti-cancer drugs (cytotoxic drugs) to kill or slow the growth of cancer cells.
Chemotherapy drugs are sometimes given as tablets or, more usually, by injection into a vein (intravenously).
It can often be given to you as an outpatient, but sometimes it will mean spending a few days in hospital.
Chemotherapy may be used at the same time as radiotherapy to improve the effectiveness of treatment.
Side effects
Chemotherapy can sometimes cause unpleasant side effects, but for women with vulvar cancer that has come back or spread, it can also make them feel better by relieving the symptoms of the cancer.
Most people have some side effects from chemotherapy, but these can usually be well controlled with medication.
Common problems include feeling sick (nausea), tiredness and a reduced resistance to infections. Chemotherapy for vulvar cancer may also increase any soreness of the skin caused by radiotherapy.
There are many different types of chemotherapy and their side effects vary. The same chemotherapy drugs affect different people in different ways. Some people find that they are able to lead a fairly normal life during their treatment, but many become very tired and have to take things much more slowly. Just do as much as you feel like and try not to overdo it.
Uterine cancer
Diagnosis
A physical examination will allow your doctor to feel your abdomen for swelling. Your doctor may also look at your vagina and cervix using a medical tool to separate the walls of the vagina (speculum). This is like having a Pap test.
- Scan uses soundwaves to create a picture of internal organs.
- A small device called a transducer is put into your vagina.
- A computer makes a picture your vagina, so the doctor can look at the size of the ovaries and uterus and the thickness of the endometrium.
- You may also have a biopsy.
A Hysteroscopy procedure allows a doctor to see inside the uterus to check for cancer. The cervix is stretched and opened, and a telescope-like device called a hysteroscope is inserted. The doctor will remove some tissue to examine (biopsy).
There are different ways of taking tissue samples from the inside of the uterus:
- Tissue can be snipped out, or a spray of fluid may be used to dislodge cells
- Tissue can be removed using a suction device. This method is called endometrial aspiration.
- Most of the uterus lining is scraped out. This is called a D&C (dilatation and curettage). This is the most common and accurate way to remove tissue for a biopsy.
These procedures are usually done in a few hours in hospital or at a day procedure centre. You will probably have a light general anaesthetic. Afterwards, you may have period-like cramps and light bleeding that can last for a few days.
Treatment
Your doctor will consider several factor to determine the best treatment for your cancer:
- the results of your tests
- where the cancer is
- if it has spread
- your age
- general health
- what you want
The main treatment for cancer of the uterus is surgery, because uterine cancer is often diagnosed before it has spread. Many women do not need treatment other than surgery. If the cancer has spread beyond the uterus, radiotherapy, hormone treatment or chemotherapy may be used in addition to surgery.
Hysterectomy
- Surgery allows the doctors to find out the type of cancer you have and if it has spread.
- Cancer of the uterus is usually treated by removing the uterus and cervix (total hysterectomy).
- The Fallopian tubes and ovaries are also usually removed (bilateral salpingo oophorectomy). Ovaries are removed during surgery because the cancer may have spread to the ovaries, or because ovaries produce oestrogen, which may help the cancer to grow.
- The operation may be done as a laparoscopic ("keyhole") procedure - using only small cuts in the abdomen. Tissue is removed through the vagina.
During the operation:
- A cut is usually made from the pubic area to the belly button. Occasionally, it may be along the pubic line.
- The surgeon removes tissue (fluid) for examination.
- The surgeon checks all the organs in the abdomen, looking for signs of cancer spread (metastasis).
- The organs are removed.
If the cancer is only on the surface or is in a very early stage, you may not need to have any more treatment.
Removing lymph nodes
If the cancer has spread into the muscle wall of the uterus, this increases the risk of spread to the abdominal lymph nodes.
Removal of lymph nodes is called a lymphadenectomy. The surgeon uses small clips to seal the lymph vessels.
If you have cancer in the lymph nodes, you may benefit from additional therapy.
After the operation
When you wake up from the operation, you will have several tubes in place. Usually, they are removed in 3-5 days.
An intravenous drip will give you fluid as well as medication. One or two tubes in your abdomen may drain away fluid from the operation site. A catheter in your bladder drains away urine. As with all major operations, you will have discomfort or some pain. You may have pain relievers through:
- an intravenous drip - some people are able to control the dose, using a patient-controlled analgesia (PCA) system
- an epidural into your spine.
A few days after your operation, your doctor will have all the test results and will discuss any further treatment with you.
Side effects
- Adhesions, or internal scar tissue that glues together tissues in the body. This can be painful and may affect the bowel and bladder. Adhesions may need to be treated with surgery.
- If you have a bilateral salpingo oophorectomy, the removal of your ovaries will cause menopause (if you are not already menopausal).
- Parts of your body may swell if you have lymph nodes removed. These symptoms can appear over two years after surgery. Swelling can be reduced with gentle massage towards the heart, compression garments and gentle exercise.
Taking care of yourself at home
A hysterectomy is a major operation and it will take time to get back to your normal activities.
- Recovery time varies from woman to woman. Some women feel better within six weeks; others may need between 6-12 months before they feel completely well. Take things easy and only do what is comfortable.
- Heavy lifting should be avoided for at least three months.
- avoid driving for about four weeks after the operation.
- Penetrative sexual intercourse should be avoided for about six weeks after the operation to give your wound time to heal. Check with your doctor when you can resume sexual intercourse.
Radiotherapy
Radiotherapy uses x-rays to kill cancer cells or injure them so they cannot multiply. The radiation can be targeted at cancer sites in your body. Radiotherapy may be giving if you are not well enough for a major operation, or as additional (adjuvant) therapy.
Radiotherapy can be given in two ways:
-
- From inside the body (internal). Radioactive material is put in thin tubes and inserted into your body on or near the cancer.
- - From outside the body (external). A machine directs radiation at the cancer and surrounding tissue.
The side effects depend on the type of treatment you have.
Internal radiotherapy (brachytherapy)
A type of radiotherapy where the radiation source is placed close to the cancer - an implant is inserted through the vagina or the tissues around the vagina using special applicators. The most common type of radiotherapy for cancer of the uterus and is commonly used after a hysterectomy.
It can be done in two ways:
- Low-dose rate treatment: Radiotherapy is given continuously, for up to 30 hours. You will go to hospital to have a radioactive implant inserted, usually under general anaesthetic. You will need to stay in a room on your own while the implant is in place, and may not be allowed to have any visitors during this time.
- High-dose rate treatment: You may not need to stay in hospital for high-dose rate treatment, but will make 4-8 visits to the treatment centre as an outpatient. The treatment time for each treatment can be as little as 5-10 minutes.
Your choice of treatment may be shaped by if you are able to make several treatment visits.
External radiotherapy
X-rays from a large machine are directed at the part of the body needing treatment (usually the lower abdominal area and pelvis, or other areas of the body, if cancer has spread). You will probably have treatment from Monday to Friday for 4-6 weeks. Treatment itself takes only a few minutes, but prep can take up to 1-3 hours. The treatment is painless when it is given.
Side effects
Radiotherapy can cause short-term and long-term side effects. The most common effects happen during or soon after treatment.
- Lethargy and loss of appetite
- Diarrhoea - treatment may irritate the bowel and cause loose stools and watery bowel movements.
- Hair loss in the area being treated - can be temporary or permanent.
- Menopause - may be permanent.
- Cystitis - treatment can cause a burning sensation when passing urine.
- Shortening and narrowing of the vagina - treatment to the pelvic area can affect the vagina, which will become tender during the course of radiotherapy and for a few weeks after it ends. This may make the vagina drier and can leave scarring that makes the vagina shorter, narrower and less flexible
- Hormone treatment
Some cancers of the uterus depend on hormones (such as oestrogen) for growth.
Hormone treatments that may be used include:
- provera, which blocks the body’s use of oestrogen, and is a form of the female hormone progesterone
- tamoxifen, which is an anti-oestrogen drug.
Hormone treatment, which is taken orally, can work well for advanced or recurrent cancer of the uterus.
Side effects
Provera can cause breast tenderness, nausea and fluid retention. In high doses, it may increase appetite and cause weight gain.
Tamoxifen can cause hot flushes, headaches and fluid retention. You may have some or none of these side effects. Discuss any problems or concerns with your doctors.
Chemotherapy
Chemotherapy uses drugs to kill or slow the growth of cancer cells. The aim is to destroy cancer cells while causing the least possible damage to normal cells.
Chemotherapy may be used:
- for certain types of cancer, such as serous carcinoma
- when cancer returns after surgery or radiotherapy
- if the cancer does not respond to hormone treatment
- if cancer has spread beyond the uterus at the time of diagnosis, such that surgery is impossible.
Chemotherapy is usually given through a needle inserted into a vein (intravenously). You may need to stay in hospital overnight or you may be treated as a day patient. You may have a number of treatments, sometimes up to six, every 3-4 weeks over several months. The length of treatment will depend on the disease and what other treatment is being used.
Side effects
The side effects of chemotherapy vary according to the particular drugs used. Your doctor will talk to you about these side effects and how to manage them.
- feeling sick
- vomiting
- feeling off-colour and tired
- some thinning or loss of your body and head hair.
- most side effects are temporary and steps can often be taken to prevent or reduce them.
Palliative treatment
Involves treatment to improve a person's quality of life by alleviating symptoms of cancer, without trying to cure the disease. It is often used if cancer spreads or returns after treatment. It is particularly important for people with advanced stages of cancer. It can include radiotherapy, chemotherapy and pain-relieving medications.