After cervical cancer surgery

Your recovery depends on the type of surgery you have. And your general health.

After surgery to remove your cervix or womb, most people can go back to normal activities after a few weeks, but it can take up to 3 months to fully recover.

Your hospital stay and recovery time may be longer if you had:

• lymph nodes from the stomach (abdomen) removed as well
• major surgery such as a pelvic exenteration

When you wake up

Radical trachelectomy or hysterectomy

You wake up in the recovery area next to the operating theatres.

At first, you'll be wearing a mask or have small tubes into your nose (nasal cannulae) to give you oxygen. You might feel dizzy and sluggish, to begin with.

You have a blood pressure cuff on your arm and a little clip on your finger to measure your pulse and oxygen level.

Once you are more awake, your nurse will take you back to the ward. They will measure your blood pressure and check your dressings regularly.

Pelvic exenteration

After a big operation, you may wake up in the intensive care unit or a high dependency recovery unit. You usually move back to the ward within a day or so.

In intensive care, you have one to one nursing care. In the high dependency unit, you have very close nursing care. Your surgeon and anaesthetist review you regularly and watch your progress closely.

These units are busy and often noisy places that some people find strange and disorientating. You'll feel drowsy because of the anaesthetic and painkillers.

Tubes and drains

When you wake up after your operation you will have a few tubes in place. You have different tubes depending on the operation you have had. 

Radical trachelectomy or hysterectomy

You may have:

• a drip (intravenous infusion) into your arm to give you fluids until you are eating and drinking again
• a tube (catheter) into your bladder to drain your urine
• a very fine tube into your spine (an epidural), carrying painkillers to control your pain after the surgery

Pelvic exenteration

You may have a:

• drip (intravenous infusion) into your arm to give you fluids until you are eating and drinking again
• very fine tube into your spine (an epidural), containing painkillers to control your pain after the surgery
• tube into a blood vessel in your neck that your doctor uses to give you fluids and to measure your blood pressure
• tube in your tummy (abdomen) to remove fluid and blood from around the operation site (wound drain)
• tube down your nose and into your stomach to drain it and stop you feeling sick (nasogastric tube)
• tube into your bladder (catheter) to drain urine into a bag (if you’ve you've not had your bladder removed)

Your nurse usually takes out these drips and tubes over the next few days as you start to drink and recover from your operation.

Depending on the operation you had, you might also have a:

• tube into an opening on your tummy (stoma) to drain urine if you had your bladder removed (urostomy tube). Or you may have a bag covering the stoma to collect urine (urostomy bag)
• bag covering an opening on your abdomen to collect poo (faeces) if you've had the lower part of your bowel removed (a colostomy bag)

Painkillers

It's normal to have pain for the first week or so. Your doctor and nurses will give you painkillers. 

Tell your doctor or nurse as soon as you feel pain. They need your help to find the right type and dose of painkiller for you. Painkillers work best when you take them regularly. 

Immediately after surgery you can have painkillers through either:

• a drip into your bloodstream that you control (PCA or patient controlled analgesia) 
• small thin tube put into your back and connected to a pump that gives you a constant dose of painkiller (epidural) 

You'll have painkillers to take home. Follow the instructions your nurse gives you about how often and how to take them. Contact your doctor if you still have pain or if it gets worse. 

Your wound

Radical trachelectomy or hysterectomy

The wound or wounds you have after surgery depends on the type of operation you had.

You might have up to 5 small wounds in your abdomen if you had keyhole (laparoscopic) surgery.

After a hysterectomy, you might have a wound that runs:

• vertically, up and down your lower abdomen - called a mid line incision
• from right to left across your lower abdomen (your bikini line) - called a transverse incision.

Your gynaecological oncologist will talk to you before your operation about the type of cut they are likely to do and why.

Pelvic exenteration

You usually have a wound running up and down your lower abdomen. You may also have a wound around your back passage (anus).

You'll have another wound on the part of the body where the surgeon took the skin and tissue to make the new vagina if you've had vaginal reconstruction as part of the operation.

You have dressings over your wounds after the operation. Your nurse will regularly check the dressings to look for signs of bleeding. After a day or so they change the dressings and clean the wounds.

Your nurse removes the wound drain once it stops draining fluid if you have one. This is not usually painful, but it can be a bit uncomfortable.

You may have stitches that gradually dissolve, so you don't need to have them taken out. Other types of stitches or clips stay in for around 10 days. Your nurse may take them out before you go home. Or a nurse at your GP surgery or a district nurse can usually remove them.

Eating and drinking

Your nurse starts offering you sips of water within a few hours. Once you can cope with these, you can gradually drink more and then try eating a light diet.

Gradually, you get back to normal over the next few days. Your nurse might give you high protein, high calorie drinks to help maintain your nutrition. Your nurse takes your drip out once you are drinking plenty of fluids.

You may get a build up of wind and feel uncomfortable. Your nurse may give you peppermint water to help and encourage you to move around.

After a pelvic exenteration, it can take a few days before your bowel (and colostomy, if you have one) starts working again.

Stoma after pelvic exenteration

For the first few days after your operation the stoma nurse helps you look after and clean the stoma or stomas, and change the bags. They will also help you to find which type of stoma bag is the best for you.

Your stoma nurse will give you stoma bags to take home. You get more from the chemist or a local stockist. Supplies are free, but you need a prescription from your GP. 

Internal urine pouch (Continent urinary diversion)

If you’ve had your bladder removed, you may have an internal pouch made inside your abdomen. This is called a continent urinary diversion. Instead of having a bag over the opening on the abdomen to collect the urine, you put a thin tube (catheter) into the stoma to drain it off.

Your stoma nurse will teach you how to do this. It may be every 2 hours at first. Gradually, you will be able to extend the time you drain it so that eventually, you can drain it every 4 to 6 hours during the day.

Vaginal discharge

You might have some vaginal bleeding or pinkish or brown discharge for up to 6 weeks after your operation. The amount of discharge may increase about 10 to 14 days after the operation. This can last a few days and is a normal part of healing. Let your GP or specialist nurse know if the bleeding is heavy or doesn't improve.

Use sanitary towels or panty liners instead of tampons for the vaginal discharge or bleeding. This is to reduce the risk of infection. You can usually use tampons for your period from about 6 weeks after the operation as long as you have no pain and the vaginal discharge has stopped.

Getting up

Getting up and walking is likely to be difficult at first. Moving about helps you to get better, but you need to start gradually. Your nurses will encourage you to get out of bed and sit in a chair as soon as possible. Once all the drips and drains are out, getting around will be much easier.

The physiotherapist might visit you after your operation to help with breathing and leg exercises. Your nurses will also remind you to do the exercises. This helps to lower the risk of more serious complications such as blood clots in the legs (DVT).

How you might feel

You may feel weepy or down for a time after having surgery. This can be partly due to the general anaesthetic but also because of feelings about your diagnosis and the type of operation you've had.

Your nurses on the ward will help support you. You can talk things through with your specialist nurse if you feel like this at home. They can refer you to a counsellor or therapist if you need more help adjusting to your body changes.

Going home

Radical trachelectomy or hysterectomy

After a radical trachelectomy, you can usually go home within 2 or 3 days.

After a radical hysterectomy, you can go home after 5 or 7 days. You might go home with a catheter to drain your urine. Your nurse will show you how to look after it. 

Pelvic exenteration

You are normally in hospital for around 14 to 21 days.

After a hysterectomy or pelvic exenteration, you will need to rest at home for at least 4 to 6 weeks after you come out of hospital. Until this time, you will not be able to:

• do heavy housework, such as vacuuming
• carry heavy bags of shopping or washing
• drive

When you can start driving again will depend on your recovery from the operation. Your doctor will help guide you about this. Remember to contact your car insurance company for advice about driving after surgery.

A short walk every day is a good idea. You will get some fresh air and gradually go further as you regain your strength. Do take it easy at first, though.

When you can return to work will depend on the type of work you do and your physical and emotional recovery. The ward clerk can give you a sick note for while you're in hospital. Once you're at home, your GP can give you more.

Your sex life

These types of operations can affect how you feel about yourself, and you may lose interest in intimate contact for a while.

After a radical trachelectomy or hysterectomy

You can usually start to have sex from around 6 weeks after your operation. This allows time for the wound at the top of your vagina to heal. You may find that it takes longer than 6 weeks before you feel ready to have sex again.

Most women don't have problems having sexual intercourse after these operations in the long term. They have the same pleasure as before. But, after a diagnosis of cervical cancer, some women find it difficult to have the same desire for sexual intimacy.

After a pelvic exenteration

Depending on the operation you've had, you may need to look for other ways of having sexual pleasure.

You may have changes in sensation during sex, which may affect your ability to reach orgasm.

If you've had vaginal reconstruction using skin and tissue from your thigh, you might feel a strange sensation in your inner thighs during intercourse. Most women get used to this over time.

You may just need time to come to terms with everything. It may help to talk to your specialist nurse or GP if you are having difficulties. They can let you know about other people or organisations that can help.

Problems after surgery

There are risks with any type of surgery, but most women don’t have severe problems. Your doctor ensures the benefits of having the surgery outweigh any possible risks.