Coping with cervical cancer treatment

JANUARY is Cervical Cancer Awareness Month, when emphasis is placed on screening and prevention. Yet this disease still affects a significant number of women, mainly in the reproductive years. Unfortunately, most people in our setting are diagnosed at an advanced stage when radical treatment has to be implemented, and these modalities can have adverse effects.

The main treatment options for cervical cancer are surgery and chemoradiotherapy. Surgery is usually offered when the cancer is small and confined to the cervix. When there is spread to the vagina, tissues around the cervix, lymph nodes and other structures, then radiation with chemotherapy is offered. Radiation may be necessary even after surgery depending on the findings in the lab report of the surgical specimen.

Complications of treatment increase when both modalities are used. Common post-treatment concerns include bowel and bladder dysfunction, ovarian failure, and sexual dysfunction.

Bowel irritation may cause diarrhoea, and in severe cases, bloody stool. Antimotility drugs, probiotics, eating frequent, small meals and having a low fibre diet may help to alleviate this.

Staying hydrated is important in preventing dehydration. Bladder issues include painful and/or frequent urination, incontinence and blood in the urine. Drinking plenty of fluids daily may ameliorate these symptoms. Lime water and cranberry extracts may be helpful. Caffeine, alcohol and soda may aggravate these symptoms and should be avoided. Seek medical attention if there is blood in the urine or stool.

Ovarian preservation options should be discussed before treatment in younger women. Ovarian failure results in early menopause and the coexisting symptoms such as hot flushes and mood swings. Thinning of the bones and increased heart disease risk ensues. Hormone replacement therapy should be prescribed in carefully selected individuals.

Sexual dysfunction is multifactorial. It may be psychological, from altered body image perception resulting in impaired desire and arousal. Reduced hormone levels associated with ovarian failure causes low libido. Surgery may cause vaginal shortening and pelvic nerve damage. Radiotherapy causes vaginal stenosis and dryness. Treatment includes hormonal replacement therapy, early and consistent use of vaginal dilators, vaginal lubricants, and pelvic floor physiotherapy. Psychological intervention may also be necessary.

Life after cancer can be fulfilling. Cancer treatment is not only about cure, but should ensure good quality of life.

Dr Natalie Medley is a consultant obstetrician and gynaecologist and gynaecologic oncologist at the Mona Institute of Medical Sciences, UHWI. She can be contacted at (876) 977-1512, (876) 618- 6048 or nmedsingh@gmail.com.