Stage 4a cervical cancer

Hi DebDebW,

Thank you for getting in touch with Macmillan Cancer Support.  My name is Kelly and I’m one of the Cancer Information Nurse Specialists.

It’s good to hear that the tumour has shrunk with the chemotherapy and it sounds like your oncologist is expecting the radiotherapy to work well alongside this.  However,  it’s still normal to feel worried and scared during treatment. 

Radiotherapy is a common treatment for cervical cancer alongside chemotherapy.   As you mention though five weeks is a long time and there is a lot consider about how best to support yourself and your children during this time.

It’s difficult for us to guide you specifically with how long your sessions will last each day.   This can be different for each person.

You will get more details about this at your planning scan on the 21^st November.  This session usually takes 30 to 60 minutes, although it may take longer if needed.   Images are taken at this appointment to check the size and position of the cancer and small permanent pinpoint marks (tattoos) are made to help position the machine used to deliver the treatment at the exact area.

The radiotherapy team will also tell you what to expect,  how to prepare for any appointments and answer any questions you may have.

Usually each radiotherapy appointment takes about 10 to 30 minutes.  The treatment itself is completed within a few minutes.  Most of the appointment is spent getting you into the correct position and checking your details. 

Although unpleasant it is important to have an enema before having radiotherapy to the pelvic area and a full bladder before each treatment.

The pelvic area includes the cervix, bladder and bowel which are very close to each other.   The contents of the bowel and the size of your bladder can affect the position of the treatment area. The aim is to make sure that the bowels are empty, and the bladder is at the same fullness for each day of radiotherapy to avoid exposure of healthy tissue and reduce risks of side effects.

The radiographer should give you instructions about this at your planning appointment too.   Each hospital should have its own patient information factsheet  but I have included an example here for you to look at in your own time.

 As you mention there are side effects from radiotherapy.  Each woman’s experience can vary, and you may not have all the effects mentioned. This can include  tiredness, skin, bladder and bowel irritation. 

The effects can last for the duration of treatment and sometimes for few weeks afterwards.  Sometimes side effects may not go away completely and are known as long term or late effect symptoms.  It may be helpful to discuss any concerns at your appointment.

I’m aware that you have struggled to get in touch with your oncologist and nurse specialist for additional support in the meantime.

As they are directly involved with your care and have access to all your medical information, they will be able to offer tailored advice and reassurance with your treatment plan.  I would encourage you to try again, even  to highlight how scared you are at the moment so they can talk through any support which may be available.

I’m  aware that you are concerned about the additional impacts this is likely to have emotionally and being able to support your young children. It’s okay to reach out to family and friends for support if needed. 

Talking to your children’s school about what is happening may be a good idea.  They can offer emotional support and potentially help guide with solutions regarding any practical issues.

It’s important to take time out for yourself and explore emotional support for you too.  Especially with how scared you are feeling.

It’s good to see that you have joined our cervical cancer forum.  The support here can be invaluable.

 Other ways of getting support can include from local cancer centres or exploring talking therapies such as our free remotely delivered counselling sessions.

I wondered if it would help to speak to one of the nurses on our phone helpline.  It is sometimes easier to share your thoughts this way so we know how best we can continue to support you at this time.

I hope this helps.  Please don’t hesitate to get back in touch with us as needed.

Best wishes and take care,

Kelly (Cancer Information Nurse Specialists).

You can speak with the Macmillan Support Line team of experts.  Phone free on 0808 808 0000 (7 days a week, 8am-8pm) or send us an email.

Ref:KA/DW

Thank you for replying. 

Just wondering, if the radiotherapy and brachytherapy did not remove all the cancer, and at the scan they found it had not all gone. What would happen next?

Hi DebDebW,

Thank you for getting back in touch with Macmillan Cancer Support. My name is Luzia and I’m one of the Cancer Information Nurse Specialists on the Macmillan Support Line.

I can understand that you are worried about the treatment not working well. The main treatment for stage 4a is chemoradiation. If the radiotherapy is unsuccessful, there may be a different chemotherapy regime that they could offer especially since you have responded well to chemotherapy before.

If it is going to spread away from the local area to a stage 4b, there are further treatment options with Immunotherapy (such as pembrolizumab), Targeted therapy such as bevacizumab) and further chemotherapy.

The question you ask is a good question to ask your healthcare team. They will be able to advise you what the next options would be for you.

Please call one of our nurses directly if you want to talk over your situation. People often find it easier to talk over their concerns. We may then be able to give you further information.

Take care,

Luzia

Cancer Information Nurse Specialist

Phone free on 0808 808 0000 (7 days a week, 8am-8pm) or send us an email. If you think it may be useful to chat things over in real time, we have our webchat service available 7 days a week 8am-8pm.

Ref: LzM/PW