For patients undergoing treatment for cervical cancer

Who is this information for? What is its aim?

You have attended our gynaecology-oncology clinic in the Rosie hospital, Addenbrooke’s. You will have probably had some tests done prior to this appointment and maybe unsure of what is happening at this stage.

The aim of this booklet is to provide you and your support team with information regarding what has been discussed in clinic.

You will be seen by one of our consultants with a clinical nurse specialist (CNS), together with anyone you may wish to bring with you. They may ask you some questions about your general health and well-being, complete a physical examination and an internal examination if required and talk through your options with you.

We aim to answer all of your questions during your appointment but this can be an overwhelming time with lots of information given.

It will outline background information about your diagnosis, surgery options, what to expect before and after your surgery and the recovery process.

If you have any further questions or need further support please do not hesitate to contact us.

Your diagnosis

Being told you have cancer requiring treatment will mean you may experience many different emotions - for example shock, fear, anger, a sense of helplessness and a loss of control. You may not believe this is happening if you don’t feel ill.

You may be frightened about the future and what this may hold for you. These are all normal reactions which may affect you, your family and friends at this time.

We understand this is a very difficult time for you. We aim to keep you and your family informed about your treatments. These will be discussed with you on an individual basis at every stage.

It can be very difficult to take everything in when you are first told about your cancer diagnosis. This booklet is designed to supplement the information given to you by other members of the healthcare team involved in your care.

If you have any concerns or questions about your diagnosis or treatment please contact us. We will try to resolve any issues you may have.

What is cancer?

The body is made up of groups of specialised cells - for example skin, liver, bone, breast cells. Worn-out cells are replaced by new ones. The growth and repair of these occurs in an organised and controlled manner. The right numbers of new cells are produced to replace the old ones.

This process can go wrong. One cell may develop its own pattern of growth and division, producing more and more abnormal cells. These abnormal cells may eventually develop into an abnormal mass of tissue or form a lump. Tumours can be benign or malignant. The pathologist can tell by examining cells whether they are benign or malignant.

Benign tumours are generally harmless. Unless they are causing problems, for example pain, they are generally left alone.

Malignant tumours consist of cancer cells. Some cancer cells have the ability to break away from the original (or primary tumour) and spread to other parts of the body. When these cells reach other parts of the body they can continue to grow and divide to form a new tumour. This is referred to as a secondary deposit or metastasis. Treatment can be offered for both primary and secondary disease.

It is important to remember that cancer is not one disease. There are many different types, which are all treated in different ways. For this reason you may find that other patients are undergoing different treatment to you.

Role of Gynae-oncology CNS

This is a nurse who specialises in the care of women with gynaecological cancers and their families. He / she is your key worker and can provide information, advice and support for you and your family, from diagnosis onwards.

This may include:

• Surgery
• Chemotherapy / radiotherapy
• Psychosexual issues
• Support agencies
• HRT and menopause information
• Fertility and infertility advice or information
• Lymphoedema services
• Finance
• Pain and symptom control
• Local and national services
• Hospice care

You may meet your nurse specialist at the outpatient clinic or on the ward.

Telephone: 01223 586892

The CNS team can be contacted Monday to Friday 08.00-16.00, we have a voicemail so if no one answers your call please leave a message and we will call you back as soon as possible.

If you have any urgent problems over the weekend please contact your out–of-hours GP.

We are always available for advice. Please do not hesitate to contact us.

If you have had surgery recently, advice is available from Daphne ward and clinic 24 - Gynaecology assessment unit; both are located in the Rosie Unit).

Daphne Ward - 01223 257206

Clinic 24 - 01223 217636

Cervical cancer

Every year in the UK, around 3,000 women will be diagnosed with cervical cancer. Cervical cancer is the most common cancer in women aged 35 and under.

Types of cervical cancer

There are two main types of cervical cancer. The most common is squamous cell carcinoma. This develops from flat cells that cover the outer surface of the cervix at the top of the vagina.

The other type is adenocarcinoma. This develops from glandular cells that line the cervical canal (the endocervix) which is located higher up than the Transformation zone towards the uterus. This can be more difficult to detect with cervical screening tests.

Less common types of cervical cancer are: adenosquamous carcinomas, clear-cell carcinoma, small-cell carcinoma and neuroendocrine carcinoma.

Causes of cervical cancer

Cervical cancer are not thought to be hereditary. In 99.7% of cases, cervical cancers are caused by persistent infections with a virus called high-risk human papillomavirus (HPV). Two strains of the HPV virus (HPV 16 and HPV 18) are known to be responsible for 70% of all cases of cervical cancer.

HPV is a very common virus transmitted through skin to skin contact in the genital area. Around four out of five sexually active adults (80%) will be infected with some type of HPV in their lives. However, for the majority of women this will not result in cervical cancer. While HPV infection is common, cervical cancer is rare.

Treatments

Cervical cancer can be treated a number of different ways depending on your clinical situation. It can be treated with surgery alone, surgery followed by chemotherapy plus radiotherapy or by chemotherapy and radiotherapy alone. The treatment will depend on the stage of the cancer. The stage depends on whether the cancer is confined to the cervix or has spread to the lymph nodes or other areas.

Surgery

Surgery can range from treatments that affect only the cervix to more radical surgery involving a hysterectomy, where both the cervix and uterus (womb) are removed. Depending on the stage and extent of the cancer, a selection of the lymph glands in the pelvis may also be removed, this is called a lymphadenectomy or lymph node dissection.

Surgical options include:

• LLETZ (Large Loop Excision of the Transformation Zone) uses a small wire loop with an electric current to remove the affected area. This is usually carried out under local anaesthetic.
• Cone biopsy - A cone of tissue is cut away from your cervix to remove all the abnormal cells. This is usually carried out under general anaesthetic (GA).
• Trachelectomy - the cervix and the upper part of the vagina are removed, but the rest of the uterus (womb) is left in place. The operation is done vaginally and the lymph nodes are removed laparoscopically. Since the uterus is not removed during a trachelectomy, it is a fertility sparing procedure. More information can be found on the trachelectomy page of Jo's cervical cancer trust website. (opens in a new tab)

• Hysterectomy - the cervix and uterus, and the fallopian tubes are removed. In a radical hysterectomy the tissue at the side of the uterus (the parametrium) and the top part of the vagina are also removed. If a woman has already gone through the menopause then the ovaries are usually removed as well. However, in younger pre-menopausal women the ovaries will ideally be left as removing them brings on an early menopause. More information can be found on the hysterectomy page of Jo's cervical cancer trust website (opens in a new tab).

Additional therapies

Radiotherapy

This treats cancer using high-energy rays that destroy the cancer cells while doing as little harm as possible to normal cells.

Radiotherapy for cervical cancer can be given either externally or internally (called brachytherapy), and often as a combination of the two.

Typically external beam therapy is given with addition of a small dose of chemotherapy called chemo-radiation which is standard of care. Your options will be explained fully to you by your oncologist if appropriate in the oncology clinic.

Chemotherapy

Chemotherapy is not usually given as the primary treatment for cervical cancer, but it can be used before surgery or radiotherapy to shrink the cancer to make these treatments more effective. If it is given this way it is called neo-adjuvant chemotherapy. Chemotherapy may also be given alone for women whose cancer is further advanced.

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 common of these is cisplatin, which may be given with other chemotherapy drugs. The drugs are usually given intravenously (by injection into a vein).

Typically external beam therapy is given with addition of a small dose of chemotherapy called chemo-radiation which is standard of care. Your options will be explained fully to you by your oncologist if appropriate in the oncology linic.

Clinic follow-up

You might go for a check-up at the surgical outpatients after surgery. You will go to the cancer clinic if you are having or have had chemotherapy or radiotherapy. The surgeon and the oncologist might share your follow up. This means you see the surgeon sometimes and the oncologist at other times.

Contact your doctor or specialist nurse if you have any concerns. You should also contact them if you notice any new symptoms between appointments. You don’t have to wait until your next visit.

Patient led follow-up

This system leaves it to the patient to take the lead in arranging to see your doctor or specialist nurse. When you first finish treatment we arrange the appointment. But once your doctors are happy with your progress you can arrange them yourself.

For example you may want to make an appointment if you have noticed any symptoms that are worrying you or if you have concerns about your health.

Telephone: 01223 216251/01223 586892

Before your operation

Between the time of your diagnosis and admission to hospital for surgery the gynae-oncology nurses can provide support, advice and information. Everyone has different needs at this time.

Prior to surgery you will be asked to attend for ‘Pre Assessment’, this may be straight after you are seen in clinic or at a pre-arranged later date.

This involves:

• a check of general state of health
• current medication
• a number of routine tests may be carried out - e.g. chest X-Ray, Electro-Cardiogram (ECG)
• blood tests

You will have been given your consent forms to read through. Please sign these and being them with you on the day of your surgery. You will have a brief opportunity to see your surgeon before your operation.

You may be examined again and the side of your operation marked. You will also go through your consent form again with your surgeon.

On the day of your operation (or surgery)

Planned date for surgery: . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Please go to: . . . . . . . . . . . . . . . . . . . . . . . . . . . .

At: . . . . . . . . . . . . . . . . . . . . . . . . . . . .

On the morning of your surgery please remember:

• Do not eat after (this includes chewing gum) . . . . . . . . . . . . . . . . . . . . . . . . . . . .
• You may drink clear water only (non-carbonated and without flavouring) until . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Please do not consume anything after these times as this may cause delay or cancellation to your surgery.

We advise you wear loose and comfortable clothing. We would also advise you to stop smoking for two days prior to surgery.

There will be some waiting involved during the day so we suggest that you bring something to do with you eg a book; and if possible for a friend or family member to be with you whilst you wait.

General anaesthetic

During a general anaesthetic (GA) medications are used to induce sleep so you are unaware of procedure / operation and do not feel any pain or move whilst it is being undertaken.

Before having an operation you will be assessed for suitability for a general anaesthetic. This will be done at pre-assessment.

It will either be given as a:

• liquid that's injected into your veins through a cannula (a thin, plastic tube that feeds into a vein, usually on the back of your hand)
• gas that you breathe in through a mask

The anaesthetic should take effect very quickly. You'll start feeling light-headed, before becoming unconscious within a minute or so. Your anaesthetist will stay with you throughout the procedure. They'll make sure you continue to receive the anaesthetic and that you stay in a controlled state of unconsciousness. They will also give you pain-relieving medicine into your veins, so that you're comfortable when you wake up.

General anaesthetics have some common side-effects; nausea and vomiting, dizziness, confusion, bruising and soreness. Your anaesthetist should discuss these with you before your surgery and you will be monitored throughout your time in hospital.

Depending on your circumstances, you'll usually need to stay in hospital for a few hours to a few days after your operation.

General anaesthetics can affect your memory, concentration and reflexes for a day or two, so it's important for a responsible adult to stay with you for at least 24 hours after your operation, if you're allowed to go home. You will also be advised to avoid driving, drinking alcohol and signing any legal documents for 24 to 48 hours.

Any further questions your anaesthetist or pre-assessment team will be able to help.

NHS Choices – General anaesthetics website (opens in a new tab)

Post-op care

After your operation (post-op)

Immediately after your operation you will be transferred to the recovery area in theatre. You will be looked after there until you have woken up from your anaesthetic. You will then return to the ward.

Following your return to the ward you may remain drowsy and sleepy for a few hours.

You will go back to Daphne ward which is located in the Rosie unit on Level 2. This is a 19 bed female general gynaecology ward.

Ward Phone number: 01223 257206

Visiting hours are 15.00 - 20.00, please contact the ward to arrange visiting outside of these hours.

Pain

The amount of pain experienced following surgery is different for each individual and the operation you have. On the whole, most women experience less pain than expected. You will be given painkillers after your operation, including some to take home with you.

PCA (Patient Controlled Analgesia)

A PCA is a pump, containing a pain killer that is connected to the patient’s Intravenous line (IV line) that allows you to administer regular pain relief.

You will likely wake up after surgery with a PCA, we will monitor your pain and when it is controlled consider converting to oral painkillers.

Epidural

An epidural is an injection in the back to help with pain post operatively. If this is an appropriate option for you your consultant or Anaesthetist will discuss this with you prior to surgery.

Getting up after your operation

In hospital we will encourage you to mobilise (walk or move around) after your operation as this prevents post-op complications and helps speed up your recovery process.

You will also be required to wear Anti-Embolism stockings (TED stockings) which will help to prevent blood clots. The duration in which you would be expected to wear these post-operatively may vary but will be explained on discharge

Catheter care

During the operation a catheter will be inserted which will remain in for possibly 6 - 72 hours. It will usually be taken out on the ward the morning after your surgery but this will be decided by your medical team.

Before you go home we will check you are emptying your bladder properly. If there are complications you can go home with a catheter in and appropriate follow-up.

If after removal of a catheter you are initially unable to pass urine or are storing it in your bladder, we may talk to you about the option of self-catheterisation. This is usually a temporary measure.

Wound

Your wound will depend on the operation you undergo. However, dissolvable stitches are used in most operations. Your medical team will inspect your wound during your stay in hospital. Please monitor for redness, swelling, wound becoming hot to touch and discharge. If you have concerns when you are at home please contact us.

At home

In the first few days following your operation a vast amount of ‘internal energy’ will be required by your body to repair itself. This may leave you with only small amounts of energy for the rest of the day. You will find that your body will naturally pace itself. After a particular activity you may find your energy levels are dipping and you require more frequent rests.

It is important you keep mobile, moving around the house and taking regular deep breaths whilst resting to reduce risk of blood clots in the legs and also chest infections and pneumonia.

As the days and weeks pass, your energy store increases so you may be back to your normal pattern. During this time you may find that there are good days when you have lots of energy and days you feel more tired. This is normal.

Housework

In the first few weeks you may find you are only able to do light housework such as dusting and preparing light meals. As your energy levels increase you will be able to incorporate more of your daily tasks into you routine but listen to your body.

Physical exercise

If you participate in regular exercise it is advisable to refrain from this in the first few days to weeks. When your energy levels increase, gentle exercise is encourage but build this up slowly.

Driving

The main requirement for driving is that you feel safe behind the wheel. This involves being able to perform an emergency stop or to swerve very quickly.

This is not usually possible in the first few weeks and often takes up to six weeks. When you feel ready we would recommend that you go for a short drive to see how well you can manage.

It is also advisable to check with your insurance company as some impose restrictions on driving for a minimum period of time after surgery.

Insurance

Obtaining insurance just because you have a cancer diagnosis does not mean you will be unable to get insurance.

If you need information on such matters such as life insurance, travel or mortgage insurance visit the Amii website (opens in a new tab) for insurers in your area or Macmillan information can be helpful.

1 - 2 days after

How might I feel?

• You are still likely to be in hospital
• You will have some generalised pain in your abdomen
• You may have some bleeding

What is safe to do?

• Get up, move around, go to the toilet
• Get yourself dressed
• Start eating and drinking
• You may feel tired

Am I fit to work?

No.

3 - 7 days after

How might I feel?

• You may be at home by now
• Your pain should be slowly reducing and you will be able to move more comfortably
• You will likely still be tired

What is safe to do?

• Go for short walks
• Continue with exercises you have been given
• Wash and shower as normal
• Have a rest or sleep in the afternoon

Am I fit to work?

No.

1 - 2 weeks after

How might I feel?

• You should experience less pain and your energy levels may start to return to normal
• Bleeding should have settled or be very little

What is safe to do?

• Build up activities slowly
• Go for longer and more frequent walks
• Restrict lifting to light loads

Am I fit to work?

No.

2 - 4 weeks after

How might I feel?

• There will be less pain as you increase moving
• Energy levels should be returning to normal
• You should start to feel stronger everyday

What is safe to do?

• Continue to build up the amount of activity you are doing to normal levels
• Could start to consider low impact sport
• Make a plan for returning to work, possibly on reduced hours or lighter duties

Am I fit to work?

Yes (possibly).

4 - 6 weeks after

How might I feel?

• Almost back to normal self
• You may still feel tired and need more rest than you did previously

What is safe to do?

• All daily activities including lifting, driving and exercise
• Have sex if you feel ready
• Consider going back to work if you do not feel ready talk to your GP or employer about the reasons for this

Am I fit to work?

Yes.

Additional treatment / therapies

Gynaecological cancers can be treated with a combination of different treatments. Each case is different and your treatment will be tailored to your individual needs.

This may include:

Surgery

There are several different types of surgery. Your surgeon will discuss these with you based on your individual case.

Chemotherapy

Chemotherapy is a medicine, tablet or given as a drip that kills cancer cells. The aim of chemotherapy may be different according to the stage of disease, with some people not requiring any chemotherapy. Chemotherapy can be used to shrink disease prior to surgery, after surgery to kill any remaining cancer cells or if your cancer returns after initial treatment.

Chemotherapy is given in cycles, with a period of treatment followed by a period of rest to allow your body to recover. There are documented side effects when receiving chemotherapy; however these are dependent on the chemotherapy you receive, the dose and your individual reaction to the drug.

Side-effects may include; nausea and vomiting, tiredness / fatigue, hair loss, sore mouth, numbness / tingling in hands / feet and increase risk of infection. There are medications available to help with some of these side effects.

Radiotherapy

Radiotherapy uses high-radiation beams to kill cancer cells. Although not often used as the main treatment for cancer, but it can be helpful shrinking any secondary tumours or for symptom control. Your oncologist will speak with you about this option and the associated side-effects if appropriate

Hormonal treatment

Some gynaecological malignancies, such as endometrial cancers, are sensitive to hormonal treatment and this can be used to shrink the tumour. Your oncologist will speak about this option if appropriate.

Clinical trials

A clinical trial may be discussed about with you as a potential treatment. This discussion does not commit you to taking part. You can also speak with your doctor to see if there are any clinical trials appropriate to your diagnosis.

Getting back on track

Those who have gone through a cancer treatment describe the first few months as a ‘’time of change’’ – not so much getting back to normal, but finding out what is normal.

Whilst you might have had surgery, you may also need additional treatment and go onto have further treatment such as chemotherapy or radiotherapy. Things may still change during your recovery and as a result of your surgery.

Nutrition

Eating and drinking are an important part of our lives When you have cancer you may become more aware of what you eat and drink. You may wish to find out how diet can play a role in your recovery and future health.

A well-balanced diet is important. For a healthy diet it is important to:

• eat a variety of different foods
• eat at least five portions of fruit and vegetables in one day
• limit sugary food and drinks
• drink water
• reduce your salt intake
• drink alcohol in moderation
• most importantly, enjoy your food.

Fatigue

You may feel tired or worn out, in fact fatigue is one of the most common complaints during the first year of recovery. Rest or sleep may not cure the type of fatigue that you have.

Here are some ideas for coping with fatigue:

• Prioritising- Decide which activities are of most value each day and cut out unnecessary tasks.
• Pacing - Balance Activity and rest – take frequent breaks. Gentle exercise can help fatigue.
• Planning - Consider whether time of day affects your fatigue and avoid unnecessary exertion. Try to space activities out throughout the week and not concentrate all activities into one day.
• Posture - Avoid bending and twisting which can be tiring. Try not to sit or stand in the same position for too long without changing your position
• Permission - Give yourself permission not to do something that you feel you should and try to delegate to others!

Sex and intimacy

You’ll probably need time to recover and adapt to body changes before you feel comfortable about having sex. How long this takes depends on what feels right for you and your partner. As with all other aspects of cancer, care information needs regarding sexuality differ for each individual.

Partners may also have concerns. Talking openly with each other can have a positive effect on your relationship and make you feel more comfortable with each other.

If you experience difficulties with your sex life and these don’t improve, talk to your doctor or specialist nurse. Try not to feel embarrassed – they’re used to giving advice on intimate problems. They can give information and advice on different ways of looking at problems or other specialist services.

Support

• Macmillan – Relationship, intimacy and sex (opens in a new tab)
• Cancer Research UK – Sex, sexuality and cancer (opens in a new tab)

Psychological Support

There are a lot of emotions when dealing with cancer. It’s natural to have many different thoughts and feelings after a cancer diagnosis. Some people feel upset, shocked or anxious, while others feel angry, guilty or alone. There is no right way for you to feel.

Being able to talk openly with family and friends can certainly provide a lot of comfort.

Support groups and self-help groups give you the opportunity to share your thoughts and feelings. They can also be a good way to hear how other people affected by cancer coped with their situations. The healthcare professionals caring for you and who know your situation can also be a good source of support. There are specialist services that can provide emotional and practical support for those diagnosed with cancer and their support network.

For patients with cervical cancer Jo’s cervical cancer trust can provide individual support by the phone or e-mail. There are also support events where you can meet other people diagnosed with cervical cancer. They also have a dedicated helpline that is fully confidential.

• Telephone helpline for Jo’s Trust: 0808 802 8000
• Jo's cervical cancer trust website (opens in a new tab)

Maggie’s can provide drop in support and structured support groups to patients and their loved ones. There is a centre on the Addenbrooke’s site, as well as other centres around the UK and internationally. There are clinical psychologists within the team to provide support.

• Maggie's Cambridge website (opens in a new tab)

Fertility preservation

Fertility preservation is considered for patients who may undergo treatment that causes destruction of oocytes (eggs) leading to infertility. Those with greatest need to consider fertility preservation are women undergoing chemotherapy or radiation. This may also be discussed with women who are undergoing surgical removal or both ovaries (oophorectomy).

After oncology treatment women can have normal fertility, fertility followed by an early menopause, compromised fertility or ovarian failure (menopause). There is no test to predict your fertility response to treatment. For all patients desiring fertility preservation options would be individualised.

Female Fertility preservation options currently available:

• Embryo Cryopreservation
• Oocyte Cryopreservation (egg freezing)
• Laparoscopic oophoropexy (Ovarian Transposition, key hole surgery)
• Ovarian Suppression (hormone treatment)
• Radical trachelectomy (cervical cancer)

If you wish to discuss this further please ask in your clinic appointment or speak with your CNS.

Menopause

Some types of cancer treatment cause an early menopause. Types of cancer treatment that can cause an early menopause include:

• surgery to remove the ovaries
• radiotherapy to the pelvis
• hormone therapy
• chemotherapy

Menopause can cause:

• vaginal dryness
• hot flushes and sweating
• feeling sad or depression
• loss of confidence and self esteem
• tiredness (fatigue)
• thinning bones

Hormone replacement therapy (HRT) will reverse most of these effects for some women. It can also help with the emotional effects of menopause. Loss of sexual desire can be a problem. It is important to remember that many factors can influence the loss of sexual desire after treatment for cancer.

There are other ways to help with the symptoms of menopause if HRT is not suitable for you:

• other medications to ease symptoms e.g. gabapentin for flushing symptoms
• complimentary therapies e.g. homeopathy and acupuncture
• creams and lubricants for vaginal dryness

You can discuss these with your Consultant and your CNS.

Support

• Maggie Cancer Care Centre website (opens in a new tab)
• Patient information – Alternatives to HRT (opens in a new tab)
• Royal College Obstetrics and Gynaecologists (RCOG) – Menopause and Alternatives to HRT
• Daisy Network (opens in a new tab)
• Menopause – One stop guide, A practical Guide to understanding and dealing with the menopause, Kathy Abernethy

Lymphoedema

Lymphoedema is the swelling caused by a build-up of lymph fluid in the surface tissue of the body. Following some gynecological cancers and therapy this build up may occur as a result of damage to the lymphatic system due to surgery and / or radiotherapy to the lymph nodes.

Physical systems can include:

• swelling in the legs, ankles and feet
• discomfort and infection

Lymphoedema can be a long-term condition. The symptoms usually respond well to treatment and this means in most cases it can be controlled.

If you notice any swelling you are advised to contact the gynae-oncology clinical nurse specialists (CNS’s) for further advice and possible assessment.

Support

• Lymphoedema Support Network (LSN) (opens in a new tab)
• Macmillan – Living with Lymphoedema (opens in a new tab)

Cancer centre contact details

Consultant gynecological oncologists

Telephone (secretaries): 01223 216251

• Mr Peter Baldwin
• Mr Krishnayan Haldar
• Miss Helen Bolton
• Mr Pathiraja

Gynaecological oncology specialist nurses (surgery)

Telephone: 01223 586892

Medical oncologists

• Prof Helena Earl
• Dr James Brenton
• Dr Christine Parkinson

Telephone (secretary): 01223 217074

Clinical oncologists

• Dr Li Tee Tan
• Dr Deborah Gregory
• Dr Sarah Prewett

Telephone (secretaries): 01223 217074

Gynaecological oncology specialist nurses (chemotherapy)

Telephone: 01223 257049

Specialist radiographer

Katie Bradshaw Telephone: 01223 216580

If you call out of office hours, please leave a message on the answering machine and your call will be returned the next working day.

Glossary

• Adjuvant Treatment - Treatment – usually chemotherapy or radiotherapy, given after surgery
• Benign - A non-cancerous growth within the body, which may interfere with the function of an organ, but does not spread.
• Biopsy - The removal of a sample of tissue, which can be examined in a laboratory to find out the cause of an illness.
• Cytology - The microscopic examination of cells
• Histology - The examination of tissues in order to diagnose the underlying disease.
• Human Papillomavirus (HPV) - the most common viral infection of the reproductive tract. Most sexually active women and men will be infected at some point in their lives and some may be repeatedly infected. There are over 100 identified types of HPV and each different type has been assigned a specific number. HPV infects the skin and mucosa (any moist membrane, such as the lining of the mouth and throat, the cervix and the anus)
• Intravenous (IV) - Given into the vein, usually by injection so that the substance can work quickly.
• Laparoscopy - A minor operation which involves making a small incision in the abdomen so that a small telescope (laparoscope) can be inserted, to enable the abdomen and pelvis to be examined without performing a full laparotomy.
• Laparotomy - An operation to open the abdomen.
• Lymphatic system - A network of vessels that transport lymph – a clear fluid that comes from the blood and bathes the tissues. It contains water, protein, minerals and white blood cells. The lymph passes through a series of filters (lymph nodes) before it rejoins the blood stream.
• Lymphodema - Swelling in the arms or legs which is caused by blockage or damage to the drainage of the lymphatic system. It can happen as a result of some cancer treatments, or from the cancer itself.
• Lymph Nodes - Small pearl-like glands that are connected to the lymph system and act as filters to stray bacteria or cancer cells. They also produce lymphocytes which are one of the types of white blood cells in the body. When bacteria or cancer cells reach these nodes, they can become enlarged.
• Metastatic / Metastases - The spread of cancer from one part of the body to another by the lymphatic system or by the blood stream.
• Omentum - A double layer of membrane that is rich in fatty tissue and lies in front of the intestines, like an apron.
• Tumour Markers - Substances produced by some cancers that can be measured in the blood stream. They can be used either to assist in making a diagnosis, or to monitor how the cancer is responding to treatment.

Support

• Gynae-oncology Consultants and CNS team, Addenbrooke's: 01223 586892
• Alison Hallet (Gynae-Oncology CNS Chemotherapy): 01223 256 676
• Maggie Wallace Centre – Addenbrooke's Hospital: 01223 249220
• Macmillan Cancer Support Centre, Oncology outpatients, Addenbrooke's Hospital: 01223 274801
• Oncology Centre, Addenbrooke's: 01223 216552
• Macmillan website (opens in a new tab)
• Jo’s Cervical Cancer Trust (opens in a new tab)
• Shine Cancer Support website (opens in a new tab) – Cancer support for anyone in their 20s, 30s and 40s
  Email Shine Cancer Support

References

• Cancer Research – Cervical Cancer (opens in a new tab)
• Jo’s trust (opens in a new tab)
• Macmillan cancer support (2017) About cervical cancer (opens in a new tab)
• Lymphodema Support Network (LSN) (opens in a new tab)
• Macmillan – Living with Lymphodema (opens in a new tab)
• Macmillan – Relationship, Intimacy and Sex
• NHS Choices – General Anaesthetics (opens in a new tab)
• NHS Choices (2016) Cervical cancer (opens in a new tab)
• Patient information – Alternatives to HRT (opens in a new tab)
• Royal College Obstetrics and Gynaecologists (RCOG) – Menopause and Alternatives to HRT (opens in a new tab)
• Royal College Obstetrics and Gynaecologists (RCOG) – Recovering well (opens in a new tab)