Advanced cervical cancer means that a cancer that began in the cervix has spread to at least one other part of the body, such as the liver, lungs or bones.
The symptoms you have depend on where the cancer is in your body. Not all symptoms will mean that you have advanced cancer - they could be caused by other conditions.
Which treatments are available
Symptoms of advanced cervical cancer can be hard to cope with. But doctors and nurses can offer support and treatment to help you.
The treatment you have depends on a number of things including:
- where the cancer is
- what your symptoms are
- what treatment you've had before
- what the side effects are
Depending on the situation you might have chemotherapy or radiotherapy, or both. This can sometimes help to shrink the cancer, reduce symptoms and help you feel better.
Other treatments can treat specific symptoms, such as using a stent to relieve a blockage in the tube that drains urine from the kidney to the bladder (the ureter). Or taking medicines for symptoms such as sickness or pain.
Tiredness is a common symptom of advanced cancer. It can feel a bit overwhelming and as though you don’t have any energy.
Let your doctor or nurse know if you’re very tired as they might be able to prescribe medicine to help or other treatments. For example, a blood transfusion can give you more energy if you’re tired due to anaemia (low red blood cell levels).
It’s important to rest a few times throughout the day. Resting regularly can help you feel less tired and more able to cope. You don't have to sleep during these times. Just sitting or lying down will help.
Exercising can be hard when you feel very tired. But research shows that daily light to moderate exercise can give you more energy. Going for a gentle walk is very good. Gentle exercises in bed or standing up can help if you can’t move around easily.
Your hospital physiotherapist might be able to help you plan an exercise programme that suits your needs.
You might feel more tired if you have trouble sleeping at night. It can help to change a few things about when and where you sleep.
If you get pain, it can often be helped by cancer treatment. The pain can be reduced by shrinking the cancer with chemotherapy, radiotherapy or chemoradiotherapy.
There are also many painkillers available. Pain can usually be well controlled. With good pain control, most people should be able to be free of pain when they are lying or sitting. The first step is to tell your doctor or nurse that you have pain so that they can find the right painkillers for you.
You might not feel like eating and may lose weight. It is important to eat as much as you can.
- Eating several small meals and snacks throughout the day can be easier to manage.
- Ask your doctor to recommend high calorie drinks to sip if you are worried about losing weight.
- Eat whatever you feel like eating rather than what you think you should eat.
- Eat plenty of calories when you can to make up for times when you don’t feel like eating.
- Drink plenty of fluids even if you can't eat.
- Don't fill your stomach with a large amount of liquid before eating.
- Try to eat high calorie foods to keep your weight up.
You might have a swollen tummy (abdomen) if your cancer has spread to the liver. The swelling is due to a build up of fluid called ascites. It can make your clothes feel tighter. Your tummy might feel bloated. You might also find it difficult to sit comfortably or to move around.
Your doctor can drain off the fluid by putting a small, flexible tube into your abdomen. This helps you to feel more comfortable.
Sometimes cancer can grow so that it completely blocks the bowel. This is called a bowel obstruction. The waste from the food you have digested can't get past the blockage. This causes quite a few symptoms such as:
- feeling bloated and full
- vomiting large amounts
- feeling sick
- being unable to pass wind
To relieve the symptoms, it's sometimes possible to unblock the bowel by putting in a tube called a stent. The surgeon puts a flexible tube with a light at the end (called an endoscope) into the bowel through your back passage. This is called a colonoscopy.
The surgeon uses the endoscope to see where the blockage is and pushes the stent through it. The stent expands and holds the bowel open so that bowel motions can pass through again. The surgeon leaves the stent in the bowel to keep it open. As well as relieving symptoms, this procedure gives doctors time to plan an operation to remove the blocked part of the bowel.
If you are well enough, you can have surgery to remove the blocked part of the bowel. It might be possible to close up the cut ends of the bowel again during this operation. Or the surgeon might need to bring the upper end of the bowel out into an opening made in the skin of your tummy (abdomen). The opening is called a stoma or colostomy.
Bowel problems such as diarrhoea or constipation can be caused by the cancer. They can also be caused by cancer treatments or medicines. For example, painkillers commonly cause constipation.
Talk to your doctor or nurse if you have bowel problems. They can help by giving you medicine. And they can refer you to a dietitian for advice on what to eat or drink.
Treatment for sickness depends on what is causing it. Some painkillers or cancer treatments can cause sickness. You will also feel sick if you are constipated.
It is a good idea to talk this over in detail with a doctor or nurse. Then, you can get the treatment you need.
Some people find that ginger is a good natural remedy for sickness. Try eating stem ginger or crystallised ginger if you like it. Or you can slowly sip ginger beer or ginger ale.
Even when you feel tired you may find it hard to sleep. There are different reasons for this, including anxiety and having a lot on your mind. You may want to ask your doctor for sleeping pills. These can help to break a pattern of poor sleep and get you back into a better routine.
You can also try some other remedies for sleeplessness such as:
- warm milk drinks before bed
- natural sleep remedies (for example, homeopathic remedies)
- a warm bath in the evening
- a relaxing body massage to relieve muscle tension
- a little more exercise during the day, if you can manage it
You may hear this called hydronephrosis. In cervical cancer, one (or sometimes both) of the tubes from the kidney to the bladder (the ureters) can get blocked by the tumour. This means that the urine made by that kidney cannot drain away and builds up inside the kidney.
If not treated this can make you feel extremely ill and can cause that kidney to fail. It is even more serious if both your kidneys are affected.
To treat this, your doctor may be able to put a small tube inside the ureter to help drain the urine from the kidney into the bladder. The tube is called a stent.
If it isn't possible to put a stent in straight away or at all, your doctor will put a tube into your kidney through your skin. This tube is called a nephrostomy tube. It allows urine to drain out of the body into a bag. The bag has a tap on it so you can empty it.
After this type of surgery, a district nurse visits you at home to help you manage the tube and drainage bag. You may be able to have a stent put in after things have settled down a bit with that kidney.
A fistula is a channel that develops between two areas of the body. Having a fistula can be a very distressing symptom of advanced cervical cancer. But it is an uncommon symptom.
In cervical cancer a fistula can develop between the bladder and the vagina or the vagina and rectum. This can lead to an unpleasant smelling discharge of fluid from the vagina.
Surgery can help to repair a fistula in some people. If you are not fit enough to have surgery, medication, creams and lotions may help to reduce symptoms.
Vaginal discharge can be a distressing symptom of advanced cervical cancer. It can make you feel very self conscious, anxious and depressed. Coping with it can be hard, but depending on what’s causing the problem, a number of things can help.
An infection is a common cause of vaginal discharge. Some women are more prone to getting infections during treatment with radiotherapy or chemotherapy for cervical cancer.
Depending on the type of infection, antibiotics or antifungal medications can help clear it up. Although it can be embarrassing, tell your doctor about the symptoms you have. If it is an infection, they will be able to prescribe the right medications for you.
The unpleasant smelling discharge may also be a symptom of the cancer itself. If your cancer is very advanced, it may be difficult to get rid of the symptom completely.
To help control the smell and discharge, try to:
- Keep the area around the vagina clean and dry.
- Wear cotton underwear and loose clothes to keep the area cool.
- Change sanitary pads frequently.
- Use a deodorising spray, essential oils or an air filter around your bed or in the toilet before changing pads.
- Avoid using bubble bath and perfumed soaps around the vaginal area.
- Use scented disposable bags for used sanitary pads.
- Wipe from front to back after going to the toilet.
Ask your nurse about where you can find charcoal panty liners or underwear - this can help reduce the smell from the vaginal discharge
Symptoms can usually be well controlled.
Your doctor or specialist nurse (key worker) can:
- give you medicines
- help you to get equipment that you need
- suggest other ways of controlling your symptoms
- refer you to a symptom control team (a palliative care team)
Symptom control team
There are symptom control teams in most cancer units. They can help you to stay as well as possible for as long as possible. They are also in hospices and many general hospitals.
Most symptom control teams have home care services so they can visit you at home.