Cervical Cancer
Hysterectomy for cervical cancer
A hysterectomy or a radical hysterectomy is a standard surgical treatment for early-stage cervical cancer. It involves removing the womb (uterus) and cervix, the lymph nodes in the pelvis, and might also include removal of the fallopian tubes and ovaries.
A hysterectomy is typically only suitable for women with early-stage cervical cancer (stages 1A1-1B2; see Cancer Research UK for more information about stages and grades for cervical cancer).
A radical hysterectomy is the removal of the uterus, cervix, tissue around the cervix (parametrium), and the upper part of the vagina. The pelvic lymph nodes are also usually removed as part of this operation.
Depending on the woman’s age and the type of cancer, removal of the ovaries and fallopian tubes may also be recommended.
Most women with cervical cancer are treated with a radical hysterectomy. Sometimes some of the abdominal lymph nodes may be removed in addition to the pelvic lymph nodes during a radical hysterectomy.
Surgeons prefer to do this operation laparoscopically for early cervical cancers as it means less time in hospital and a shorter recovery time, but it can only be done in specialist cancer units with specially trained clinicians.
Decisions about whether to have the ovaries removed during surgery are discussed with the consultant before the operation.
We interviewed one woman with early-stage cervical cancer who chose to have a hysterectomy (removal of the womb, cervix and uterus) and had her ovaries removed as a precautionary measure (see interview 01).
Experiences with hysterectomy for cervical cancer
Several women described their experience before surgery.
After surgery, women usually woke up in intensive care. They were connected to an intravenous drip of fluid and salts until they were able to eat and drink normally and had a catheter (a small tube put in the bladder connected to a small bag to collect urine) in place with drainage tubes coming from the wound.
Describes her experiences prior to hysterectomy.
Describes her experiences prior to hysterectomy.
A few experienced very little post-operative pain. Others did have abdominal pain but some said this had been effectively managed by either an epidural (a small needle inserted in to the spine prior to surgery) and/or by PCA (patient-controlled analgesia, a machine which releases controlled doses of medication at the push of a button). Some experienced problems with their pain control.
The epidural effectively managed her pain after her hysterectomy and she was surprised by how quickly she recovered.
The epidural effectively managed her pain after her hysterectomy and she was surprised by how quickly she recovered.
I was very, very surprised. They gave me an epidural for I think about 24 hours and so I didn't have any pain at all and then after that again they were giving me pain killers but I didn't actually feel the need for it. I think I was very surprised at how numb my abdomen had become and I just think a nice blessing seems to be I have a body that seems to numb itself. So it actually wasn't half as painful and half as difficult as I expected the operation to be.
Describes the pain she experienced after her hysterectomy.
Describes the pain she experienced after her hysterectomy.
Describes an episode where she had problems with her pain relief after her hysterectomy.
Describes an episode where she had problems with her pain relief after her hysterectomy.
Explains why she changed her type of pain relief when she realised morphine was making her feel sick.
Explains why she changed her type of pain relief when she realised morphine was making her feel sick.
The anaesthetist comes and gives you the option of having, I don't know what they're called but they're machines that will deliver morphine on your demand after you're hooked up to it and you can actually press the button to give you pain relief by morphine after you've had the operation. Which you think is a fantastic idea and it's only afterwards that you discover that morphine makes you feel sick as a dog. And nobody tells you that, nobody tells you that slightly useful bit of information. So you go through about a day of feeling sick as a dog before somebody says "Oh it's the morphine," and I then decided to stop using the morphine and just let me them use some other perfectly good pain killers which apparently are actually anti inflammatories as well so they're really good. They can actually use other tablets which are good pain killers and have anti inflammatory properties. So they give you information by which to make an educated choice but they don't actually give you the whole story which I always thought that's the one thing I'd tell people, don't use too much morphine because you'll feel dreadful and there's lots of other ways they can deal with the pain.
Many described feeling very weak and tired, and some felt nauseous after their operation, but within 3 to 4 days they were able to walk around. In contrast, one woman who had considerable post-operative pain (see below and interview 07) said she took longer to recover.
A few found the removal of their drainage tubes painful; others didn't.
Describes her recovery in hospital after her hysterectomy.
Describes her recovery in hospital after her hysterectomy.
She didn't find it painful when the drains were being removed.
She didn't find it painful when the drains were being removed.
People recover at different speeds from surgery. Some were playing sports, cycling and horse-riding, and going on walking holidays within 3 months.
Others found they needed longer to recover. Some had found it very tiring returning to work.
Describes why she felt it important not to overdo things after her hysterectomy.
Describes why she felt it important not to overdo things after her hysterectomy.
Describes what it was like going back to work after her hysterectomy and suggests doing this gradually.
Describes what it was like going back to work after her hysterectomy and suggests doing this gradually.
Going back to work again, I wish I'd gone back part time. I did go and see the occupational therapist but I thought I was going to be fine. And I'd had three months and one week off but I was so tired after the first day, the first full day. I also felt a bit guilty that I'd had too long off but the advice I'd give is don't feel like that because you really don't want to rush back as soon as you can sit at your desk. You, it was psychological as well as physical getting better. And so the fact that the last month I was going out on my bike during the day, I needed that to get stronger because like I say after the first day at work which is an office job I had the following day off as annual leave because I was just so tired. I should really have gone back, phased going back, I should have done like four hours a day for a week, that kind of thing, but I didn't I went back full time.
Some women who had a Wertheim's hysterectomy had both their ovaries removed and they started menopause, but many found that hormone replacement therapy (HRT) meant that they had few, if any, menopausal symptoms.
A few described their emotions as being 'very up and down' for a few days after surgery because of hormonal changes.
Describes how her emotions were very up and down after her hysterectomy because of hormonal changes.
Describes how her emotions were very up and down after her hysterectomy because of hormonal changes.
A few women experienced no long-term side effects apart from having a small scar.
Others did have some side effects, including initial or long-term bladder problems. Some needed a catheter for a short while after leaving hospital.
Describes the bladder problems she had for one month after her hysterectomy.
Describes the bladder problems she had for one month after her hysterectomy.
And when did that all sort itself out?
Probably about a month after the operation so a few weeks, yeah.
Describes the problems she had with her bladder after her hysterectomy.
Describes the problems she had with her bladder after her hysterectomy.
I felt that was a major major setback for me because instead of coming home to feel that I'm getting better I felt that I was coming home with this catheter in. So I had that in for a couple of weeks and I found that very hard. I didn't find changing the thing hard, that was easy, but I just felt like an invalid. Instead of feeling well I'm getting better, I felt like an invalid.
And I had to go back in a fortnight later they said they would try to remove it. See how things were going so they said I'd stay in overnight to see whether my bladder worked and I was very worried about it. Very concerned that my bladder wouldn't work. So I went in and they took the catheter out and my bladder wouldn't work and I lay there all night just getting frantic. I didn't sleep a wink. I was so upset I just thought my bladder isn't working, it's not going to work, it's never going to work and I'm going to have to spend the rest of my life with a catheter in. And I was absolutely totally distraught. Phoned my other half first thing next morning in hysterics and said "My bladder is not working," and the nurse obviously had been in to see me and talk to me and the senior registrar came and he said "Look," he said "we're going to keep you in for another night," he said "you can stay in," he said "part of the problem is that you're so upset about it, you're actually causing part of the problem yourself." He said "Try to relax and drink lots." I said "I've been drinking gallons of the stuff." And he said "We'll see what happens." And he was very calm and tried to calm me down. And thank goodness that afternoon suddenly I was able to pee normally. And I went out to find my nurse, I'm not allowed to tell you her name but she was, and she gave me a big hug. So we had a hug because I'd peed properly and I was just so relieved. I felt that when I came home then, the next day, that I could start my recovery properly and I did.
Long-term bladder problems are unusual, but some women did experience these. A woman described the unusual long term bladder problems she experienced.
A few experienced numbness in the area of the surgery and a few experienced bouts of constipation. One had soreness in her throat for many months. Another had considerable post-operative pain but she found that a TENS unit helped (see also 'Complementary approaches for cervical cancer')
A third experienced severe constipation, ovarian cysts, a nerve granuloma, and reflux oesophagitis, which she believed resulted from her hysterectomy.
She experienced a change in how her bladder works after her hysterectomy.
She experienced a change in how her bladder works after her hysterectomy.
So you didn't have the feeling that you needed to go?
No and I still don't fully. I've replaced with it other things, I've realised I've replaced it with other feelings. When I know my stomach feels full that's when I go, so I've sort of replaced it with a different way round. And I think it's unlikely that people have that. I think they said it doesn't normally happen that it never comes back. I think it's normally just temporary but for some reason it can't have reconnected somewhere down there. I think it's where they cut the urethra, its just whether that re-forms, the nerves for some reason didn't sort of reconnect for me.
Her post-operative pain from her hysterectomy affected her ability to drive her car daily to work but a TENS unit has helped reduce her pain.
Her post-operative pain from her hysterectomy affected her ability to drive her car daily to work but a TENS unit has helped reduce her pain.
I went back to work full time. I started from home because I had a very understanding employer and I started from home sort of part time and then I went back to the office part time but worked full time some from home and then in the October, I had the operation at the end of May, in October I went back to the office full time. But I was in a terrible amount of pain and I don't know why I put myself through it now because I should have realised I'm on sort of maximum doses of pain killers and in agony all the time but determined to get on and do my job and ignore it.
I went back to the consultant and she recommended some treatment, which was a sort of heat treatment thing called Curapuls. I went to the local Physiotherapy Department for that quite close by. And they warned me that might make it feel worse to start with which it did. It made it feel a lot worse but it didn't start feeling better so in the end I stopped that before the end of the treatment because it was just too much for me.
But around that time I actually rang up one of my colleagues in the morning and said I couldn't come into work that day and she sort of made me realise that I was going on too much and so I actually had to take another six weeks off sick leave from work. Because the first time, when I had my operation the company were very good and kept me on full pay which was wonderful but on the other hand I felt very much obliged to get back to work as soon as possible so the second time I actually took sick leave which meant the pressure was off a bit.
Following that I arranged to work, I set up an office from home and I arranged to work from home more or less all the time rather than try and go into the office. I went in two days a week instead of five days a week and that helped because I found, even now driving is one of the things that really brings on the pain and it's a very hard thing to understand unless you're familiar with pain cycles. If you do it one day it's fine you can cope with it, if you have to do something like that three days in a row it builds up and then takes quite a while to subside again so it's a question of managing it really. As I say even now nearly eight years later if I overdo it, I get really bad pain again which is very distressing after all this time because you think you're over it and then it brings it all back again.
I have used a TENS unit actually for the pain which has been very helpful, do you know what that is?
Tens?
It stands for, what does it stand for, it's something subcutaneous nerve or whatever. Tens TENS that's initials. What is it is little electrodes, a battery, little electrodes which vibrate. Basically even though it's scientifically accepted it actually works sort of like acupuncture principal in a way and it does for some reason it vibrates the nerve endings and manages to relieve the pain. People use it for back pain a lot as well.
Where did you find out about that?
I had read about it, I had, over my sort of search for help I had contact with all sorts of people. There's a Pain Association and they sent me a lot of information which was probably where I heard about that. When I went to pain clinic they went through all these various things further injections which was one of the options which I didn't want to take up and drugs as well. I mean I don't want to keep on taking pain killers all the time obviously. This was one of the things they suggested, I tried it and it actually left me with it to use when I need which is great.
Some initially felt aware during sexual intercourse that their vagina felt like it had been shortened (see also 'Sex & sexuality').
Three women developed lymphoedema in the leg or below the scar in the groin area (a swelling caused by the removal of lymph nodes) and massage and support underwear or stockings had helped.
One woman found that her operation had restricted her mobility a little while, but another was able to go on walking holidays again one year after her surgery.
A third was able to wear jeans, swim, and play badminton again 10 months after her operation.
Describes how she was affected by lymphoedema in her leg and that massage and support stockings have helped.
Describes how she was affected by lymphoedema in her leg and that massage and support stockings have helped.
So I arranged a holiday just with my husband, going to Tuscany, doing a bit of sightseeing and walking as part of a group. And I'd started going back to the gym after the operation, obviously gradually, and I was doing OK, although my left leg was, it stiffened up when I did exercise. And I told the consultant and he said 'Oh well it could be that your channels are finding new ways,' but he said 'It'll get better.' So I didn't worry too much, or find out very much. And I went on this holiday and it involved doing some walking, obviously and no sooner had I set off walking and my leg began to hurt and over the period of the week, well over a few days it really expanded and it was painful and it was very, it was like it weighed twice as much as the other one. And it made walking difficult, and I didn't know what it was, and so yes I was worried that it was cancer. I just didn't know why it had swollen up so much and it was really tight because it had swollen the skin was really tight, my muscles were tight and I was miserable. And I didn't tell the other people on holiday I'd had cervical cancer because I didn't want to be treated differently. And so I came back from that holiday, which wasn't a holiday. I wanted it to increase my confidence so that I felt like I was getting back to my normal life and I was sort of "normal", and it just did the opposite, it took away my confidence. And I had my normal appointment with the consultant a few days after I came back from holiday and he said 'Oh yes it's the lymph fluid that's collecting there, I'll take it out.' And so he inserted a needle, which wasn't painful, gave me a little local anaesthetic and took out about a coffee cup full of fluid which I'd had in me from going on holiday, which had blocked the whole lymphatic drainage system. So no wonder my leg had swelled up. But I didn't know that, no one had explained to me that this was happening.
I also went to my own GP and said 'my leg has got stiff I'm having problems with it.' And he said 'I'll send you to physiotherapy.' Now the local hospital just down the road contacted me within a few days and made an appointment for me. And they said 'Oh yes, its your lymphatic drainage,' because I told them about having the fluid out and 'We need to massage it,' and I was then going twice a week. But by then I was back to work, so it wasn't easy to go twice a week. I went twice a week for about four weeks and they taught me how to do my own massage, but not lymphatic massage, that's a different thing. It was actually just fairly, fairly vigorous massage but with the onus on going upwards and trying to get the fluid here moving around my body and not accumulating and causing a blockage, like plumbing, they did explain that. And it was good to go really, it did make a difference. And then I went down to see them once a week and I don't go anymore now. I was taught how to do that myself. But at the same time I was waiting to see the lymph nurse and it ended up being about two months. I went to see her and she said well I would need some support stockings, well really just one for my left leg, which compresses your leg and helps the drainage.
She couldn't wear trousers for six months because of her lymphoedema.
She couldn't wear trousers for six months because of her lymphoedema.
More information about options for radical hysterectomy surgery may be found at Cancer Research UK and Macmillan Cancer Support (see ‘Resources and Information’).
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