Managing the symptoms of advanced cervical cancer

If you have had treatments for cervical cancer in the past, they can also cause long-term effects. These can include:

• early menopause
• bladder and bowel problems
• skin changes
• bone problems 
• swelling in the groin and legs (lymphoedema).

It can be hard to tell the difference between effects from previous treatments and new symptoms caused by advanced cervical cancer. 

If you haven’t been diagnosed with advanced cervical cancer, try not to panic that every symptom is a sign of it. You should tell your healthcare team so they can assess the problem and give you the treatment or care you need. 

Read about treatment for cervical cancer >

These symptoms may also be caused by other health issues that you have. It’s important to talk to your GP or healthcare team as soon as possible so they can assess and find the cause of the problem.

If you have been diagnosed with advanced cervical cancer or your cancer has come back, you will have a multidisciplinary team (MDT). This team of experts will help treat the cancer, as well as managing any symptoms. Your clinical nurse specialist (CNS) is usually your main point of contact, so you should tell them or another member of your MDT.

You may have been referred to a palliative care team. These are experts who specialising in managing advanced cervical cancer symptoms. If you haven’t been referred, you can ask your MDT about it.    

Read about your MDT >

We know that vaginal bleeding for a long time or on and off can be very upsetting and disruptive. Your healthcare team can give you urgent treatment to make it stop. They can also assess whether there is anything making the bleeding worse – for example, any medications you are taking.  

There are different treatments for vaginal bleeding: 

• Vaginal packing. This involves putting rolls of gauze bandages inside your vagina. You may need to have a catheter put into your bladder to help drain wee when the packing is in place. Both the vaginal packing and the catheter are usually temporary.  
• A short course of radiotherapy.
• Surgery. 
• Losing lots of blood can cause anaemia, which means you may feel very tired and breathless because of a lack of red blood cells.  You may need to have a blood transfusion to help with this.

It’s common to feel unusually tired or exhausted when you have advanced cervical cancer. This is sometimes called fatigue. 

Fatigue can be caused by the cancer itself, other symptoms of the cancer or treatments. Your healthcare team will assess you to try and work the cause. They can also give you specific treatments – for example, a blood transfusion may help if you are tired due to anaemia (low red blood cell levels).  

Here are some tips that can help monitor and manage fatigue:

• Get support for other symptoms that might be causing the fatigue, such as pain or feeling sick. 
• Use a fatigue diary or app to plan your time, prioritise activities and keep track of your energy levels. You can download a diary from the Macmillan Cancer Support website >
• Do some gentle exercise. This kind of activity can increase your energy levels. It could be exercises from your bed or chair, or a short walk – it depends what you feel up to. You can ask your healthcare to refer you to a physiotherapist who can help.
• Stick to a bedtime routine. Knowing when you will go to sleep and using the time before to unwind and relax can help with sleep problems.
• Get support for your emotional wellbeing. Anxiety and depression can cause sleep problems and fatigue, so it’s important to talk to your healthcare team about getting support for your mental health.

Pain is a common symptom of advanced cervical cancer.       

Living with pain can be difficult, but most pain can be controlled. Tell your healthcare team about any pain you’re experiencing as soon as possible. They may be able to suggest ways to help:

• Some general treatments for advanced cervical cancer can sometimes help to shrink the cancer, which may reduce pain. These includes chemotherapy, radiotherapy and a drug called Avastin (bevacizumab). 
• Sometimes having radiotherapy to specific parts of the body where cancer may have spread, such as the bones, can also help relieve pain.  
• Pain medication can also help. There are different types of medication available, depending on the type of pain you have.  

Some people find that complementary and alternative treatments can help them deal with pain. This might include massage, relaxation therapy and acupuncture. Many complementary therapies are safe, but some may affect cancer treatment. Talk to your healthcare team before trying a complementary therapy. Hospitals, hospices and local charities may offer some complementary therapies for free. 

If pain is having an impact on your emotional wellbeing, getting emotional support may also help you feel better. 

Read about cervical cancer and mental health >

Advanced cervical cancer may cause changes to your bowel habits including:

• loose or runny poo (diarrhoea) 
• not being able to poo (constipation).  

Remember that these symptoms may also be an effect of treatment you may have had in the past, like radiotherapy. Or a side effect of medicines, such as painkillers.  

Your healthcare team can assess you and figure out what’s causing the problems. They may be able to prescribe you medicines to help relieve your symptoms.  

It might also help to make some simple changes to your diet, drink enough fluids and move around as much as possible 

Read about bowel changes >

Feeling or being sick and losing your appetite can make you feel tired and affect your mood, so it’s important to get help as soon as possible.

If you are feeling or being sick, your healthcare team will need to figure out what is causing it so you can get the right treatment.  Sickness may be caused by:

• the advanced cervical cancer itself
• a side effect of treatment like chemotherapy
• because of problems with your kidneys and ureters that can be treated. 

Depending on the cause, you may be able to have anti-sickness medication, as well as other treatments. 

Advanced cervical cancer may mean you feel sick or cause other effects that can make you lose your appetite. You may lose weight anyway because of the cancer and not feel like eating as much.

Making some simple changes to your diet may help with feeling sick and getting your appetite back. It can also boost your calories and protein to:

• help with weight loss 
• make you feel generally better in yourself
• have more energy.

It is important to speak with your healthcare team before changing your diet. Ask for a referral to a dietician.

Vaginal discharge is fluid or mucus that comes out of your vagina. Advanced cervical cancer, treatment or infection may cause it to become brown or unpleasant smelling.   

This can be distressing, but there are things that can help, such as medicines to treat any infection or surgery if it is caused by a fistula. Other tips for managing unpleasant vaginal discharge include:    

• sitting in a warm bath
• drying yourself carefully after bathing or showering
• using zinc oxide cream or petroleum jelly to prevent and soothe any itchiness. 
• changing your underwear and pads regularly – charcoal panty liners or underwear may help reduce the smell from the vaginal discharge. 

If the tubes from your kidney to your bladder (the ureters) get blocked by cancer, wee can build up inside the kidney. This can make you seriously ill if it is not treated. 

You may need to have surgery that puts a small tube (stent) inside the ureters to widen them.   

Another option is to have a tube (nephrostomy) into your kidney through the skin of your back. It drains the wee out of the kidney and into a bag. A nurse can visit you at home to help you manage the bag. If this is successful, you may be able to have stent put in the ureters instead.

A fistula is a small connection that develops between two areas of the body. 

It is rare to get a fistula if you have advanced cervical cancer, but may happen. A fistula may form between the bladder and the vagina, or the vagina and back passage (rectum).   

A fistula means that poo or wee can leak through the vagina. This can cause an unpleasant smelling vaginal discharge. It may be treated by an operation called a colostomy or ileostomy, where a loop of bowel is brought up through the stomach (stoma) and poo is collected in a bag on the stomach.  

Your lymph nodes are small glands that are part of your lymphatic system. This is the system that helps drain fluid away from the tissues in your body. 

If cervical cancer has spread to your lymph nodes or you have had your lymph nodes removed, this can cause parts of your body to become swollen. This called lymphoedema.     

We have detailed information about lymphoedema on another page, including ways to manage it and where to get support.

Read about lymphoedema >

If you have advanced cervical cancer, it can have a big impact on your emotional wellbeing. You may be more likely to have depression and anxiety.  

You are going through a lot, so this is understandable. It may be difficult, but it’s important to ask for help. Your healthcare team, especially your CNS, will be able to offer emotional support. They can also refer you to an expert in mental health, like a clinical psychologist, who can work with you to explore your feelings. If you would prefer to choose who you see, you could consider private counselling. 

Read about mental health and cervical cancer >