Supportive care for uterine cancer

Supportive care helps with the physical, practical, emotional and spiritual challenges of cancer. This important part of cancer care focuses on improving the quality of life of people with cancer and their loved ones, especially after treatment has ended.

Adjusting to life after treatment is different for everyone. Your recovery will depend on many different factors, such as where the cancer was in your body, the stage of the cancer, the organs and tissues removed during surgery, the type of treatment and side effects.

If you have been treated for uterine cancer, you may have the following concerns.

Self-esteem is how you feel about yourself. Body image is how you see your own body. They are often closely linked. Uterine cancer and its treatments can affect your self-esteem and body image. Often this is because cancer or cancer treatments change your body in different ways, such as:

• scars
• hair loss
• skin problems
• changes in body weight
• loss of body parts, such as your uterus, fallopian tubes and ovaries
• loss of body function, such as the ability to control when you have to use the bathroom (called incontience)
• having a stoma after an ostomy
• sexual problems, such as vaginal dryness or loss of interest in having sex

Some of these changes can be temporary. Others can last for a long time or be permanent.

But treatment can affect your self-esteem or body image even if it doesn’t affect how you look. Other people may not be able to see changes to your body, but you may still worry about how they now see you. For example, some people who had treatment for uterine cancer may feel less like a woman or less feminine because they no longer have a uterus or had vaginal reconstruction. This may affect your self-esteem, making you feel angry or upset, afraid to go out or worried that others will reject you.

Find out more about coping with body image and self-esteem worries.

Some treatments for uterine cancer can cause side effects that make having sex painful, difficult or undesirable. Many people continue to have strong, supportive relationships and a satisfying sex life after uterine cancer. If sexual problems occur because of uterine cancer treatment, there are ways to manage them.

Some of the side effects of cancer treatment that can make having sex painful or difficult include:

• vaginal dryness, caused by radiation therapy and hormone therapy
• vaginal narrowing (also called vaginal stenosis), caused by scarring from radiation therapy or surgery
• treatment-induced menopause

Some people may lose interest in having sex. It’s common to have a decreased interest in sex around the time of diagnosis and treatment.

When a person first starts having sex after treatment for uterine cancer, they may be afraid that it will be painful or that they will not have an orgasm. The first attempts at being intimate with a partner may be disappointing. It may take time for the couple to feel comfortable with each other again. Some people 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.

Most people who have treatment for uterine cancer identify as women. If you do not identify as a woman, the sexual problems discussed here may not reflect your experience after uterine cancer. Your healthcare team can help to answer any questions you may have about sex after uterine cancer.

Find out more about sex, intimacy and cancer, and sexual problems – female sex organs.

Uterine cancer and treatments for it often cause damage to, or the loss of, your reproductive organs, including your uterus, fallopian tubes and ovaries. This can affect your fertility, which is your ability to conceive (get pregnant) and carry a pregnancy to term.

Many people who have treatment for uterine cancer will have fertility problems. Depending on the treatment you have, these problems may be temporary or permanent.

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.

Some people may have treatment for uterine cancer that preserves their ability to conceive and carry a pregnancy. If you cannot have this kind of treatment, your healthcare team may suggest other fertility-preservation techniques that can help you have children after uterine cancer even if you can’t get pregnant.

Taking steps to preserve your fertility before treatment starts gives you the best chance of conceiving when you are ready.

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 you develop lymphedema after treatment for uterine cancer, your healthcare team will suggest ways to manage it. This may include:

• changes to your physical activity habits to help increase drainage of lymph fluid
• keeping your legs elevated whenever possible to help fluid drain out
• wearing compression bandages or sleeves to reduce how much fluid can build up in the tissue
• massage to help move lymph fluid through the vessels (called lymphatic massage)
• changes to your diet

Find out more about lymphedema.

An ostomy is a surgical procedure that creates a stoma (artificial opening) that opens from an organ or structure to the outside of the body. You may have an ostomy if you have a pelvic exenteration to treat uterine cancer.

In a colostomy, the surgeon connects part of your large intestine (colon) to a stoma in your abdomen. After a colostomy, stool (poop) will leave your body through the stoma and empty into a bag (called a colostomy bag) you wear over your stoma. You’ll have a colostomy after uterine cancer if you’ve had your rectum removed as part of a pelvic exenteration.

In a urostomy, the surgeon creates a pouch with a piece of your small intestine to drain urine (pee) and then connects it to your ureters. This pouch is then connected to a stoma in your abdomen. After a urostomy, urine will leave your body through the stoma and empty into a bag (called a urostomy bag) you wear over your stoma. You’ll have a urostomy after uterine cancer if you’ve had your bladder removed as part of a pelvic exenteration. A urostomy is a type of urinary diversion.

If you had both your bladder and rectum removed, you will have 2 ostomies and 2 stomas.

Learning to live with an ostomy and care for a stoma takes time and practise. Specially trained healthcare professionals (called enterostomal therapists) teach people how to live with their ostomies and care for their stomas. Local or national ostomy groups and associations can also give you support and information.

Find out more about living with a colostomy and urostomy.

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