Supportive care for uterine cancer

Supportive care helps women meet the physical, practical, emotional and spiritual challenges of uterine cancer. It is an important part of cancer care. There are many programs and services available to help meet the needs and improve the quality of life of people living with cancer and their loved ones, especially after treatment has ended.

Recovering from uterine cancer and adjusting to life after treatment is different for each person, depending on the extent of the disease, the type of treatment and many other factors. The end of cancer treatment may bring mixed emotions. Even though treatment has ended, there may be other issues to deal with, such as coping with long-term side effects. A woman who has been treated for uterine cancer may have concerns about the following.

How a person feels about or sees themselves is called self-esteem. Body image is a person’s perception of their own body. Uterine cancer and its treatments can affect a woman’s self-esteem and body image. Often this is because cancer or cancer treatments may result in body changes, such as:

• scars
• hair loss
• skin problems
• changes in body weight
• sexual problems
• an ostomy
• urinary or bowel problems

Some of these changes can be temporary, others will last for a long time and some will be permanent. For many women, body image and their perception of how others see them are closely linked to self-esteem. Loss of self-esteem may be a real concern for them and can cause considerable distress. Even though the effects of treatment may not always be visible to other people, body changes can still be troubling. Some women may be afraid to go out or that others will reject them. They may feel angry or upset.

A woman may feel differently about her body and herself as a woman, especially after a hysterectomy or pelvic exenteration. She may feel less like a woman or less feminine because she no longer has a uterus or has had vaginal reconstruction. A woman may also feel self-conscious because the way she urinates or has a bowel movement is different after a pelvic exenteration.

Find out more about self-esteem and body image and managing symptoms and side effects.

Some cancer treatments can cause sexual problems for women that make sex painful or difficult. For example, radiation therapy to the pelvis can cause vaginal dryness. Scarring after radiation therapy to the pelvic area or some surgeries for uterine cancer can also cause vaginal narrowing (also called vaginal stenosis). Some treatments can cause women to enter menopause early (called treatment-induced menopause).

Some women may have other sexuality problems, such as a loss of interest in sex. It is common to have a lower sex drive around the time of diagnosis and treatment.

There are ways to manage most sexual problems that develop because of treatments for uterine cancer. When a woman first starts having sex after treatment, she may be afraid that it will be painful or that she will not have an orgasm. It may take time for partners to feel comfortable with each other again, and the first attempts at being intimate with a partner may be disappointing. Some women and their partners may need counselling to help them cope with these feelings and the effects of cancer treatments on their ability to have sex.

Find out more about sexuality and cancer, sexual problems for women and treatment-induced menopause.

Fertility problems can occur after treatment with radiation therapy or chemotherapy for uterine cancer. Women who have had a hysterectomy will not be able to become pregnant.

Before you start any treatment for uterine cancer, talk to your healthcare team about possible side effects that may affect your ability to have children after treatment. You can work with your healthcare team to discuss and plan fertility options before cancer treatment begins.

Find out more about fertility problems and how you can manage them.

Lymphedema is a chronic form of swelling that occurs when lymph fluid builds up in soft tissues. It usually occurs in parts of the body where large numbers of lymph nodes have been removed.

You may have lymphedema in your legs if lymph nodes were removed from your pelvis during surgery to treat uterine cancer. Lymphedema is more likely to occur if you were also given radiation therapy to the pelvis.

If lymphedema develops, your healthcare team can suggest ways to help prevent further fluid buildup and reduce swelling as much as possible. This may include elevating the limb, exercise, physical therapy and pain management. You can also ask for a referral to a healthcare professional who specializes in managing lymphedema.

Find out more about lymphedema.

Many women who are treated for uterine cancer worry that the cancer will come back, or recur. It is important to learn how to deal with these fears to maintain a good quality of life.

In addition to the support offered by the treatment team, a mental health professional, such as a social worker or counsellor, can help you learn how to cope and live with a diagnosis of uterine cancer.

Although uncommon, a different (second) cancer may develop after treatment for uterine cancer. While the possibility of developing a second cancer is frightening, the benefit of treating uterine cancer with chemotherapy or radiation therapy usually far outweighs the risk of developing another cancer. Whether or not a second cancer develops depends on the type and dose of chemotherapy drugs given and if radiation therapy was also given. The combination of chemotherapy and radiation therapy increases the risk of second cancers.

Women who have radiation therapy to the pelvis have a small risk of developing a second cancer in the area treated with radiation. This area can include the colon, rectum, anus or bladder.

Women who have chemotherapy for uterine cancer can develop a second cancer at any time, but it usually occurs up to 10 years after treatment. The most common cancer that develops in women treated with chemotherapy for uterine cancer is acute myelogenous leukemia (AML).

Living a healthy lifestyle and working with your healthcare professional to develop a wellness plan for staying healthy may help lower the risk of second cancers. Routine screening to find a second cancer early, being aware of changes in your health and reporting problems to your doctor are also important parts of follow-up care after cancer treatment.

An ostomy connects an internal cavity to an opening (stoma) on the abdomen. Women who have a pelvic exenteration will have the bladder, rectum or both removed. A urostomy allows urine to pass out of the body and a colostomy allows stool to pass out of the body. Women who have the bladder and rectum removed will have 2 ostomies.

Many women can adapt to and live normally with an ostomy, although they have to learn new skills and how to care for it. Specially trained healthcare professionals (called enterostomal therapists) teach people how to care for their ostomies.

Find out more about living with an ostomy.

To make the decisions that are right for you, ask your healthcare team questions about supportive care after treatment.