Download Understanding cervical cancer

A practical guide to
understanding cancer
Understanding
cerviCal
CAnCER
Contents
Contents
About Understanding cervical cancer
4
What is cancer? 5
The lymphatic system
7
The cervix 9
How cervical cancer develops
10
Symptoms of cervical cancer
13
How cervical cancer is diagnosed
14
Types of cervical cancer 18
Tests after diagnosis 19
Staging 24
Treatment overview 27
Surgery 34
Radiotherapy
43
Chemotherapy 58
Research – clinical trials 64
Menopausal symptoms and fertility 66
After treatment
70
Your feelings 75
If you’re a relative or friend 80
Talking to children 81
Who can help? 83
1
Understanding cervical cancer
Financial help and benefits
85
Work 91
How we can help you 92
Other useful organisations 96
Further resources 102
Questions you might like to ask your doctor or nurse 106
2
3
Understanding cervical cancer
About Understanding
cervical cancer
This booklet is about cancer of the cervix.
We hope it answers some of your questions
and helps you deal with some of the feelings
you may have. We’ve also listed other sources
of support and information, which we hope
you’ll find useful.
We can’t advise you about the best treatment for you.
This information can only come from your doctor, who knows
your full medical history.
If you’d like to discuss this information, call the Macmillan
Support Line free on 0808 808 00 00, Monday–Friday,
9am–8pm. If you’re hard of hearing you can use textphone
0808 808 0121, or Text Relay. For non-English speakers,
interpreters are available. Alternatively, visit macmillan.org.uk
Turn to pages 96–105 for some useful addresses and websites,
and page 106 to write down questions for your doctor or nurse.
If you find this booklet helpful, you could pass it on to your
family and friends. They may also want information to help
them support you.
4
What is cancer?
What is cancer?
The organs and tissues of the body are made up of tiny
building blocks called cells. Cancer is a disease of these cells.
Cancer isn’t a single disease with a single cause and a single
type of treatment. There are more than 200 different kinds of
cancer, each with its own name and treatment.
Although cells in different parts of the body may look different
and work in different ways, most repair and reproduce
themselves in the same way. Normally, cells divide in an orderly
and controlled way. But if for some reason the process gets out
of control, the cells carry on dividing, and develop into a lump
called a tumour. Tumours can be either benign (non-cancerous)
or malignant (cancerous). Doctors can tell whether a tumour is
benign or malignant by removing a piece of tissue (biopsy) and
examining a small sample of cells under a microscope.
Normal cells
Cells forming a tumour
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Understanding cervical cancer
In a benign tumour, the cells do not spread to other parts of
the body and so are not cancerous. However, they may carry
on growing at the original site, and may cause a problem by
pressing on surrounding organs.
In a malignant tumour, the cancer cells have the ability to
spread beyond the original area of the body. If the tumour
is left untreated, it may spread into surrounding tissue.
Sometimes cells break away from the original (primary)
cancer. They may spread to other organs in the body through
the bloodstream or lymphatic system (see pages 7–8).
When the cancer cells reach a new area they may go
on dividing and form a new tumour. This is known as a
secondary cancer or a metastasis.
6
The lymphatic system
The lymphatic system
The lymphatic system is part of the immune system – the body’s
natural defence against infection and disease. It’s made up
of organs such as bone marrow, the thymus, the spleen,
and lymph nodes. The lymph nodes throughout the body
are connected by a network of tiny lymphatic tubes (ducts).
The lymphatic system has two main roles: it helps to protect
the body from infection and it drains fluid from the tissues.
Neck (cervical)
lymph nodes
Thymus
Armpit
(axillary)
lymph nodes
Spleen
Groin
(inguinal)
lymph nodes
The position of lymph nodes in the body
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Understanding cervical cancer
Pelvic
lymph
nodes
Cervix
The pelvic lymph nodes
8
The cervix
The cervix
The cervix is the lower part of the womb (uterus) and is often called
the neck of the womb. The womb is a muscular, pear-shaped
organ at the top of the vagina. The lining of the womb is shed
each month, which results in bleeding called a period. If a
woman becomes pregnant, her periods stop temporarily,
then they’ll normally continue until she goes through the
menopause. Close to the cervix is a collection of lymph nodes.
Fallopian
tube
Ovary
Womb
(uterus)
Bladder
Cervical
canal
Cervix
Vagina
The cervix and surrounding structures
This booklet is about cancer of the cervix (neck of
the womb). Cancer of the womb is different and is
discussed in our booklet Understanding cancer of
the womb (uterus).
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Understanding cervical cancer
How cervical cancer develops
Each year, over 2,900 women are diagnosed with cervical
cancer in the UK. It usually occurs in women over the age of
20. The highest rates occur between the ages of 30–39, but it
can also affect younger and older women.
Cancer of the cervix can take many years to develop. Before it
does, changes occur in the cells of the cervix. These changes
are known as cervical intrapepithelial neoplasia (CIN). The
abnormal cells are not cancerous, but some doctors refer to
the changes to these cells as ‘pre-cancerous’. This means that
the cells might develop into cancer in some women if they are
not treated. But most women with CIN do not develop cancer,
and if treatment is needed for CIN it’s nearly always effective.
Our booklet Understanding cervical screening has
more detailed information about CIN and its treatment.
Risk factors for cervical cancer
HPV and sex
CIN is usually the result of an infection from the human
papilloma virus (HPV). HPV is a very common virus that
can affect the cells of the cervix. It’s mainly passed on
during sex.
Having sex at an early age and having several sexual
partners can increase the risk of catching HPV and
developing cervical cancer.
But many women who have only had one sexual partner
have HPV at some point in their life, and may go on to
10
How cervical cancer develops
develop CIN or cervical cancer. So there’s no reason for you or
others to feel that you’re to blame for having cervical cancer.
We have more detailed information about HPV and
cancer, which we can send you.
Smoking
Women who smoke are more likely to develop CIN and the
most common type of cervical cancer, known as squamous cell
cervical cancer (see page 18).
A weakened immune system
Having a weakened immune system may allow CIN to develop
into cancer. The immune system can be weakened by smoking,
a poor diet and infections such as HIV/AIDS.
Contraceptive pill
Long-term use of the contraceptive pill (for more than 10
years) can slightly increase the risk of developing cervical
cancer. But for most women the benefits of taking the pill
outweigh the risks.
Cancer of the cervix is not infectious and can’t be
passed on to other people.
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Understanding cervical cancer
Preventing cervical cancer
Vaccines
Two vaccines are now available in the UK to prevent HPV infection
– Gardasil® and Cervarix®. There are more than 100 types of HPV,
and each type is identified by a number. Both of the vaccines
have been shown to protect against HPV 16 and 18, which are
high-risk types. It is hoped that the vaccines will prevent at least
7 out of 10 cases (70%) of the most common type of cervical
cancer (squamous cell cervical cancer – see page 18).
These vaccines work best if they are given to children before
puberty and before they might start having sex. For this reason,
all 12–13-year-old girls in the UK are now routinely offered an
HPV vaccination. The vaccines can also be obtained privately.
Cervical screening
This is an important way of detecting early changes in cells of
the cervix, so that treatment can be given to prevent a cancer
developing. It involves taking a sample of cells from the cervix
using a test known as a liquid-based cytology. In the UK,
the NHS provides cervical screening tests for all women within
a specific age range who are registered with a GP. The age
range for screening varies across the UK. In England and
Northern Ireland screening takes place between the ages of
25–64, in Scotland it’s between the ages of 20–60, and in
Wales it’s between the ages of 20–64.
If abnormal cells are found during your cervical screening test,
you will be referred for a colposcopy to have a biopsy taken.
We have detailed information about cervical
screening in our booklet Understanding cervical
screening. We can send you a copy.
12
Symptoms of cervical cancer
Symptoms of cervical cancer
Very early-stage cervical cancer may have no symptoms.
This means it’s important to attend regular cervical screening,
so that any cell changes can be picked up early.
The most common symptom of cervical cancer is abnormal
vaginal bleeding, usually between periods or after sex.
Women who’ve gone through the menopause (who are no
longer having periods) may find they have some new bleeding.
Symptoms of cervical cancer can also include a smelly vaginal
discharge and discomfort during sex.
If you’re attending regular screening, you should let your GP
know if you develop symptoms between your tests.
There are many other conditions that can cause these
symptoms, but it’s important that you see your GP
or practice nurse to get them checked out. It can be
embarrassing to talk about these symptoms, but the
sooner you see someone and a diagnosis is made,
the better the chance of treatment being successful.
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Understanding cervical cancer
How cervical cancer
is diagnosed
Usually you begin by seeing your family doctor (GP), who will
examine you and refer you to the hospital for any necessary
tests and for specialist gynaecological advice and treatment.
If your GP suspects you may have cancer, you should be seen
at the hospital within 14 days.
Colposcopy
A colposcopy can be carried out by a specialist doctor or a nurse
colposcopist and is usually done in a hospital outpatient clinic.
In a colposcopy, a specially adapted type of microscope with a
light, called a colposcope, is used to show the cervix in detail.
It acts like a magnifying glass so that the nurse or doctor can
make a thorough examination of the abnormal cells of the
cervix. The test takes about 15–20 minutes.
Before your test you’ll be helped to position yourself on a
specially designed chair or examination table. In the same way
as when you had the screening test (see page 12), the nurse or
doctor will use a speculum to hold the vagina open. The doctor
or nurse may first repeat the screening test. The cervix is then
painted with a liquid to make the abnormal areas show up more
clearly. A light is shone onto the cervix and the nurse or doctor
looks through the colposcope to examine the area in detail.
A small sample of surface cells (a biopsy) will be taken from
the cervix and examined under a microscope by a pathologist
14
How cervical cancer is diagnosed
in the laboratory. It may be slightly painful when the biopsy is
taken, and for a short time afterwards. Taking a mild painkiller
can help with this. Having a biopsy may also cause a bit of
light bleeding for a few days afterwards.
Large loop excision of the transformation zone (LLETZ)
If the abnormal area can’t be seen properly with a colposcope,
you may have a LLETZ procedure. Sometimes the LLETZ may
be done during your colposcopy appointment.
Abnormal cells are most likely to develop in an area of the cervix
known as the transformation zone (see page 16). A LLETZ
is a common procedure that removes the abnormal cells.
Having a LLETZ normally takes about 5–10 minutes. It’s usually
done under a local anaesthetic as an outpatient at the hospital.
Once you’re in a comfortable position, the doctor will put some
local anaesthetic onto your cervix to numb it. The doctor uses
a colposcope to see a magnified image of your cervix. A thin
wire, which is shaped in a loop, is then used to cut away the
affected area. The procedure may feel uncomfortable and it’s
usual to have slight bleeding or discharge, which can last for
a few weeks after this treatment. You may be asked not to use
tampons or have sex for a month afterwards.
Needle excision of the transformation zone (NETZ)
This is similar to a LLETZ, except that the thin wire used to
cut away the affected area is straight, rather than in a loop.
The straight wire acts like a knife and enables the doctor to
cut away the precise area of affected tissue.
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Understanding cervical cancer
Cone biopsy
Sometimes a procedure known as a cone biopsy may be
used if the abnormal area in the cervix can’t be seen with
a colposcope.
A cone biopsy is usually done under a general anaesthetic,
although a local anaesthetic may sometimes be used. You may
need to stay in hospital overnight.
Womb
(uterus)
Cervix
Vagina
Area of biopsy
Transformation
zone
Area of cone biopsy – shown by dotted line
16
How cervical cancer is diagnosed
A small, cone-shaped section of the cervix is removed, which is
large enough to contain the abnormal cells.
If there’s only a very small growth of cancer cells (known as
a microinvasive cancer), the cone biopsy may remove it all so
that no further treatment is needed. Even if the cone biopsy
doesn’t remove all the cancer cells, it’s still useful, as it will help
the doctors decide on the right type of treatment for you.
After a cone biopsy a gauze pack, which is like a tampon,
may be placed in your vagina to prevent bleeding. This is
usually removed within 24 hours, before you go home.
You may also have a thin tube, called a catheter, put into
your bladder so that you can pass urine while the gauze pack
is in place. It’s normal to have some light bleeding for a few
weeks after a cone biopsy. Strenuous physical activity and sex
should be avoided for four weeks to allow the cervix to heal.
It may take some time for you to get the results of
these tests. You could ask your gynaecologist about
when and how you’ll be told about whether you need
more tests or treatment. It’s a difficult time for most
women and you may need support from family,
friends or support organisations (see pages 96–105)
while you’re waiting for your results.
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Understanding cervical cancer
Types of cervical cancer
There are two main types of cervical cancer. The most common
is called squamous cell carcinoma. This develops from the
flat cells that cover the outer surface of the cervix at the top of
the vagina.
The other type is called adenocarcinoma. This type develops
from the glandular cells that line the cervical canal (the endocervix
– see page 9). As adenocarcinoma starts in the cervical canal,
it can be more difficult to detect with cervical screening tests.
There are also other, less common types of cancer of the
cervix, known as adenosquamous carcinomas, clear-cell
carcinomas and small-cell carcinomas. Our cancer support
specialists can give you more information about these types of
cervical cancer – call us on 0808 808 00 00.
The tests listed on pages 14–17 will show which type of cervical
cancer you have. They can also give information about the
stage of the cancer (see pages 24–26) and whether there are
signs of microscopic cancer cells in the lymph or blood vessels.
This information, as well as the physical examination and the
results of further tests (see pages 19–23), will help your doctors
decide which type of treatment is best for you.
18
Tests after diagnosis
Tests after diagnosis
Your gynaecologist will need to do some further tests to check
your general health and see whether the cancer has spread
beyond the cervix. The tests may include any of the following:
Blood tests
A sample of blood is taken to check the number of cells in your
blood (your blood count), and to see how well your kidneys and
liver are working.
Chest x-ray
This is to check that your lungs and heart are healthy.
Examination under anaesthetic (EUA)
This is an examination of the vagina and cervix under a general
anaesthetic. It allows the doctor to examine you thoroughly
without it being uncomfortable. The doctor may also look into
your bladder and the lower end of your large bowel (the colon
and rectum) to see if the cancer has spread.
To look into your bladder the doctor will use a cystoscope,
which is a small, fibre-optic tube with a light. If there are
any abnormal areas, the doctor can use the cystoscope
to take biopsies. To look into the lower end of the colon
and the rectum, the doctor uses a similar tube called a
proctosigmoidoscope. The proctosigmoidoscope is also
used to take biopsies from any abnormal areas.
19
Understanding cervical cancer
You may have some slight bleeding for a couple of days
after this examination. Your healthcare professional will be
able to give you more information about the examination
and what to expect afterwards.
CT (computerised tomography) scan
A CT scan takes a series of x-rays, which build up a
three-dimensional picture of the inside of the body (see the
photo opposite). The scan takes 10–30 minutes and is painless.
It uses a small amount of radiation, which is very unlikely to
harm you and will not harm anyone you come into contact with.
You will be asked not to eat or drink for at least 3–4 hours
before the scan.
Someone having a CT scan
20
Tests after diagnosis
21
Understanding cervical cancer
You may be given a drink or injection of a dye, which allows
particular areas to be seen more clearly. This may make
you feel hot all over for a few minutes. It’s important to let
your doctor know if you’re allergic to iodine or have asthma,
because you could have a more serious reaction to the injection.
You’ll probably be able to go home as soon as the scan is over.
MRI (magnetic resonance imaging) scan
This test uses magnetism to build up a detailed picture of areas
of your body. The scanner is a powerful magnet, so you may
be asked to complete and sign a checklist to make sure it’s
safe for you. The checklist asks about any metal implants you
may have, for example a pacemaker, surgical clips or bone
pins. You should also tell your doctor if you’ve ever worked with
metal or in the metal industry, as very tiny fragments of metal
can sometimes lodge in the body. If you do have any metal in
your body, it’s likely that you won’t be able to have an MRI scan.
In this situation another type of scan can be used.
Before the scan you’ll be asked to remove any metal belongings,
including jewellery. Some people are given an injection of dye
into a vein in the arm, which doesn’t usually cause discomfort.
This is called a contrast medium and can help the images
from the scan to show up more clearly. During the test you’ll
lie very still on a couch inside a long cylinder (tube) for about
30 minutes. It’s painless but can be slightly uncomfortable,
and some people feel a bit claustrophobic. It’s also noisy,
but you’ll be given earplugs or headphones. You’ll be able
to hear, and speak to, the person operating the scanner.
22
Tests after diagnosis
PET/CT scan
This is a combination of a CT scan, which takes a series
of x-rays to build up a three-dimensional picture (see page
20), and a positron emission tomography (PET) scan,
which uses low-dose radiation to measure the activity of cells
in different parts of the body.
PET/CT scans give more detailed information about the part of
the body being scanned. You may have to travel to a specialist
centre to have a PET/CT scan.
You won’t be able to eat for six hours before the scan, although
you may be able to have a drink. At least an hour before the
scan, a mildly radioactive substance is injected into a vein,
usually in your arm. The radiation dose used is very small.
The scan itself usually takes 30–90 minutes.
You should be able to go home after the scan.
It will probably take several days for the results
of these tests to be ready. The waiting period will
obviously be an anxious time for you. You may find
it helpful to talk things over with your clinical nurse
specialist, or with a relative or close friend. You can
also contact one of our cancer support specialists on
0808 808 00 00, or one of the organisations listed on
pages 96–102.
23
Understanding cervical cancer
Staging
The stage of a cancer is a term used to describe its size and
whether it has spread beyond the area of the body where it
first started. Knowing the extent of the cancer helps the doctors
decide on the most appropriate treatment for you.
Cervical cancer is divided into four main stages. Each stage
then has further sub-divisions:
Stage 1
The cancer cells are only within the cervix. Stage 1 can be
further divided into:
Stage 1A
The cancer can only be seen with a microscope or colposcope.
• Stage 1A1 The cancer is 3mm or less deep and 7mm or
less wide.
• Stage 1A2 The cancer is between 3–5mm deep and 7mm
or less wide.
Stage 1B
The cancer growth is larger but still confined to the cervix.
• Stage 1B1 The cancer is not larger than 4cm.
• Stage 1B2 The cancer is larger than 4cm.
24
Staging
Stage 2
The cancer has spread into surrounding structures, such as
the upper part of the vagina or the tissues next to the cervix.
Stage 2 can be further divided into:
Stage 2A
The cancer has spread into the upper part of the vagina.
• Stage 2A1 The tumour size is not larger than 4cm.
• Stage 2A2 The tumour size is larger than 4cm.
Stage 2B
The cancer has spread into the tissues next to the cervix.
Stage 3
The cancer has spread to areas such as the lower part of the
vagina, or the tissues at the sides of the pelvic area. Stage 3
can be further divided into:
Stage 3A
The cancer has spread into the lower part of the vagina.
Stage 3B
The cancer has spread through to the tissues at the sides of the
pelvic area and may be pressing on one of the ureters (the tubes
urine passes through from the kidneys to the bladder). If the
tumour is causing pressure on a ureter, there may be a build-up
of urine in the kidney.
25
Understanding cervical cancer
Stage 4
The cancer has spread to the bladder or bowel or beyond the
pelvic area. Stage 4 can be further divided into:
Stage 4A
The cancer has spread to nearby organs, such as the bladder
and bowel.
Stage 4B
The cancer has spread to distant organs, such as the lungs,
liver or bone.
Your doctors may use the following terms to describe your cancer:
• Early-stage cervical cancer – this usually includes stages
1A to 2A.
• Locally advanced cervical cancer – this usually includes
stages 2B to 4A.
• Advanced-stage cervical cancer – this usually means
stage 4B.
If the cancer comes back after initial treatment, this is known
as recurrent cancer.
26
Treatment overview
Treatment overview
Cancer of the cervix can be treated with surgery, radiotherapy,
chemotherapy, or a combination of these treatments. Your
doctor will advise you on the best plan of treatment for you,
taking into account a number of factors. These include your
age and general health, and the type and stage of the cancer.
Early-stage cancer
Surgery
Surgery is often the main treatment for women with early-stage
cancer of the cervix.
Radiotherapy
Radiotherapy is as effective as surgery for early-stage cancer
and may be used as an alternative to surgery.
Sometimes radiotherapy may also be given after surgery if
there’s a risk that cancer cells may have been left behind.
This helps reduce the risk of the cancer coming back.
Radiotherapy rather than surgery is usually used to treat
larger tumours in the cervix (tumours over 4cm). This is because
it’s often not possible to completely remove a larger tumour
with surgery alone, whereas radiotherapy treatment can be
very effective.
Radiotherapy is often given in combination with chemotherapy
treatment for larger tumours. This is known as chemoradiation.
It’s thought that the chemotherapy makes cervical cancer more
sensitive to the effects of the radiotherapy, so that the treatment
is more effective.
27
Understanding cervical cancer
Locally advanced cancer
Chemoradiation
This is the main treatment for locally advanced cancer.
Surgery
Very occasionally, an operation known as a pelvic exenteration
(see page 71) may be carried out if the cancer has spread to
nearby organs in the pelvis (such as the bladder or bowel),
but not to distant organs (such as the lungs). This type of
surgery involves a major operation and is only suitable for
a small number of women.
Advanced-stage cancer
Chemotherapy
This may be used to treat cancer that has spread to more distant
parts of the body, such as the liver and lungs.
Chemotherapy can help to shrink and control the cancer and
relieve symptoms, to prolong a good quality of life. This is
known as palliative treatment.
Planning your treatment
In most hospitals, a team of specialists will work together to
decide which treatment is best for you. This multidisciplinary
team (MDT) will include:
• a gynaecological oncologist (a surgeon who specialises in
gynaecological cancers)
• a clinical oncologist (a doctor who specialises in treating
cancer with radiotherapy and chemotherapy)
28
Treatment overview
• a medical oncologist (a doctor who specialises in treating
cancer with chemotherapy)
• a specialist nurse, who will be your main contact and
will make sure you get help and support throughout
your treatment.
The MDT may also include other healthcare professionals,
such as a radiographer (a person who operates the machine
that gives radiotherapy treatment), dietitian, physiotherapist,
occupational therapist, psychologist or counsellor.
The MDT will take a number of factors into account when
advising you on the best course of action. These factors
include your age, general health, the type and size of the
tumour, and whether the cancer has begun to spread.
If two treatments are equally effective for your type and stage
of cancer, your doctors may offer you a choice of treatments.
Sometimes people find it hard to make a decision. If you’re asked
to make a choice, make sure you have enough information
about the different options, what’s involved and the possible side
effects, so that you can decide on the right treatment for you.
Remember to ask questions about any aspects that you don’t
understand or feel worried about. It may help to discuss the
benefits and disadvantages of each option with your cancer
specialist, your nurse specialist or our cancer support specialists
on 0808 808 00 00.
If you have any questions about your treatment, don’t be
afraid to ask your doctor or nurse. It often helps to make a
list of questions and to take a relative or close friend with
you. You could use the form on page 106 to write down your
questions and the answers you receive.
29
Understanding cervical cancer
30
Treatment overview
Giving your consent
Before you have any treatment, your doctor will explain its
aims. They will usually ask you to sign a form saying that you
give permission (consent) for the hospital staff to give you the
treatment. No medical treatment can be given without your
consent, and before you’re asked to sign the form you should
be given full information about:
• the type and extent of the treatment
• its advantages and disadvantages
• any significant risks or side effects
• any other treatments that may be available.
If you don’t understand what you’ve been told, let the staff
know straight away so they can explain again. Some cancer
treatments are complex, so it’s not unusual for people to need
explanations repeated.
It’s a good idea to have a relative or friend with you when the
treatment is explained, to help you remember the discussion.
You may also find it useful to write a list of questions before
your appointment.
People sometimes feel that hospital staff are too busy to answer
their questions, but it’s important for you to know how the
treatment is likely to affect you. The staff should be willing to
make time for your questions.
You can always ask for more time if you feel that you can’t
make a decision when your treatment is first explained to you.
31
Understanding cervical cancer
You are also free to choose not to have the treatment. The staff
can explain what may happen if you don’t have it. It’s essential
to tell a doctor or the nurse in charge, so they can record your
decision in your medical notes. You don’t have to give a reason
for not wanting treatment, but it can help to let the staff know
your concerns so they can give you the best advice.
The benefits and disadvantages of treatment
Many people are frightened at the idea of having cancer
treatments, particularly because of the possible side effects.
However, these can usually be controlled with medicines.
Treatment can be given for different reasons, and the potential
benefits will vary depending upon the individual situation.
In women with early-stage cervical cancer, treatment is given
with the aim of curing the cancer.
With advanced cancer (cancer that has spread to distant
organs), treatment is usually given to control the cancer rather
than to cure it. The aim is to improve symptoms and give a
better quality of life. However, for some women the treatment
will have little effect on the cancer and they will have the side
effects without a great deal of benefit.
If you’ve been offered treatment that aims to cure your cancer,
deciding whether to accept it may not be difficult. However, if a
cure is not possible and the purpose of treatment is to control
the cancer for a period of time, it may be more difficult to
decide whether to go ahead.
Making decisions about treatment in these circumstances is
always difficult, and you may need to discuss in detail with
32
Treatment overview
your doctor whether you wish to have treatment. If you choose
not to have it, you can still be given supportive (palliative) care,
with medicines to control any symptoms.
Second opinion
Your multidisciplinary team uses national treatment guidelines
to decide the most suitable treatment for you. Even so, you may
want another medical opinion. If you feel it will be helpful,
you can ask either your specialist or GP to refer you to another
specialist for a second opinion. Getting a second opinion may
delay the start of your treatment, so you and your doctor need
to be confident that it will give you useful information.
If you do go for a second opinion, it may be a good idea to
take a relative or friend with you, and have a list of questions
ready, so that you can make sure your concerns are covered
during the discussion.
33
Understanding cervical cancer
Surgery
Surgery for cervical cancer should be carried out in a
specialist cancer centre by a gynaecological oncologist or
a gynaecologist with a special interest in cancer.
The type of surgery you have will depend on the size of the
cancer and whether it has spread beyond the cervix.
Types of surgery
Cone biopsy
If the cancer cells have spread only slightly beyond the surface
of the cervix, it may be possible to treat this by removing a
cone-shaped piece of tissue from the cervix. This is called a
cone biopsy – see pages 16–17.
Hysterectomy
Often an operation called a hysterectomy is needed to treat
cancer of the cervix.
Two different types of hysterectomy are used to treat cervical
cancer. The type you have will depend on the stage of your cancer:
• A total hysterectomy involves removing the womb and
cervix, and occasionally the fallopian tubes and ovaries.
A total hysterectomy is only suitable for women with very
early-stage cervical cancer (stage 1A1 – see page 24).
• A radical hysterectomy is the removal of the womb, cervix,
tissue around the cervix (parametrium), fallopian tubes, pelvic
lymph nodes and upper part of the vagina, and sometimes
the ovaries. Most cancers of the cervix are treated with a
radical hysterectomy. Sometimes some of the abdominal
34
Surgery
lymph nodes may be removed in addition to the pelvic lymph
nodes during a radical hysterectomy (see page 8).
Where possible, the ovaries are not taken out in young women
with cancer of the cervix. This is because removal of the
ovaries brings on an early menopause. If you need to have
your ovaries removed, your healthcare team will discuss this
with you before your surgery. They will also be able to tell you
about treatments to help you cope with menopausal symptoms.
We have more detailed information on pages 66–67.
A hysterectomy can be carried out in different ways. The most
common way is through a cut (incision) in the abdomen,
known as an abdominal hysterectomy. However, for
some women it may be possible to have a laparoscopic
hysterectomy or keyhole surgery. During keyhole surgery,
your doctor makes small cuts (incisions) in your abdomen.
Small surgical instruments and a laparoscope (a telescope with
a camera on the end) are inserted through these. The womb,
cervix and ovaries (if needed) are then removed through the
vagina or through a small cut in the abdomen. If you’re having
keyhole surgery the doctors will explain in more detail how your
operation will be carried out.
We have more information about the different types of
hysterectomy in our fact sheet Having a hysterectomy.
After a hysterectomy you will no longer have a womb, so even
if you’re of child-bearing age you will be unable to become
pregnant. Being told that your cancer treatment will mean
you can no longer have children can be very difficult. If you’re
told you need to have a hysterectomy, you can ask your
hospital doctor to refer you to a fertility specialist to discuss
your fertility options. Your options may include embryo
35
Understanding cervical cancer
(fertilised egg) storage and surrogacy, which is when another
woman carries a child in her womb for you (see pages 67–70).
Fertility treatments such as embryo-storage need to be carried
out before surgery, so it’s important that you ask your hospital
team to refer you before your hysterectomy.
Radical trachelectomy
For some women it may be possible to have an operation
known as a radical trachelectomy, where the womb (uterus)
is left in place so it’s still possible to have a baby.
This type of operation is only suitable for women with
very early-stage cancer of the cervix.
A radical trachelectomy involves removal of the cervix,
the tissues next to the cervix and the upper part of the
vagina. The lymph nodes in the pelvis are also removed,
usually through tiny cuts in the abdomen (called keyhole or
laparoscopic surgery). The womb is left in place and a stitch
is placed at the bottom of the womb during the surgery.
This helps to keep the womb closed during pregnancy.
There is a higher chance of miscarriage after this procedure,
and if you become pregnant the baby would need to be
delivered by caesarean section.
This type of surgery is only done in a few hospitals in the UK.
You may need to ask your gynaecologist to refer you to a
specialist hospital if you would like to discuss the possibility of
having a radical trachelectomy. It’s important that your doctor
fully explains to you the benefits and possible risks of this type
of operation.
36
Surgery
After your operation
After your hysterectomy or trachelectomy you’ll be encouraged
to start moving about as soon as possible. This is an essential
part of your recovery. Even if you have to stay in bed, the nurses
will encourage you to do regular leg movements and deep
breathing exercises. You may be seen by a physiotherapist who
can help you do the exercises. You’ll also be given injections of
a drug to help prevent blood clots.
Drips and drains
When you get back to the ward, you’ll have a drip (an intravenous
infusion) going into a vein in your arm until you’re able to eat
and drink normally. You may also have drainage tubes from
the wound to drain off any excess fluid. The drip and drains are
taken out within a few days.
Usually a small tube (catheter) is put into your bladder to
drain your urine into a collecting bag. This is removed when
you become more mobile. Some women may have difficulty
passing urine once their catheter has been removed and
need to have the catheter put back in again. This is usually a
temporary problem, and the catheter usually only needs to stay
in for 2–3 weeks until normal bladder function returns.
Pain
It’s normal to have some pain or discomfort for a few days, but
this can be controlled effectively with painkillers. It’s important
to let your doctor know as soon as possible if the pain isn’t
controlled, so that your painkillers can be changed.
Some women may be given painkillers through an epidural
for the first day after surgery. This is a small, thin tube
that’s inserted in your back into the space just outside the
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Understanding cervical cancer
38
Surgery
membranes surrounding your spinal cord. An epidural will
give you continuous pain relief.
Other women may have painkillers through a special pump
known as a patient-controlled analgesia pump (PCA pump).
If you have a PCA pump it will be attached to a fine tube
(cannula), which is placed in a vein in your arm. You can
control the pump yourself using a handset that you press when
you need more of the painkiller. It’s fine to press the handset
whenever you have pain, as the pump is designed so that you
can’t give yourself too much painkiller. You will be shown how
to use this type of pump.
Some painkillers can cause constipation. Let your nurse
know if you have difficulty opening your bowels.
Going home
Your hospital team will give you more information about how
long you might need to stay in hospital. You may be ready to go
home about 3–8 days after an abdominal hysterectomy. If you’ve
had laparoscopic (keyhole) surgery or a trachelectomy, you may
be able to go home 2–4 days after your operation.
If you think you might have problems when you go home,
for example if you live alone or have several flights of stairs
to climb, let your nurse know when you are admitted to the
hospital, so that help can be arranged.
Before you go home, you’ll be given an appointment to
attend an outpatient clinic for your post-operative check-up.
If you need to go home with a urinary catheter (see page 37),
the hospital team can arrange for a district nurse to visit you at
home to check how things are.
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Understanding cervical cancer
You’ll be given instructions on how to look after yourself to make
sure your wound heals and you recover well. It’s important that
you follow the advice you’re given.
Vaginal care
If you have a hysterectomy, it’s common to have a vaginal
discharge for up to six weeks afterwards. This is usually
reddish-brown in colour. If the discharge becomes bright red,
heavy, or contains clots, contact your doctor straight away.
To reduce the risk of an infection, use sanitary pads rather than
tampons and have a shower or bath every day.
After a trachelectomy it’s normal to have a light reddish-brown
vaginal discharge. Your healthcare professionals will let you
know how long this discharge is likely to last. You’ll be advised
to shower daily and not to have sex or place anything in your
vagina (such as tampons) for about six weeks after your
surgery. Swimming should also be avoided. This is so
the surgical area can heal properly and the risk of infection
is reduced.
Sex
You’ll be able to go back to your usual sex life, but your doctor
will probably advise you not to have sex for at least six weeks
after your operation, to allow the wound to heal properly.
Many women find they need more time before they’re ready
to resume a sexual relationship. Being able to resume a
sexual relationship is likely to take more time if you’ve had
radiotherapy as well as surgery.
However, this is an important part of your recovery, so don’t be
afraid to discuss it with your doctor, specialist nurse or one of
40
Surgery
our cancer support specialists on 0808 808 00 00. You might
also find it useful to read our booklet Sexuality and cancer.
Physical activity
It’s important to avoid strenuous physical activity or heavy
lifting for about three months if you’ve had your surgery
through an incision in your abdomen. If you’ve had
laparoscopic surgery you should avoid heavy lifting and also
activities that involve excessive pushing, pulling or stretching
for about six weeks. Your physiotherapist or nurse will be able
to give you advice about physical activity.
Some women find it uncomfortable to drive for a few weeks
after their surgery. It’s probably a good idea to wait a few
weeks before you start driving again. Some insurance
companies have guidelines about this, and it may be helpful
to contact your own insurer.
Getting support
Some women take longer than others to recover from their
operation. If you find you’re having problems, it may be helpful
to talk to someone who is not directly associated with your
illness. Your clinical nurse specialist or our cancer support
specialists are always happy to talk to you, and they may be
able to put you in touch with a counsellor or a support group
in your area, so you can discuss your experiences with other
women who are in a similar situation.
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Understanding cervical cancer
Enhanced Recovery Programme (ERP)
Some hospitals follow an Enhanced Recovery Programme,
which can help reduce complications following surgery and
speed up your recovery. The programme involves careful
planning before your operation, so that you’re properly
prepared and any arrangements that are needed for you to go
home are already in place. You’ll also be encouraged to start
moving around as soon as possible after surgery – sometimes
on the day of the operation. Any catheters and drips will be
removed soon after surgery, and you’ll also be allowed to eat
and drink soon after surgery. After you’ve gone home you’ll be
regularly reviewed to make sure that you’re recovering well.
You can ask your doctor whether you’ll be suitable
for the ERP – not all hospitals use it for surgery.
Possible long-term complications of surgery
Most women will have no long-term complications after
surgery for cancer of the cervix. However, some women –
in particular those who’ve had radiotherapy or chemotherapy
as well as surgery – are more likely to develop long-term
complications of surgery.
Rarely, women may have bladder or bowel problems after
a hysterectomy, because of damage to the nerves that
control them during the operation. To avoid these problems,
surgeons try to not damage the nerves during surgery. This is
known as nerve-sparing or nerve-preserving surgery.
If the lymph nodes have been removed, there’s a risk of
developing swelling (lymphoedema) in one or both legs.
This is a build-up of lymph fluid that can’t drain away normally
42
Radiotherapy
because the lymph nodes have been removed. It’s more likely
to happen if you’ve had radiotherapy to the pelvic area as well
as surgery. We can send you information about lymphoedema.
If you develop any problems after your surgery, let your surgeon
or nurse know, so that you can get the right kind of help.
Radiotherapy
Radiotherapy treats cancer by using high-energy x-rays,
which destroy the cancer cells while doing as little harm as
possible to normal cells.
Radiotherapy for cancer of the cervix can be external or internal,
and is often given as a combination of the two. Treatment with
radiotherapy may last for 5–8 weeks. Your cancer specialist
(clinical oncologist), who plans your treatment, will discuss your
treatment in detail with you.
Radiotherapy may be given to treat early-stage cervical cancer.
It’s also usually given for larger tumours contained in the cervix,
or if the cancer has spread beyond the cervix and is not curable
with surgery alone. Radiotherapy may also be used after surgery
if there is a high risk that the cancer may come back. It’s often
given in combination with chemotherapy (called chemoradiation).
Radiotherapy treatment for cervical cancer will affect the
ovaries. For younger women who are still having their monthly
periods, radiotherapy will stop the ovaries producing eggs and
the hormones oestrogen and progesterone. This will make you
infertile, so that it’s no longer possible to have a child. It will
43
Understanding cervical cancer
also bring on an early menopause, usually about three months
after the treatment starts. Your healthcare team will discuss this
with you before your treatment starts. They will also be able to
give you information about treatments to help you cope with
menopausal symptoms, and options for preserving your fertility
if you’d like to have a child. We have more detailed information
about this on pages 66–70.
Some women may be offered an operation before radiotherapy
to reposition their ovaries higher in the abdomen, out of the
radiotherapy site. The aim of this surgery is to prevent an
early menopause, as the ovaries won’t be affected by the
radiotherapy treatment. It’s known as ovarian transposition
and is usually carried out at the same time as initial surgery
(see pages 34–43) if it’s thought that radiotherapy will be
needed afterwards. It may also be possible to have an ovarian
transposition using laparoscopic (keyhole) surgery.
For some women, ovarian transposition isn’t successful and an
early menopause still happens.
External radiotherapy
External radiotherapy is normally given as an outpatient,
as a series of short daily treatments in the hospital radiotherapy
department. High-energy x-rays are directed from a machine
(called a linear accelerator) at the area of the cancer.
Planning your treatment
Planning is a very important part of your treatment and
may take a few visits. It makes sure that your treatment is as
effective as possible.
44
Radiotherapy
On your first visit to the radiotherapy department you’ll have
a CT scan (see pages 20–22), which will take images of the
area to be treated. These images are used to plan the precise
area of treatment.
Once the treatment area has been decided, some small tattoo
markings are made on your skin. These help the radiographer
(the person who gives you your treatment) ensure that you’re
in the correct position for your treatment. The marks are
permanent, but they are the size of a pinpoint and you’ll
only have them if you give your permission. It’s a little
uncomfortable while the tattoo is being done, but it’s a good
way of making sure that treatment is directed accurately.
Having your treatment
The treatments are usually given from Monday–Friday, with a
rest at the weekend. Occasionally if you’ve missed a treatment
due to illness or a bank holiday, you may be asked to have two
treatments on the same day (6–8 hours apart).
The number of treatments will depend on the type and size of
the cancer, but the whole course of external radiotherapy will
usually last 5–6 weeks. Your doctor or radiographer will discuss
the treatment and possible side effects with you.
Before each session of radiotherapy, the radiographer will
position you carefully on the couch and make sure that you are
comfortable. During your treatment you will be left alone in the
room, but you’ll be able to talk to the radiographer who will
be able to see you from the next room. The treatment itself will
only last a few minutes.
45
Understanding cervical cancer
Positioning the radiotherapy machine
External radiotherapy isn’t painful, but you do have to lie still for
a few minutes during treatment (see the photo opposite). The
treatment will not make you radioactive and it’s perfectly safe
for you to be with other people, including children, afterwards.
Internal radiotherapy
Internal radiotherapy (also called brachytherapy) gives radiation
directly to the cervix and the area close by. It’s usually given
following external radiotherapy. The treatment may be given
as an inpatient or outpatient.
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Radiotherapy
47
Understanding cervical cancer
To give brachytherapy, a piece of radioactive material called
a source is put close to the cancer or, if you’ve had surgery,
the area where the cancer was before it was removed. The
source is placed inside specially designed hollow tubes called
applicators. A brachytherapy machine is used to place the
source into the applicators and to deliver the radiotherapy.
Intrauterine brachytherapy If you’ve not had a hysterectomy,
you will have intrauterine brachytherapy. A doctor inserts the
applicators into the vagina and passes them up through the
cervix into the womb. Sometimes additional applicators are
placed alongside the cervix. The applicators are inserted in
an operating room while you’re sedated or under a general
anaesthetic. Occasionally a spinal anaesthetic may be used –
your doctor will be able to tell you more about this. To prevent
the applicators moving, a pack of cotton/gauze padding is
placed inside the vagina. Occasionally a piece of gauze is
also placed inside the back passage (rectum), and you may
have a catheter put into your bladder to drain off urine.
While the applicators remain in place during treatment they
can be uncomfortable, so you will usually need painkillers to
ease any discomfort.
Intravaginal brachytherapy If you have had a hysterectomy,
a single larger hollow tube applicator is placed in the vagina.
With intravaginal brachytherapy you won’t need an anaesthetic
or sedation to insert the applicator and padding isn’t necessary.
You’ll have an MRI scan, CT scan or x-rays to check the position
of the applicators. Once it’s confirmed that the applicators are
in the correct position, they are connected to the brachytherapy
machine. The machine is then used to place the source into the
applicators and deliver the radiotherapy treatment.
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Radiotherapy
Brachytherapy may be given in several short bursts or in one
long slow treatment, depending on the systems used. There are
several different systems in use, and they’re described over the
next few pages.
High-dose rate treatment
This is the most common way of giving brachytherapy to the
cervix in the UK. With high-dose rate treatment, a machine
containing a radioactive source of iridium or cobalt is used to
give a high dose of radioactivity over a few minutes. High-dose
rate treatment may be given as an inpatient or outpatient.
How high-dose rate treatments are given varies from hospital
to hospital. Your radiotherapy team will be able to tell you
exactly how your treatment will be given.
Usually the treatment takes about 10–15 minutes and is
repeated several times, a few days apart. For example,
you may have treatment four times over several days while
you’re an inpatient. The applicators are usually removed
between treatments, but in a few hospitals they’re left in
place between treatments and then removed after the final
treatment. Alternatively the treatment may be given as an
outpatient or day case on three or four occasions over several
days or a week. If you have your treatment as an outpatient,
the applicators are removed before you go home. A plastic
tube may be left in your cervix to help your radiotherapy team
position the applicators for your next treatment.
You may have a tube (catheter) put into the bladder to drain
urine during high-dose rate treatment.
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Understanding cervical cancer
Low-dose rate treatment
Low-dose rate treatment is usually given over 12–24 hours
as an inpatient, but sometimes it may be given over a few
days. One type of brachytherapy machine that’s used to give
low-dose rate treatment is known as a Selectron. A Selectron
places a radioactive source of small balls of caesium into the
applicator tubes to deliver the treatment.
The applicators are usually left in place until the treatment has
finished. You will be asked to stay in bed to make sure that
the applicators stay in the right position. You will also have a
urinary catheter. It can be uncomfortable while the applicators
remain in place, so you’ll usually be given regular strong
painkillers until the treatment has finished and the applicators
have been removed.
You’ll be cared for in a single room. This is to prevent other
people being exposed to radioactivity while the machine is
delivering the treatment. However, the radioactive source can
be withdrawn from the applicators back into the brachytherapy
machine if a nurse or doctor needs to come into the room.
This keeps the dose of radioactivity to the nurses and doctors
as low as possible. Visitors are usually restricted and children
aren’t encouraged to visit while you’re having your treatment.
The safety measures and visiting restrictions might make
you feel isolated, worried and depressed at a time when you
might want people around you. If you have these feelings,
it’s important to tell someone so that you can get some support.
It might also help to take in plenty of things to read, an MP3
player and other things to keep you occupied while you’re in
isolation. You only need to be in isolation while the applicators
are in place. Once they’re removed the radioactivity disappears
and it’s perfectly safe to be with other people.
50
Radiotherapy
‘They put everything near me like food, water.
I had a book. There was a TV in the room and
I could move my head and my arms.’
The applicators will be removed by one of the doctors or nurses
and this may be a bit uncomfortable. You’ll be given painkillers
beforehand. To make it easier for you, sometimes you might be
sedated or given gas (nitrous oxide) and air, known as Entonox®.
‘Because I was using the gas it was not painful. I
could feel them coming out, but it was not painful.’
Pulsed-dose rate brachytherapy
In this treatment the applicators stay in place for the same
length of time as low-dose rate treatment, but the radiation
dose is given in pulses rather than as a continuous low dose.
Side effects of radiotherapy
It’s usual to have slight vaginal bleeding or discharge once the
radiotherapy treatment has ended. If it continues for more than
a couple of weeks or becomes heavy, it’s important to let your
doctor or nurse know.
Radiotherapy to the pelvic area can cause side effects such
as tiredness, diarrhoea and a burning sensation when
passing urine. For some people these side effects may be mild,
while for others they can be more troublesome. Your specialist
will be able to advise you on what to expect and how any
side effects can be treated. The side effects should gradually
disappear once your treatment is over.
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Understanding cervical cancer
We can send you more information about the early and late
effects of pelvic radiotherapy in women, and about ways of
dealing with them.
Diarrhoea
Diarrhoea is a common side effect that can occur during and
after radiotherapy treatment. It’s important to drink plenty of
fluids if you have diarrhoea, so that you don’t get dehydrated.
If your diarrhoea is not controlled with medicines, let your
doctor or nurse know.
Nausea
You may feel sick during radiotherapy treatment, but this is
not common. If you don’t feel like eating, you can have
nutritious high-calorie drinks instead of meals. The drinks are
available from most chemists and can be prescribed by your
GP. Our booklet Eating problems and cancer has some helpful
tips on eating well when you feel ill.
Sore skin
Your skin may get sore in the area being treated. Perfumed soaps,
creams and deodorants may irritate the skin and should not be
used during the treatment. Your radiographer or nurse can talk
to you about taking care of your skin.
Tiredness
Radiotherapy can make you very tired. It’s important to get as
much rest as you can, especially if you have to travel a long
way for treatment each day.
We have a booklet called Coping with fatigue,
which we can send you.
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Radiotherapy
Effects on the vagina
Radiotherapy to the pelvis can make the vagina become
narrower, and this can make internal examinations and
penetrative sex uncomfortable.
Your hospital team may recommend that you use vaginal
dilators to try to prevent the vagina from narrowing.
Dilators are tampon-shaped plastic tubes of different
sizes that you use along with a lubricant.
You may be advised to start using a vaginal dilator during your
radiotherapy treatment or afterwards. Using a dilator regularly
may make it easier for your doctors to examine your vagina
and cervix after treatment. It may also make it easier for you
to have penetrative sex.
Although vaginal dilators are commonly used, there isn’t strong
evidence to say how effective they are. Rarely, they may cause
damage to the vagina, especially if they aren’t used correctly.
Your specialist nurse, doctor or radiographer will advise you on
whether dilators would be helpful in your particular situation
and will explain how to use them.
Having regular penetrative sex may also help prevent vaginal
narrowing. But even if you are having regular sex, you may still
be advised to use a dilator.
Hormone creams applied to the vagina can also help with
vaginal narrowing, and these are available on prescription
from your doctor.
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Understanding cervical cancer
54
Radiotherapy
Sex
After radiotherapy you should be able to go back to your usual
sex life after a few weeks. Many women feel nervous about
having sex after treatment for cancer, but it’s perfectly safe.
Sex won’t make the cancer come back and your partner can’t
‘catch’ cancer from you.
Women may find they need to take more time over sex to help
the vagina relax. It may be easier if your partner is gentle at
first so that the vagina can stretch more slowly. Regular gentle
sex and the use of dilators will help the vagina stretch slowly
and become more supple again.
Some women may temporarily lose interest in sex due to
menopausal symptoms – there are various treatments that
can help overcome these symptoms (see pages 66–67).
Smoking
The side effects of radiotherapy are made worse by smoking,
so if you can cut down or stop smoking during and after your
treatment this will help. If you want help or advice on how to
quit, you can talk to your clinical oncologist, GP or a specialist
nurse. Organisations such as QUIT (see page 99) can also
offer advice and support.
We have a leaflet called Giving up smoking, which we
can send you.
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Understanding cervical cancer
Possible long-term side effects
Radiotherapy to the pelvic area can sometimes lead to long-term
side effects (sometimes called late effects), but these are not
common. Ways of dealing with the long-term effects of
radiotherapy are discussed in our booklet Pelvic radiotherapy
in women: possible late effects.
Effects on the bowel or bladder
In a small number of women, the bowel or bladder may be
permanently affected by the radiotherapy. 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 in the urine
or bowel movements. These effects can take many months or
years to occur. If you notice any bleeding, it’s important to let
your doctor know so that tests can be done and appropriate
treatment given.
Very occasionally, radiotherapy to the pelvis can cause the
bowel to narrow, which may lead to a blockage sometimes
known as bowel obstruction. Bowel obstruction can cause
sickness (vomiting), abdominal pain and constipation.
Having treatment for bowel obstruction may mean being
admitted to hospital.
Effects on the vagina
Radiotherapy can cause small fragile blood vessels to develop
in the vagina, which can lead to slight vaginal bleeding,
particularly after sex. Let your doctor or nurse know if this
happens so they can check that everything is okay. Often you
will need to meet regularly with the clinical nurse specialist,
who can give you practical advice and support.
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Radiotherapy
For some women, sex may continue to be difficult due to
narrowing of the vagina. If sex is difficult, you and your partner
might find it helpful to discuss this with one of your treatment
team. Although it might feel embarrassing at first, it can really
help to talk things through. Your nurse or doctor will have
experience in this area and can advise you on what might
help. They may also be able to refer you to a specially trained
counsellor who has experience dealing with sexual problems.
You can also talk to our cancer support specialists on 0808
808 00 00.
We have a booklet called Sexuality and cancer,
which we can send you.
Swelling of the legs, pelvic area or genitals (lymphoedema)
Some people find that the radiotherapy affects the lymph
nodes in the pelvic area, and this can cause swelling of the
legs, pelvic area or genitals. This is known as lymphoedema,
and is more likely if you’ve had surgery as well as radiotherapy.
It can be very upsetting when it occurs, but there are
lymphoedema specialists who can help.
Our booklet Understanding lymphoedema has
suggestions to help lower your risk of getting
lymphoedema, or help improve it if it does develop.
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Understanding cervical cancer
Chemotherapy
Chemotherapy uses anti-cancer (cytotoxic) drugs to destroy
cancer cells. There are several chemotherapy drugs that can be
used to treat cervical cancer. The most commonly used drug is
cisplatin, which is often given in combination with radiotherapy
or in combination with other chemotherapy drugs. The drugs
are usually given intravenously (by injection into a vein).
Early-stage and locally advanced cervical cancer
Chemotherapy may be used to treat larger tumours that are
just in the cervix or those that have spread locally (to the
surrounding area). It’s commonly combined with radiotherapy
to make the radiotherapy more effective – this is called
chemoradiation. Usually the chemotherapy is given once
a week during the course of radiotherapy.
Advanced-stage cancer
Chemotherapy may also be given to women whose cancer
has spread to other parts of the body. It’s used in this situation
to try to shrink and control the cancer and relieve symptoms,
to prolong a good quality of life. In some women the
chemotherapy will achieve this. Unfortunately for others the
chemotherapy will not shrink the cancer, and in this situation
the treatment will be stopped to avoid the side effects it may
cause. It’s helpful to discuss the pros and cons of chemotherapy
in your particular situation with your cancer specialist.
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Chemotherapy
Side effects
Chemotherapy can cause side effects, which may be slightly
worse when it’s given alongside radiotherapy. Over the
next pages we’ve listed some of the side effects you may
experience. There’s more detailed information in our booklet
Understanding chemotherapy.
Lowered resistance to infection (neutropenia)
Chemotherapy can temporarily reduce the production of
white blood cells in your bone marrow, making you more
prone to infection.
This effect can begin about seven days after treatment has
been given, and your resistance to infection usually reaches its
lowest point about 10–14 days after chemotherapy. Your white
blood cells will then increase steadily and will usually return to
normal before your next cycle of chemotherapy is due.
You should contact your doctor or the hospital straight away if:
• your temperature goes above 38˚C (100.4˚F)
• you suddenly feel unwell, even with a normal temperature.
You will have a blood test before having more chemotherapy
to make sure that your white blood cells have recovered.
Occasionally it may be necessary to delay your treatment
if your blood count is still low.
Anaemia
If the level of red blood cells in your blood is low, you may feel
tired and breathless. This is called anaemia. Anaemia can be
treated by having a blood transfusion. We have a fact sheet
about blood transfusions.
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Understanding cervical cancer
Bruising and bleeding
The chemotherapy can reduce the production of platelets,
which help the blood to clot. Having low numbers of platelets
increases your chance of bleeding, and this can affect
people in different ways. Let your doctor know if you have
any unexplained bruising or bleeding, such as nosebleeds,
bleeding gums, blood in your urine or stools, blood spots or
rashes on the skin. You may need to have a platelet transfusion.
Nausea and vomitting
Some chemotherapy drugs can make you feel sick (nauseated)
or be sick (vomit). Your cancer specialist can prescribe effective
anti-sickness (anti-emetic) drugs to prevent or greatly reduce
this. If the sickness is not controlled, or continues, let your
doctor know. They can prescribe other anti-sickness drugs that
may be more effective.
Tiredness (fatigue)
Chemotherapy affects people in different ways. Some people
find they’re able to lead a fairly normal life during their
treatment, but many find they become very tired and have
to take things much more slowly. Try to pace yourself by
balancing periods of rest with some gentle exercise, such as
short walks.
Effects on the kidneys
Some of the chemotherapy drugs used to treat cancer of the
cervix may affect the kidneys. Usually this doesn’t cause any
symptoms, but sometimes the effect can be severe and the
kidneys can be permanently damaged unless the treatment
is stopped.
For this reason your kidney function will be checked by a blood
test before each treatment. You may be asked to drink plenty
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Chemotherapy
of fluids, and to measure how much liquid you drink and the
amount of urine you pass.
Sore mouth
Chemotherapy drugs can sometimes make your mouth
sore and cause small mouth ulcers. Some people find that
sucking on ice may be soothing. Drinking plenty of fluids,
and cleaning your teeth regularly and gently with a soft
toothbrush, can help to reduce the risk of this happening.
Tell your nurse or doctor if you have any of these problems,
as they can prescribe mouthwashes and medicine to prevent
or clear mouth infections.
Loss of appetite
Some people lose their appetite while they’re having
chemotherapy. This can be mild and may only last a few days.
If it doesn’t improve you can ask to see a dietitian or specialist
nurse at your hospital. They can give you advice on improving
your appetite and keeping to a healthy weight.
Numbness or tingling in hands or feet
This is due to the effect of some chemotherapy drugs on your
nerves and is known as peripheral neuropathy. Tell your
doctor if you notice this symptom, as it may be controlled
by slightly lowering the dose of the chemotherapy drug.
The problem usually improves slowly over a few months after
treatment is over, but for some people it can persist. Talk to
your doctor if this happens.
Hair loss
Some chemotherapy drugs can cause temporary hair loss.
Your doctor or nurse will be able to tell you if you’re likely to
experience this. There are many ways of covering up hair loss,
including wigs, hats and scarves. If you are an inpatient when
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Chemotherapy
you have your treatment, or if you’re on income support,
you can get a free wig from the NHS.
If you do lose your hair, it should start to grow back within
3–6 months of finishing treatment.
Although they may be difficult to cope with at times,
most of these side effects will disappear once your
treatment is over. We have more information about
many of these side effects and how to cope with them,
which we can send you. We also have fact sheets about
individual chemotherapy drugs and drug combinations.
Fertility
Chemotherapy can affect your ability to become pregnant
after treatment. It’s important to discuss any concerns you have
about this with your hospital team before your treatment starts.
See pages 66–70 for more information.
Contraception
It’s not advisable to become pregnant while having chemotherapy,
as the drugs may harm the developing baby. For this reason,
your doctor will advise you to use a reliable method of
contraception (usually a ‘barrier method’, such as condoms)
throughout your treatment and for a few months afterwards.
You can discuss this with your doctor or nurse.
Condoms should be used if you have sex within the first 48
hours after chemotherapy. This is to protect your partner from
any of the drug that may be present in the vaginal fluid.
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Understanding cervical cancer
Research – clinical trials
Cancer research trials are carried out to try to find new and
better treatments for cancer. Trials that are carried out on
patients are known as clinical trials. These may be carried out to:
• test new treatments, such as new chemotherapy drugs,
gene therapy or cancer vaccines
• look at new combinations of existing treatments, or change
the way they are given, to make them more effective or
reduce side effects
• compare the effectiveness of drugs used to control symptoms
• find out how cancer treatments work
• find out which treatments are the most cost-effective
• find out how treatment affects your quality of life.
Trials are the only reliable way to find out if a different type
of surgery, chemotherapy, radiotherapy or other treatment is
better than what’s already available.
Taking part in a trial
You may be asked to take part in a treatment research trial,
and there can be many benefits in doing this. Trials help to
improve knowledge about cancer and develop new treatments.
You will be carefully monitored during and after the study.
Usually, several hospitals around the country take part in these
trials. It’s important to bear in mind that some treatments that
look promising at first are often later found to be less effective
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Research – clinical trials
than existing treatments or to have side effects that outweigh
the benefits.
If you decide not to take part in a trial, your decision will be
respected and you won’t have to give a reason. There will be
no change in the way you are treated by the hospital staff and
you’ll be offered the standard treatment for your situation.
Our booklet Understanding cancer research trials
(clinical trials) describes clinical trials in more detail.
We can send you a copy.
Blood and tumour samples
Blood and tumour samples may be taken to help make the
right diagnosis. You may be asked for your permission to use
some of your samples for research into cancer. If you take
part in a trial you may also give other samples, which may be
frozen and stored for future use when new research techniques
become available. Your name will be removed from the
samples so you can’t be identified.
The research may be carried out at the hospital where you
are treated, or at another one. This type of research takes
a long time, and results may not be available for many
years. The samples will be used to increase knowledge about
the causes of cancer and its treatment, which will hopefully
improve the outlook for future patients.
Current research
Some current research trials for women with cervical cancer are
looking at the side effects of internal radiotherapy treatments
and ways to improve external radiotherapy. Other trials are
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Understanding cervical cancer
looking at different combinations of chemotherapy treatments
and newer drug treatments for advanced cancer.
Your hospital team will be able to let you know about any trials
that may be suitable for you.
Our website macmillan.org.uk has information about
current clinical trial databases.
Menopausal symptoms
and fertility
The treatments for cervical cancer may cause menopausal
symptoms and affect your fertility. There are different treatment
options for coping with these effects.
Menopausal symptoms
If you’ve had a hysterectomy and your ovaries have been removed,
or if you’ve had radiotherapy to the pelvis, you will go through
the menopause if you haven’t done so already. Some types of
chemotherapy can also bring on an early menopause.
Menopausal symptoms can include:
• hot flushes
• dry skin
• dryness of the vagina
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Menopausal symptoms and fertility
• feeling low or anxious
• being less interested in sex.
Many of these effects can be eased by hormone creams,
skin patches or tablets, which can all be prescribed by
your doctor. These replace the hormones that are normally
produced by the ovaries. However, these hormone replacement
therapies may not be suitable for all women. Your doctor will
let you know if they are suitable for you.
If dryness of the vagina is a problem, your doctor can
prescribe creams or you can buy lubricating gels such as Sylk®
or Astroglide® from the chemist. You can also buy organic
lubricants online, such as Yes®. You or your partner can apply
them directly to the penis or vagina during sex.
An organisation called the Daisy Network supports women
who have an early menopause (see page 96). You may find it
helpful to contact them if you feel you need a bit more support.
Fertility
Pelvic radiotherapy or surgical removal of your womb or
ovaries will mean you are no longer able to have children.
Some chemotherapy drugs may also affect your fertility.
This can feel devastating. Infertility is very hard to come to
terms with, especially if you were planning to start a family in
the future, or to have more children to complete your family.
The sense of loss can be very painful and distressing for people
of all ages. Sometimes it can feel as though you have actually
lost a part of yourself. You may also feel less feminine because
you can’t have children.
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It’s important to discuss any concerns you have about your fertility
with your healthcare team before treatment starts. They can discuss
any options you may have for preserving your fertility. For example,
you may be able to store embryos (fertilised eggs), or have your eggs
frozen and stored for future use. This would have to happen before
treatment starts. Ovarian tissue that contains eggs can also be
removed for future use, but this is still a very experimental technique.
If you would like to have fertility treatment, your hospital team
will refer you to a fertility specialist. Embryo storage may be
available on the NHS, but you often have to pay privately for
other treatments.
Our booklet Relationships, sex and fertility for young people
affected by cancer and our leaflet Cancer treatment and fertility
– information for women discuss the options for having a baby
(such as adoption, surrogacy or egg storage) if treatment has
affected your fertility.
People react differently to the risk of infertility. Some women
may come to terms with it more quickly and feel that dealing
with the cancer is more important. Others may accept the news
calmly when they start treatment, and find that they don’t feel
the full impact until the treatment is over and they are sorting
out their lives again.
There is no right or wrong way to react. If you have a partner,
it’s important for them to be involved in any discussions about
fertility and future plans. You may both need to speak to a
professional counsellor or therapist specialising in fertility
problems. They can help you come to terms with your situation.
Your doctor may be able to refer you to a specialist, or you
can be put in touch with one directly by contacting the
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Understanding cervical cancer
organisations on pages 96–99. Our cancer support specialists
on 0808 808 00 00 can discuss any problems you may have
and they can also help you find a counsellor who can offer
you help and advice. We can also send you more information
about the emotional effects of infertility.
After treatment
Follow-up
After your treatment has finished you will need to have regular
check-ups. These will often go on for several years and may
include blood tests, x-rays or scans.
‘The first couple of times I went back I was quite
anxious – being in the same place, it just brings
back all the memories of being there and how
scared you were, and you’re quite relieved when
you go home. The more time goes on it becomes
better, much better.’
If you have any problems or ongoing side effects from the
treatment, or notice any new symptoms between your checkups, let your doctor or specialist nurse know as soon as possible.
Many women who are treated for early-stage cervical cancer
will be completely cured of their cancer and their cancer won’t
come back.
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After treatment
What if the cancer comes back?
If the cancer does come back, you will be given further
treatment. The treatment you have will depend on where
the cancer is and which treatments you’ve had before.
Treatment may include surgery, chemotherapy or radiotherapy,
and these may be given alone or in combination.
Very occasionally, if the cancer comes back just in the pelvic
area, it may be possible to have an operation called a pelvic
exenteration. This is a major operation and involves removing
some or all of the organs in the pelvis, including the womb,
cervix, vagina, fallopian tubes, ovaries, bladder and the lower
end of the large bowel (rectum). It’s only suitable for a small
number of women, and various investigations and scans will be
needed to see if it’s possible. If a pelvic exenteration is suitable
for you, your hospital consultant will give you more detailed
information about this operation and what to expect.
If the cancer has spread to other parts of the body (such as
the lungs, liver or bone), then chemotherapy is usually given
(see pages 58–63).
What you can do
After treatment you’ll probably be keen to get back to doing
the things you did before your cancer diagnosis. But you may
still be coping with side effects of treatment, such as tiredness,
and also with some difficult emotions (see pages 73–78).
Recovery takes time, so try not to be hard on yourself.
It’s not unusual to feel anxious and even a bit isolated at this
time. Women often worry about the cancer coming back, and
that any new symptom is a sign that it has returned. If you have
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Understanding cervical cancer
any concerns or questions it’s important to talk these over with
your hospital doctor, specialist nurse or GP. They can tell you if
there’s anything you should or shouldn’t be doing, and how to
make the most of your health.
Lifestyle changes – making positive decisions
When you’ve had time to recover from your treatment you may
want to think about making changes to your lifestyle and find
out more about healthy living. Perhaps you already followed a
healthy lifestyle before your cancer, but you may now want to
be more focused on making the most of your health. There are
things you can do to help your body recover. These can also
help improve your sense of wellbeing and lower your risk of
getting other illnesses and some cancers.
Eating well and keeping to a healthy weight
Eat plenty of fresh fruit and vegetables (at least five portions
a day) and eat more high-fibre foods. Cut down on red meat,
animal fats and salted, pickled and smoked foods.
Our booklet Healthy eating and cancer has more
helpful advice on nutrition.
Regular exercise
This can be an important part of your recovery after treatment.
It can improve your sense of wellbeing and build up your
energy levels. It also reduces the risk of heart disease, stroke,
diabetes and bone thinning (osteoporosis). Talk to your cancer
specialist or GP before you start. Start slowly and increase your
activity over time.
You can read more about exercise and its benefits in
our booklet Physical activity and cancer treatment.
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After treatment
Stopping smoking
If you’re a smoker, speak to your doctor or call a stop smoking
helpline for further advice and to find out where your local stop
smoking service is.
Our leaflet Giving up smoking has more information
and tips to help you quit.
Drinking sensibly
Alcohol has been linked with an increased risk of developing
some types of cancer. So try to stick to sensible drinking
guidelines, which recommend that women drink less than two
units a day and have at least a couple of alcohol-free days
each week.
Emotional support
It’s common to have different and sometimes difficult feelings
after cancer treatment (see pages 75–78). But as you recover
and get back to your everyday life, these usually get easier to
deal with.
The type of treatment you’ve had can have an effect on how
you feel. Some women may experience ongoing side effects,
which can be difficult to cope with emotionally. Talking to
family and friends about how you’re feeling often helps.
Ask your doctor or nurse for advice and support.
Some women find the impact of the cancer leaves them feeling
depressed, helpless or anxious. Let your doctor or nurse know
how you’re feeling, as there’s specialist help available to help
you cope with these feelings. Your hospital consultant or GP
can refer you to a psychologist or counsellor who specialises
in the emotional problems of people with cancer.
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Our cancer support specialists on freephone 0808 808 00 00
can tell you more about counselling and let you know about
services in your area.
Support groups
Self-help or support groups offer a chance to talk to other
women who may be in a similar situation and facing the same
challenges as you. Joining a group can be helpful if you live
alone or don’t feel able to talk about your feelings with people
you know. Not everyone finds talking in a group easy, so it
might not be for you. Try going along to see what the group
is like before you join.
You can call us on 0808 808 00 00 or visit our website
macmillan.org.uk for information about cancer support
groups across the UK.
Online support
Many people get support through the internet. There are online
support groups, social networking sites, forums, chat rooms
and blogs for people affected by cancer. You can use these
to share your experience and to ask questions, get and give
advice based on your cancer experience.
Our online community macmillan.org.uk/community is a
social networking site where you can talk to people in our chat
rooms, blog your journey, make friends and join support groups.
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Your feelings
Your feelings
Most people feel overwhelmed when they’re told they have
cancer, and experience many different emotions. These are part
of the process that people go through while dealing with their
illness. Partners, family members and friends often have similar
feelings and may also need support and guidance to cope.
Reactions differ from one person to another – there’s no right
or wrong way to feel. We describe some of the common
emotional effects here. However, reactions vary and people
have different emotions at different times.
Our booklet How are you feeling? discusses the
feelings you may experience and has advice on
how to cope with them.
Shock and disbelief
Often disbelief is the immediate reaction when cancer is
diagnosed. You may feel numb and unable to express any
emotion. You may also find that you can take in only a small
amount of information and so you have to keep asking the
same questions again and again, or you need to be told the
same bits of information repeatedly. This need for repetition
is a common reaction to shock.
Some people find that their feelings of disbelief make it
difficult for them to talk about their illness with family and
friends. For others it may be the main topic of conversation,
as it’s the main thing on their mind.
You may find our booklet Talking about your
cancer helpful.
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Fear and uncertainty
Cancer is a frightening word surrounded by fears and myths.
One of the greatest fears people have is whether they will die.
Many cancers are curable if caught at an early stage. When a
cancer is not curable, current treatments often mean that it can
be controlled for years.
Many people also worry about the symptoms of cancer, such
as pain. In fact, some people with cancer have no pain at
all. If you do have pain or other symptoms, there are many
medicines and other ways to help relieve them or keep them
under control. Our booklets Controlling cancer pain and
Controlling the symptoms of cancer describe these methods.
Many people are anxious about whether their treatment will
work and how to cope with possible side effects. It’s best to
discuss your individual treatment and possible outcomes in
detail with your doctor. You can write a list of the questions to
ask on page 106.
You may find that doctors can’t answer your questions fully,
or that their answers sound vague. It’s often impossible for
them to say for certain how effective treatment has been.
Doctors know approximately how many people will benefit
from a certain treatment, but they can’t predict the future for
a particular person. Many people find this uncertainty hard
to live with.
Uncertainty about the future can cause a lot of tension, but your
fears may be worse than the reality. Finding out about your
illness can be reassuring. Discussing what you have found out
with your family and friends can also help to relieve some of
the worry.
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Your feelings
Denial
Many people cope with their illness by not wanting to know
much or talk much about it. If that’s the way you feel, then just
explain that you’d prefer not to talk about your illness, at least
for the time being.
Sometimes, however, it’s the other way round. You may find
that your family and friends don’t want to talk about your
illness. They may appear to ignore the fact that you have
cancer, perhaps by playing down your anxieties and symptoms
or deliberately changing the subject. If this upsets or hurts you,
try telling them. Perhaps start by reassuring them that you do
know what is happening and that it will help you if you can talk
to them about your illness.
Anger
People often feel very angry about their illness. Anger can also
hide other feelings, such as fear or sadness. You may direct
your anger at the people who are closest to you and at the
doctors and nurses who are caring for you.
It’s understandable that you may be very upset by many aspects
of your illness, so you don’t need to feel guilty about your angry
thoughts or irritable moods. Bear in mind that your relatives and
friends may sometimes think that your anger is directed at them,
when it’s really directed at your illness. It may help to tell them
this, or perhaps show them this section of the booklet.
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Blame and guilt
Sometimes people blame themselves or others for their illness,
trying to find reasons to explain why it has happened to them.
This may be because we often feel better if we know why
something has happened. In most cases it’s impossible to
know exactly what has caused a person’s cancer. So there’s
no reason for you to feel that anyone is to blame.
Resentment
Understandably, you may feel resentful because you have
cancer while other people are well. These feelings may crop
up from time to time during the course of your illness and
treatment. Relatives too can sometimes resent the changes that
your illness makes to their lives. It usually helps to discuss these
feelings, rather than keeping them to yourself.
Withdrawal and isolation
There may be times when you want to be left alone to sort
out your thoughts and emotions. This can be hard for your
family and friends who want to share this difficult time with you.
It may make it easier for them to cope if you reassure them
that, although you don’t feel like discussing your illness at the
moment, you will talk to them about it when you’re ready.
Sometimes depression can stop you wanting to talk. If you
or your family think you may be depressed, discuss this with
your GP. They can refer you to a doctor or counsellor who
specialises in the emotional problems of people with cancer
or prescribe an antidepressant drug for you.
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If you’re a relative or friend
Some families find it difficult to talk about cancer or share
their feelings. You might think it’s best to pretend everything
is fine, and carry on as normal. You might not want to worry
the person with cancer or you might feel you are letting them
down if you admit to being afraid. Unfortunately, denying
strong emotions like this can make it even harder to talk,
and may lead to the person with cancer feeling very isolated.
Partners, relatives and friends can help by listening carefully
to what the person with cancer wants to say. Don’t rush into
talking about the illness. Often it’s enough just to listen and let
the person with cancer talk when they are ready.
Our booklet Lost for words: how to talk to someone with cancer
is written for the relatives and friends of people with cancer.
It looks at some of the difficulties people may have when talking
about cancer and suggests ways of overcoming them.
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Talking to children
Talking to children
Deciding what to tell your children or grandchildren about your
cancer is difficult. An open, honest approach is usually best.
Even very young children can sense when something is wrong,
and their fears can sometimes be worse than the reality.
How much you tell your children will depend on their age and
how mature they are. It may be best to start by giving only
small amounts of information and gradually tell them more to
build up a picture of your illness.
Children often feel that they are somehow to blame for illness,
and may feel guilty for a long time. Whether they show it or
not, they will need to be reassured that your illness is not their
fault. They may also want reassurance about what they are told
by friends and other people, as they may misunderstand what
they hear.
Very young children are usually concerned with what’s
happening in the present and don’t worry about what will
happen later. They usually need only simple explanations of
why you need to go into hospital or are not your usual self.
They may ask the same question again and again, which
can be difficult to deal with when you are already coping
with the cancer and its effects. Slightly older children may
understand better with a story about ‘good cells’ and ‘bad
cells’. Most children of about 10 years and over can grasp
fairly complicated explanations.
Children of any age may worry that you are going to die.
If your cancer is likely to be cured, or controlled for a long
time, it’s important to tell them this. If the cancer is advanced,
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it’s helpful to sensitively prepare the child for your death.
Obviously this can be a very difficult thing to do and you
may need help and support.
Our booklet Talking to children when an adult has
cancer includes discussion about sensitive topics.
We can send you a copy.
Teenagers
Teenagers can have an especially hard time. At a stage when
they want more freedom, they may be asked to take on new
responsibilities and they may feel over-burdened. It’s important
that they can go on with their normal lives as much as possible
and still get the support they need.
If they find it hard to talk to you, you could encourage them to
talk to someone close who can support and listen to them, such
as a grandparent, family friend, teacher or counsellor. They
may also find it useful to look at the website riprap.org.uk
which has been developed especially for teenagers who have
a parent with cancer.
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Who can help?
Who can help?
Many people are available to help you and your family.
Different people can offer support in the community.
District nurses work closely with GPs and, if needed, they can
make regular visits to patients and their families at home.
The hospital social worker can give you information about
social services and other benefits you may be able to claim
while you are ill. For example, you may be entitled to meals
on wheels, a home helper or money to help with hospital
transport fares. The social worker may also be able to help
arrange childcare during and after treatment and, if necessary,
help with the cost of childminders.
Some people need more than advice and support. You may
find that the impact of cancer leads to depression, feelings of
helplessness or anxiety. There is specialist help available to
help you cope with these emotions. Often it’s easier to talk to
someone who is not directly involved with your illness, such
as a counsellor who specialises in the emotional problems
of people with cancer, and their relatives. You can ask your
hospital consultant or GP to refer you to a counsellor.
Some hospitals have their own emotional support services,
with specially trained staff. Nurses may have had training in
counselling and can also give advice about practical problems.
Some people find comfort in religion at this time and it may
help them to talk to a local minister, hospital chaplain or other
spiritual or religious adviser.
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In many areas of the country there are also specialist nurses
called palliative care nurses. They’re experienced in
assessing and treating your symptoms, and they can offer you
support from when you’re diagnosed with cancer. They can
also visit you at home and support you and your family. Some
palliative care nurses are linked to the local hospice. Your GP
can usually arrange for you to be seen by a specialist nurse
at home.
Palliative care nurses are sometimes referred to as Macmillan
nurses. However, many Macmillan professionals are nurses
who have specialist knowledge about a particular type of
cancer. You may see them when you’re at a clinic or in hospital.
Marie Curie nurses help to care for people who are having
treatment to control their symptoms and want to stay in their
own homes. They provide nursing care during the day and
overnight. The district nurse usually decides whether to request
a Marie Curie nurse.
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Financial help and benefits
Financial help and benefits
When you or someone close to you has been diagnosed
with cancer, money may not be one of the first things you
think about. But having cancer can be expensive in ways you
may never have expected – you may have to pay for telephone
calls, special dietary needs, childcare or travel to hospital.
If you’re struggling to cope with the financial effects of cancer,
help is available.
In this section we outline some of the financial help and
benefits you may be entitled to. The benefits system can be
complicated, so it’s a good idea to talk to an experienced
benefits adviser. You can speak to one by calling the Macmillan
Support Line on 0808 808 00 00.
Statutory Sick Pay
If you’re an employee and unable to work because of illness,
you may be able to get Statutory Sick Pay. This is paid by your
employer for up to 28 weeks of sickness, and if you qualify for
it, your employer can’t pay you less.
Employment and Support Allowance
Before your Statutory Sick Pay is due to end, you should check
your entitlement to Employment and Support Allowance.
This benefit provides financial help to people who are unable
to work because of illness or disability. It also provides
personalised support to those who are able to work.
There are two parts to Employment and Support Allowance: a
contributory part and an income-related (means-tested) part.
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People may get either or both, depending on their national
insurance contribution record and their income and savings.
The assessment phase
Employment and Support Allowance may be paid at a basic
rate for the first 13 weeks of the claim. During this time, unless
you are terminally ill, you may need to take part in a work
capability assessment. This involves filling in and sending back
a questionnaire about how your illness or disability affects your
ability to complete everyday tasks.
Your doctor may also be asked to complete a report.
This evidence will be considered by an approved healthcare
professional who may recommend you attend a face-to-face
assessment if more information is needed about your condition.
If the work capability assessment shows your illness or disability
limits your ability to work, you’ll be placed into one of two
groups: the support group or the work-related activity group.
The main phase
If you still qualify for Employment and Support Allowance after
13 weeks, you’ll enter the main phase of the benefit. If your
illness or disability has a severe effect on your ability to work,
you’ll be placed in the support group and you won’t have to
undertake work-related activities. An additional is payment
made to anyone in the support group.
If your ability to work is limited, but not severely so, you’ll be
placed in the work-related activity group, and you’ll have
to attend six work-focused interviews. A smaller additional
payment will be made to anyone in this group.
If you are receiving intravenous (by injection into a vein)
chemotherapy or are likely to receive it within six months,
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you will automatically be assessed as having limited capability
for work and will be placed in the support group.
If you are self-employed, you’re entitled to claim Employment
and Support Allowance as long as you have paid the correct
level of national insurance contributions.
If you’re ill and unable to claim, remember to ask your GP for
a medical certificate for the period of your illness. If you’re in
hospital, ask your doctor or nurse for a certificate to cover the
time that you are an inpatient. This is necessary if you need to
claim a benefit.
Time-limits for Employment and Support Allowance
Under the Welfare Reform Act 2012, the amount of time
a person can receive contributory-based Employment and
Support Allowance in the work-related activity group is limited
to 12 months. After 12 months, the benefit will stop unless you
claim and qualify for income-related Employment and Support
Allowance or you request to be placed in, and are accepted
for, the support group. If you think this may affect you, speak
to a welfare rights adviser as soon as possible.
Disability Living Allowance
This benefit is for people under 65 who have difficulty
walking or looking after themselves (or both). To qualify,
you need to have had difficulty walking or taking care of
yourself for at least three months. These difficulties should
be expected to last for at least the next six months. You
need to make a claim before you turn 65, but if you’re
awarded the benefit, it will still be paid after you turn 65,
provided you still meet the qualifying criteria. You don’t
need to have a carer to qualify for this benefit. If you are
88
Financial help and benefits
terminally ill, you don’t have to meet the three- and six-month
qualifying conditions.
As part of the Welfare Reform Act 2012, Disability Living
Allowance will be replaced by a Personal Independence
Payment for people of working age from April 2013. Everyone
aged 16–64 receiving Disability Living Allowance will be
reassessed to see whether they are entitled to a Personal
Independence Payment.
Attendance Allowance
This benefit is for people aged 65 or over who have difficulty
looking after themselves. You may qualify if you need help with
personal care, such as getting out of bed, having a bath or
dressing yourself. The benefit is based on the amount of care
you need and not any care you may currently be getting. You
must have needed care for at least six months prior to making
a claim, unless you’ve been diagnosed with terminal cancer.
Community care assessment
If you have been diagnosed with cancer, you have the right to
a community care assessment from your local social services
department. This is to see whether you have a need for services
that the local authority should meet.
If you’ve been assessed as having a need for social services,
you may be entitled to get direct payments from your local
authority. This means that you’re given payments to organise
care services yourself, rather than the local social services
organising and paying for them for you.
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Understanding cervical cancer
Information about benefits and financial help
For more information about benefits and financial support,
call us on 0808 808 00 00. You may also find our booklet
Help with the cost of cancer useful.
You can find out more about benefits from Citizens Advice
(see page 100), or by calling the Benefit Enquiry Line on
0800 882 200. Visit direct.gov.uk (nidirect.gov.uk if you
live in Northern Ireland) for practical information about public
services and information about financial support, your rights,
employment and independent living.
Insurance
After having treatment for cancer, it can be more difficult to get
certain types of insurance, including life and travel insurance.
An independent financial adviser (IFA) can help you assess
your financial needs and find the best deal for your particular
situation. You can find a local IFA by referral from family or
friends, looking in your phone book, by contacting the Personal
Finance Society (see page 100) or at unbiased.co.uk
We can send you booklets about financial information for
people affected by cancer and getting travel insurance.
This information is also on our website.
90
Work
Work
You may need to take time off work during your treatment, and
for a while afterwards. It can be hard to judge the best time to
go back to work, or whether to go back at all. Your decision is
likely to depend mainly on the type of work you do and how
much your income is affected. Your consultant, GP or specialist
nurse can help you decide when and if you should go back to
work. It’s important to do what is right for you.
Getting back into your normal routine can be very helpful and
you may want to go back to work as soon as possible. Many
people find that going back to work as soon as they feel strong
enough gives them a chance to put their worries to one side by
becoming involved with their job and colleagues again. It can
help to talk to your employer about the situation – it may be
possible for you to work part-time or job share.
On the other hand, it can take a long time to recover fully from
cancer treatment, and it may be many months before you feel
ready to return to work. It’s important not to feel pressurised
into taking on too much, too soon. If you have a disability
caused by the cancer, your employer can get specialist help
to enable you to work.
Our booklets Work and cancer and Self-employment
and cancer give information about employment rights,
disability rights and financial issues for people with
cancer. We also have a booklet called Working while
caring for someone with cancer.
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Understanding cervical cancer
How we can help you
Cancer is the toughest
fight most of us will ever
face. But you don’t have
to go through it alone.
The Macmillan team is with
you every step of the way.
Clear, reliable information
about cancer
Get in touch
We can help you by phone,
email, via our website and
publications or in person.
And our information is free to
everyone affected by cancer.
Macmillan Cancer Support
89 Albert Embankment,
London SE1 7UQ
Questions about cancer?
Call free on 0808 808 00 00
(Mon–Fri, 9am–8pm)
www.macmillan.org.uk
Hard of hearing?
Use textphone
0808 808 0121 or Text Relay.
Non-English speaker?
Interpreters are available.
Macmillan Support Line
Our free, confidential phone
line is open Monday–Friday,
9am–8pm. Our cancer
support specialists provide
clinical, financial, emotional
and practical information and
support to anyone affected
by cancer. Call us on 0808
808 00 00 or email us via our
website, macmillan.org.uk/
talktous
Information centres
Our information and support
centres are based in hospitals,
libraries and mobile centres,
and offer you the opportunity
to speak with someone
face-to-face. Find your nearest
one at macmillan.org.uk/
informationcentres
92
Publications
We provide expert, up-to-date
information about different
types of cancer, tests and
treatments, and information
about living with and after
cancer. We can send you free
information in a variety of
formats, including booklets,
leaflets, fact sheets and audio
CDs. We can also provide
our information in Braille
and large print.
How we can help you
Need out-of-hours support?
You can find a lot of
information on our website,
macmillan.org.uk
For medical attention out of
hours, please contact your GP
for their out-of-hours service.
Someone to talk to
When you or someone you
know has cancer, it can be
difficult to talk about how
you’re feeling. You can call
our cancer support specialists
You can find all of our
information, along with several to talk about how you feel and
what’s worrying you.
videos, online at macmillan.
org.uk/cancerinformation
We can also help you find
support in your local area,
Review our information
so you can speak face-to-face
Help us make our resources
with people who understand
even better for people
what you’re going through.
affected by cancer. Being
one of our reviewers gives
you the chance to comment
on a variety of information
including booklets, fact sheets,
leaflets, videos, illustrations
and website text.
93
Understanding cervical cancer
Professional help
Support for each other
Our Macmillan nurses, doctors
and other healthcare and
social care professionals offer
expert treatment and care.
They help individuals and
families deal with cancer from
diagnosis onwards, until they
no longer need this help.
No one knows more about
the impact cancer has on a
person’s life than those who
have been affected by it
themselves. That’s why we
help to bring people with
cancer and carers together in
their communities and online.
You can ask your GP, hospital
consultant, district nurse
or hospital ward sister if
there are any Macmillan
professionals available
in your area, or call us on
0808 808 00 00.
Support groups
You can find out about support
groups in your area by calling
us or by visiting macmillan.
org.uk/selfhelpandsupport
94
Online community
You can also share your
experiences, ask questions,
get and give support to others
in our online community
at macmillan.org.uk/
community
How we can help you
Financial and
work-related support
Find out more about the
financial and work-related
support we can offer at
Having cancer can bring extra macmillan.org.uk/
costs such as hospital parking, financialsupport
travel fares and higher heating
Learning about cancer
bills. Some people may have
to stop working.
You may find it useful to learn
more about cancer and how
If you’ve been affected in
to manage the impact it can
this way, we can help. Call
have on your life.
the Macmillan Support
Line and one of our cancer
support specialists will tell you You can do this online on our
Learn Zone – macmillan.org.
about the benefits and other
uk/learnzone – which offers
financial help you may be
a variety of e-learning courses
entitled to.
and workshops. There’s
also a section dedicated to
We can also give you
information about your rights supporting people with cancer
at work as an employee, and – ideal for people who want
help you find further support. to learn more about what
their relative or friend is
going through.
Macmillan Grants
Money worries are the last
thing you need when you have
cancer. A Macmillan Grant is
a one-off payment for people
with cancer, to cover a variety
of practical needs including
heating bills, extra clothing,
or a much needed break.
95
Understanding cervical cancer
Other useful organisations
The Daisy Network:
Premature Menopause
Support Group
PO Box 183,
Rossendale BB4 6WZ
Email
[email protected]
www.daisynetwork.org.uk
A support group for women
who have early ovarian failure.
The website gives information
about premature menopause
and related issues. Also has a
mailing list for subscribers and
details of other helpful groups.
Gynae C
Helen Jackson – Co-ordinator,
1 Bolingbroke Road,
Swindon SN2 2LB
Tel 01793 491116
Email [email protected]
www.gynaec.co.uk
Offers confidential support for
women with gynaecological
cancer, their partners, families
and friends.
96
Jo’s Cervical Cancer Trust
16 Lincoln’s Inn Fields,
London WC2A 3ED
Tel 020 7936 7498
Helpline 0808 802 8000
Email [email protected]
www.jostrust.org.uk
The only UK charity dedicated
to women and their families
affected by cervical cancer
and cervical abnormalities.
Offers information, support
and friendship to women of
all ages.
Women’s Health Concern
4–6 Eton Place, Marlow,
Buckinghamshire SL7 2QA
Tel 01628 478 473
Email from the website
www.womens-healthconcern.org
A charity providing help and
advice to women on a wide
variety of gynaecological,
urological and sexual health
conditions. Offers information
by email, in print and online.
Has a wide range of fact
sheets. Runs a confidential
email advice service – email
its nurses or medical advisers
from the website. Asks for a
donation of £5.00, payable
online, to cover the costs of
this service.
General cancer and
support organisations
Cancer Black Care
79 Acton Lane,
London NW10 8UT
Tel 020 8961 4151
(Mon–Fri, 9.30am–4.30pm)
Email
[email protected]
www.cancerblackcare.org
Offers information
and support for people
with cancer from ethnic
communities, their families,
carers and friends. Welcomes
people from different ethnic
groups including African,
Asian, Turkish and AfricanCaribbean communities.
Other useful organisations
Irish Cancer Society
43–45 Northumberland Road,
Dublin 4, Ireland
Cancer helpline
1 800 200 700 (Mon–Thurs,
9am–7pm, Fri, 9am–5pm)
Email [email protected]
www.cancer.ie
Operates Ireland’s only
freephone cancer helpline,
which is staffed by qualified
nurses trained in cancer care.
Maggie’s Cancer
Caring Centres
8 Newton Place,
Glasgow G3 7PR
Tel 0131 537 2456
Email enquiries@
maggiescentres.org
www.maggiescentres.org
Located throughout the
country, Maggie’s Centres
offer free, comprehensive
support. You can access
information, benefits
advice, and emotional or
psychological support.
97
Understanding cervical cancer
Tak Tent Cancer Support
Flat 5, 30 Shelley Court,
Gartnavel Complex,
Glasgow G12 0YN
Tel 0141 211 0122
Email [email protected]
www.taktent.org
Offers information and
support for cancer patients,
families, friends and health
professionals. Runs a
network of support groups
across Scotland. Also
provides counselling and
complementary therapies.
Tenovus
9th Floor, Gleider House,
Ty Glas Road, Llanishen,
Cardiff CF14 5BD
Freephone helpline
0808 808 1010
Tel 029 2076 8850
Email [email protected]
www.tenovus.org.uk
Provides a range of services
to people with cancer and
their families, including
counselling and a freephone
cancer helpline.
98
Ulster Cancer Foundation
40–44 Eglantine Avenue,
Belfast BT9 6DX
Freephone helpline
0800 783 3339
Tel 028 9066 3281
Helpline email
[email protected]
Email [email protected]
www.ulstercancer.org
Provides a range of services
to people with cancer and
their families including a free
telephone helpline, which is
staffed by specially trained
nurses with experience in
cancer care.
Counselling, bereavement
and emotional support
British Association
for Counselling and
Psychotherapy (BACP)
BACP House,
15 St John’s Business Park,
Lutterworth LE17 4HB
Tel 01455 883300
Email [email protected]
www.bacp.co.uk
Aims to promote awareness
of counselling and increase
its availability, and to signpost
people to appropriate
Other useful organisations
counselling services. The website Northern Ireland helpline
has a database where you can 0800 85 85 85
search for a qualified counsellor. Isle of Man helpline
01624 642 404
The United Kingdom
(All helplines are open
Council for
Mon–Fri, 9am–8pm,
Psychotherapy (UKCP)
Sat–Sun, 11am–5pm.)
2nd Floor, Edward House,
www.smokefree.nhs.uk
2 Wakley Street,
Get free support, expert
London EC1V 7LT
advice and tools including
Tel 020 7014 9955
the Quit Kit to help you stop
Email [email protected]
smoking. Watch videos from
www.psychotherapy.org.uk real quitters on what helped
A membership organisation
them stop.
with over 75 training and
listing organisations, and over QUIT
6,600 individual practitioners. 20–22 Curtain Road,
Holds the national register
London EC2A 3NF
of psychotherapists and
Helpline 0800 00 22 00
psychotherapeutic counsellors, Bengali helpline
listing those practitioner
0800 00 22 44
members who meet
Gujarati helpline
exacting standards and
0800 00 22 55
training requirements.
Hindi helpline
0800 00 22 66
Stopping smoking
Punjabi helpline
0800 00 22 44 77
NHS Smokefree
Urdu helpline
England helpline
0800 00 22 44 88
0800 022 4 332
Turkish and Kurdish
Scotland helpline
helpline 0800 00 22 99
0800 84 84 84
(Thurs and Sun, 1–9pm)
Wales helpline
Email [email protected]
0800 169 0 169
99
Understanding cervical cancer
Counselling email
[email protected]
www.quit.org.uk
Provides support and practical
guidance to people who want
to give up smoking.
Money or legal advice
and information
or at citizensadvice.org.
uk Find advice online, in
a range of languages, at
adviceguideorg.uk
Citizens Advice Scotland
www.cas.org.uk
Personal Finance Society –
‘Find an Adviser’ service
42–48 High Road,
London E18 2JP
Tel 020 8530 0852
Email [email protected]
www.thepfs.org and
www.findanadviser.org
The UK’s largest professional
body for individual financial
advisers. Use the ‘Find an
Adviser’ website to find
qualified financial advisers
in your area.
Benefit Enquiry Line
Warbreck House, Warbreck
Hill Road, Blackpool FY2 0YE
Tel 0800 882 200
Textphone 0800 243 355
Email [email protected]
www.direct.gov.uk/
disabilitymoney
A benefits helpline offering
confidential advice and
information on benefits and
how to claim them. Has a
national service covering
Turn2Us
England, Scotland and Wales. 1 Derry Street,
London W8 5HY
Citizens Advice – England
Helpline 0808 802 2000
and Wales
(Mon–Fri, 8am–8pm)
Provides free, confidential,
Email [email protected]
independent advice on a
www.turn2us.org.uk
variety of issues including
Offers an online service to
financial, legal, housing and
help the millions of people
employment. Find your local
in financial need in the UK.
office in the phone book
Access information on the
100
benefits and grants available
to you from both statutory
and voluntary organisations.
In many cases, applications for
support can be made directly
from the website.
Other useful organisations
Support for carers
Carers Direct
PO Box 4338,
Manchester M61 0BY
Helpline 0808 802 0202
(Mon–Fri, 8am–9pm,
Unbiased Ltd
weekends, 11am–4pm)
117 Farringdon Road,
Email from the website
London EC1R 3BX
www.nhs.uk/carersdirect/
Consumer hotline
Pages/CarersDirectHome.
0800 085 3250
aspx
Email
Aims to offer all the
[email protected]
information you should need
www.unbiased.co.uk
as a carer to access the
Helps people search for details financial help you’re entitled
of local member independent to, as well as advice on getting
financial advisers via online
a break from caring, going to
searches at unbiased.co.uk
work and much more.
and moneyadviceservice.
Carers UK
org.uk
20 Great Dover Street,
London SE1 4LX
Tel 020 7378 4999
Carers’ line
0808 808 7777 (Weds–Thurs,
10am–12pm and 2–4pm)
Email [email protected]
www.carersuk.org
Offers information and
support to carers. Puts people
in contact with support groups
for carers in their area. Has
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Understanding cervical cancer
national offices for Scotland,
Wales and Northern Ireland:
Carers Scotland
The Cottage, 21 Pearce
Street, Glasgow G51 3UT
Tel 0141 445 3070
Email
[email protected]
www.carersuk.org/
scotland
Further
resources
Related Macmillan
information
You may want to order some
of the booklets and leaflets
mentioned in this booklet.
These include:
Carers Wales
• Cancer treatment and
River House, Ynsbridge
fertility – information
Court, Gwaelod-y-Garth,
for women
Cardiff CF15 9SS
Tel 029 2081 1370
• Controlling cancer pain
Email
• Controlling the symptoms
[email protected]
of cancer
www.carersuk.org/wales
• Coping with fatigue
Carers Northern Ireland
• Eating problems and cancer
58 Howard Street,
Belfast BT1 6PJ
• Healthy eating and cancer
Tel 028 9043 9843
Email [email protected]
• Help with the cost of cancer
www.carersuk.org/
• How are you feeling?
northernireland
• Getting travel insurance
when you have been
affected by cancer
• Giving up smoking
102
Further resources
• Lost for words: how to talk to
To order, visit be.macmillan.
someone with cancer
org.uk To order the fact
• Pelvic radiotherapy in
sheets mentioned in this
women: possible late effects booklet, call 0808 808 00 00.
This information is also
• Physical activity and
available online.
cancer treatment
• Relationships, sex and
fertility for young people
affected by cancer
• Self-employment and cancer
• Sexuality and cancer
• Talking about your cancer
• Talking to children when an
adult has cancer
• Understanding cancer
research trials (clinical trials)
Macmillan
audio resources
Our high-quality audio
materials, based on our
variety of booklets, include
information about cancer
types, different treatments
and living with cancer.
To order your free CD
visit be.macmillan.org.uk
or call 0808 808 00 00.
• Understanding cancer of
the womb (uterus)
• Understanding
cervical screening
• Understanding chemotherapy
• Understanding lymphoedema
• Work and cancer
• Working while caring for
someone with cancer
103
Understanding cervical cancer
Useful websites
•
how Macmillan can help,
the services we offer and
where to get support
A lot of information about
cancer is available on the
internet. Some websites
• how to contact our cancer
are excellent; others have
support specialists,
misleading or out-of-date
including an email form
information. The sites listed
to send your questions
here are considered by
nurses and doctors to contain • local support groups
search, links to other
accurate information and are
cancer organisations
regularly updated.
and a directory of
information
materials
Macmillan Cancer Support
www.macmillan.org.uk
• a huge online community
Find out more about living
of people affected by
with the practical, emotional
cancer sharing their
and financial effects of cancer.
experiences, advice
Our website contains expert,
and support.
accurate and up-to-date
information on cancer and
www.cancer.org
its treatments, including:
(American Cancer Society)
Nationwide community-based
• all the information from
voluntary health organisation
our 100+ booklets and
dedicated to eliminating
350+ fact sheets
cancer as a major health
problem. It aims to do this
• videos featuring realthrough research, education,
life stories from people
advocacy and service.
affected by cancer
and information from
www.cancerhelp.org.uk
medical professionals
(Cancer Research UK)
Contains patient information
on all types of cancer and has
a clinical trials database.
104
www.healthtalkonline.org
and
www.youthhealthtalk.org
(site for teens and young adults)
Both websites contain
information about some
cancers and have video and
audio clips of people talking
about their experiences of
cancer and its treatments.
www.cancer.gov
(National Cancer Institute –
National Institute of
Health – USA)
Gives comprehensive
information on cancer
and treatments.
www.nhs.uk
(NHS Choices)
NHS Choices is the online
‘front door’ to the NHS. It is
the country’s biggest health
website and gives all the
information you need to make
choices about your health.
www.nhsdirect.nhs.uk
(NHS Direct Online)
NHS health information
site for England – covers
all aspects of health, illness
and treatments.
Further resources
www.nhs24.com
(NHS 24 in Scotland)
Health information site
for Scotland.
www.nhsdirect.wales.
nhs.uk
(NHS Direct Wales)
Provides health information
for Wales.
www.n-i.nhs.uk
(Health and Social Care
in Northern Ireland)
The official gateway to health
and social care services in
Northern Ireland.
www.patient.co.uk
(Patient UK)
Provides good quality
information about health and
disease. Includes evidencebased information leaflets on
a wide range of medical and
health topics. Also reviews
and links to many health- and
illness-related websites.
www.riprap.org.uk
(Riprap)
Developed especially for
teenagers who have a parent
with cancer.
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Understanding cervical cancer
Questions you might like to
ask your doctor or nurse
You can fill this in before you see the doctor or nurse, and then
use it to remind yourself of the questions you want to ask and
the answers you receive.
1.
Answer
2.
Answer
3.
Answer
4.
Answer
5.
Answer
6.
Answer
106
Notes
Notes
107
Understanding cervical cancer
Notes
108
Disclaimer, thanks and sources
Disclaimer
We make every effort to ensure that the information we provide is accurate, but it
should not be relied upon to reflect the current state of medical research, which is
constantly changing. If you are concerned about your health, you should consult
a doctor. Macmillan cannot accept liability for any loss or damage resulting from
any inaccuracy in this information or third-party information, such as information
on websites to which we link. We feature real-life stories in all of our articles.
Some photographs are of models.
Thanks
This booklet has been written, revised and edited by Macmillan Cancer Support’s
Cancer Information Development team. It has been approved by our medical
editor, Dr Terry Priestman, Consultant Clinical Oncologist.
With thanks to: Ms June Allen, Macmillan Gynae-oncology Clinical Nurse
Specialist; Dr Peter Blake, Consultant Clinical Oncologist; Ms Eileen Fort,
Gynae-oncology Clinical Nurse Specialist; Dr Deborah Gregory, Consultant
Clinical Oncologist; Ms Pauline Humphrey, Consultant Radiographer in
Brachytherapy; Professor David Luesley, Professor of Gynaecological Oncology;
Dr Melanie Powell, Clinical Oncologist; Ms Lisa Punt, Macmillan Consultant
Radiographer in Gynaecological Oncology; and the people affected by cancer
who reviewed this edition.
Patient quotes sourced from Healthtalkonline – www.healthtalkonline.org
Sources
The American Joint Committee on Cancer (AJCC). Staging cervical cancer –
7th edition. 2010. UpToDate. www.uptodate.com (accessed 2011).
Cervical cancer: UK incidence statistics. Cancer Research UK (accessed
December 2011).
109
Understanding cervical cancer
De Los Santos J et al. Invasive cervical cancer: management of early stage
disease (FIGO 1A, 1B1, nonbulky 2A1) and special circumstances. 2011. UpToDate.
www.uptodate.com (accessed January 2012).
De Los Santos J et al. Management of stages 1B2, bulky 2A2, and locally advanced
disease. 2011. UpToDate. www.uptodate.com (accessed January 2012).
High-dose rate brachytherapy for carcinoma of the cervix. 2006. National Institute
for Health and Clinical Excellence (NICE).
Plante M. Patient information: fertility preservation in women with early stage
cervical cancer. 2011. UpToDate. www.uptodate.com (accessed January 2012).
110
Can you do something to help?
We hope this booklet has been useful to you. It’s just one of our
many publications that are available free to anyone affected by
cancer. They’re produced by our cancer information specialists
who, along with our nurses, benefits advisers, campaigners and
volunteers, are part of the Macmillan team. When people are
facing the toughest fight of their lives, we’re there to support
them every step of the way.
We want to make sure no one has to go through cancer alone,
so we need more people to help us. When the time is right for you,
here are some ways in which you can become a part of our team.
5 ways
you can someone
hElP with
cAncer
Share your cancer experience
Support people living with cancer by telling your story,
online, in the media or face-to-face.
Campaign for change
We need your help to make sure everyone gets the right support.
Take an action, big or small, for better cancer care.
Help someone in your community
A lift to an appointment. Help with the shopping.
Or just a cup of tea and a chat. Could you lend a hand?
Raise money
Whatever you like doing, you can raise money to help.
Take part in one of our events or create your own.
Give money
Big or small, every penny helps.
To make a one-off donation – see over.
Call us to find out more
0300 1000 200
macmillan.org.uk/getinvolved
Please fill in your
personal details
Don’t let the taxman
keep your money
Mr/Mrs/Miss/Other
Do you pay tax? If so, your gift will
be worth almost a third more to us –
at no extra cost to you. All you have
to do is write your name below, and
the tax office will give 25p for every
pound you give.
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for that tax year.
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prior to this year and all
donations I make in future
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Please cut out this form and return it in an envelope (no stamp required) to:
Supporter Donations, Macmillan Cancer Support, FREEPOST LON15851,
89 Albert Embankment, London SE1 7UQ 27530
Cancer is the toughest fight most of us
will ever face. If you or a loved one has
been diagnosed, you need a team of
people in your corner, supporting you
every step of the way. That’s who we are.
We are the nurses and therapists helping you through
treatment. The experts on the end of the phone.
The advisers telling you which benefits you’re entitled to.
The volunteers giving you a hand with the everyday
things. The campaigners improving cancer care.
The community supporting you online, any time.
The fundraisers who make it all possible.
You don’t have to face cancer alone.
We can give you the strength to get through it.
We are Macmillan Cancer Support.
Questions about living with cancer?
Call free on 0808 808 00 00 (Mon–Fri, 9am–8pm)
Alternatively, visit macmillan.org.uk
Hard of hearing? Use textphone
0808 808 0121, or Text Relay.
Non-English speaker? Interpreters available.
© Macmillan Cancer Support, 2012. 12th edition. MAC11648.
Next planned review 2014. Macmillan Cancer Support, registered
charity in England and Wales (261017), Scotland (SC039907) and
the Isle of Man (604).
Printed using sustainable material. Please recycle.