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Gynaecology Cancer Leaflets

Each of the Gynaecology Cancer leaflets are detailed below, select the heading of the one you would like to view and the content will expand with an option for you to download the PDF version.

Leaflets can be made available in difference formats on request, to view in a different language select the language change in the bottom left of the screen.

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If you would like to make any suggestions or comments about the content of this leaflet, then please contact the Patient Experience Team on 0151 702 4353 or by email at Pals@lwh.nhs.uk.

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  • Your Questions Answered - Introducing you to your Keyworker / Clinical Nurse Specialist for Gynaecological Cancer

    The leaflet is detailed below, or you can download the 'Your Questions Answered - Introducing you to your Keyworker / Clinical Nurse Specialist for Gynaecological Cancer' leaflet in PDF.

    What Is a Keyworker Clinical Nurse Specialist (CNS’)?

    Your keyworker is the person who helps to co-ordinate your care throughout your illness and recovery. At Liverpool Women's NHS Foundation Trust this is a Clinical Nurse Specialist (CNS).

    The CNS’ you may be linked to are fully trained nurses who now specialise in the area of Gynaecological Oncology and the associated issues related to Women’s Health. Some CNS’ are also known as Macmillan Nurses and are closely associated with the national organisation MacMillan Cancer Support.

    This organisation is devoted to helping patients and their families cope with the diagnosis, treatment and effects of cancer. At the Liverpool Women's NHS Foundation Trust the role of this CNS includes support for the patient / family when a cancer is suspected but not confirmed.

    Our specialist skills can also help when there is not a cancer.

    How Can Your Keyworker (CNS) Help You?

    They can help meet your needs by:

    • Providing you with information about cancer, treatment and support
    • Access to local and national organisations for further information and support
    • Ensuring you can access information to your local support groups as well as a specific gynaecological support group such as EVOC
    • Supporting you with issues or concerns regarding re-adjustment following treatment ie: altered body image / sexual health, anxiety or emotional concerns, physical symptoms
    • Pointing you in the right direction for financial or family issues
    • Liaising with other health care professionals in the hospital or in the community ie: lymphoedema nurse, dietician, district nurse, outreach teams and hospice organisations who may also be able to help you.

    Will I Have To See A Keyworker CNS?

    No – All patients and their families are given information about the CNS service and this is why we have produced this leaflet. We hope very much that you will feel that you would like us to be involved in your care.

    If I Want To See A CNS How Can I Be Referred?

    You can be referred to us by any of the following people and at any time:

    • The nurses or doctors in the Outpatient Department or on the ward
    • Pre-Operative clinic
    • Your GP
    • The Community Care Team

    You or any member of your family can make a self-referral by phoning the number in the “Our Contact Details” section of this leaflet. If you have met your Keyworker (CNS) in a different hospital they will liaise with our team to ensure that you have shared care at each step of your pathway of care.

    Will The Hospital CNS Visit Me At Home?

    No – We work very closely with the Community nurses who work in your local are and we will refer you to their care. This means that all your needs will be met by the team closest to your home. This will only be done with your consent and only if you wish it.

    Is Confidentiality Maintained?

    Yes – Confidentiality is maintained at all times. We recognise that each patient and their family will have their own personal needs and that these will be different from one person to another. All your contacts with us will be treated with the strictest confidentiality and will only be discussed with another member of the team if you agree.

    What If I Have A Problem Out Of Hours?

    A non-urgent message may be left on the answerphone. If you are concerned about pain or symptoms, please contact your GP or district nurse. If you have been in the ward recently, please contact the ward.

    Our Contact Details

    The telephone number for our team is 0151 702 4186.

    Other Useful Contact Information

    MacMillan Cancer Support

    89 Albert Embankment

    London SE1 7UQ

    Cancerline: 0808 8080000

    Mon-Fri 9am-8pm

    Website: www.MacMillan.org.uk

    Details: The Macmillan Cancerline Team is there to listen to your concerns and put you in touch with the right support for you – whether it’s Macmillan services, another organisation offering information and guidance, or your local cancer self help and support group or one-to-one support. Our database gives you access to support and practical help in your area. Many people affected by cancer find it helpful to talk to someone who has gone through the same thing.

    Wherever possible they will help you to talk to someone with experience similar to yours – someone with the “inside knowledge” you need.

    Women’s Health Information and Support Centre Limited (WHISC)

    120 Bold Street

    Liverpool,

    L1 4JA.

    Tel: Margie Hughes on 0151 707 1826

    Website: www.whisc.org.uk

    Details: A chance to talk about women’s health and related issues in a friendly, information atmosphere.

    Cheshire and Merseyside Clinical Network

    Website: www.cmcns.nhs.uk

    Details: Contains valuable information on local and national support groups and information booklets.

  • Cancer of the Uterus

    The leaflet is detailed below, or you can download the 'Cancer of the Uterus' leaflet in PDF.

    This leaflet has been written to help you understand about cancer of the Uterus (Endometrial Cancer), its diagnosis, treatment and support available. You may wish to discuss some aspects with your doctor or Clinical Nurse Specialist.

    What is Cancer?

    The organs of the body are made up of cells. Cancer is a disease of these cells. The cells normally divide in an orderly manner. Sometimes the cells divide out of control - developing into a lump/tumour. A tumour which is malignant consists of cancer cells which have the ability to spread beyond the original site, destroying surrounding tissue. Sometimes they can break away and spread to other parts of the body.

    The Uterus

    The uterus is a muscular organ, usually about the size and shape of a pear, sits in the pelvis. It is here that a baby develops during pregnancy. The lining of the uterus is called the endometrium. This thickens during the menstrual cycle, in preparation for a fertilised egg and is shed during a period if the egg is not fertilised.

    How does Cancer of the Uterus Develop?

     We may not know the exact cause of your cancer, but of the 9324 (ONS 2014) cases in England each year, 80% of women are post-menopausal. Therefore, the changes in your hormones at this time are an important factor in the development of this type of cancer.

    What are the Signs and Symptoms?

    The most common early presentation is unusual vaginal bleeding, post-menopausal bleeding or vaginal discharge (RCN 2014). Other symptoms include:

    • Bleeding in between periods
    • Heavier periods than usual
    • A watery or bloody vaginal discharge
    • Pain/discomfort in pelvic area
    • Pain during sex

    (Macmillan.org.uk, 2017)

    These symptoms may also be due to other conditions, you should seek medical advice.

    Diagnosing Cancer of the Uterus

    A full medical history will be undertaken and a number of other tests may be carried out before a definite diagnosis can be made. This may include:

    • Vaginal examination
    • An ultrasound scan to look at the lining of the womb
    • Hysteroscopy/pipelle biopsy - whereby a tiny telescope is passed through the vagina and cervix to look inside the womb and allow biopsies (samples) to be taken of the endometrium and examined.

    Other investigations (e.g. a MRI scan) may be added to this to allow the doctor to determine the site and stage of the cancer, in order to plan your treatment. (See hospital information leaflets).

    Stages of Cancer

    Staging is a process of investigations which may be used to determine type/size of the tumour and if there is any spread. Staging is important to help decide treatment options.

    If the cancer is diagnosed at an early stage, the treatment for cancer of the uterus may be more successful.

    Stages of Cancer of the Endometrium

    The following stages are used for cancer of the endometrium.

    Stage 1 - Cancer found only in the main part of the uterus.

    Stage 2 - Cancer cells have spread to the cervix.

    Stage 3 - Cancer cells have spread outside the Uterus but have not spread outside the pelvis.

    Stage 4 - Cancer cells have spread beyond the pelvis to other body parts or into the lining of the bladder (the sac that holds urine) or rectum.

    Recurrent Disease - Recurrent disease means the cancer has come back (recurred) after it has been treated.

    Treatment Options

    There are four main treatment options for cancer of the Endometrium including:

    • Surgery
    • Radiotherapy
    • Chemotherapy
    • Hormone Therapy

    The type of treatment that is best for you will be decided by your consultant in discussion with yourself. 

    Clinical Trials

    Research into new methods of treating cancer of the uterus, are going on all the time. You may be asked to consider taking part in a clinical trial.

    Clinical trials are research studies involving patients which compare a different type of medical care with the best treatment currently available. You may be approached regarding a clinical trial which your consultant or specialist nurse will be able to discuss with you.

    Macmillan cancer support, produce a booklet which may be helpful to you. The type of treatment will be decided by the consultant in discussion with you.

    Surgery

    Surgical treatment involves the removal of the uterus (Hysterectomy) the ovaries and the fallopian tubes will also be removed if possible. This is called a Total Laparoscopic Hysterectomy and Bilateral Salpingo Oophorectomy, (TLH & BSO). You may require a Total Abdominal Hysterectomy and Bilateral Salpingo Oopherectomy. (TAH BSO) (see hospital information leaflet for specific information).

    Radiotherapy

     Radiotherapy is the use of high energy X Rays (like having an X- Ray) to destroy cancer cells. Radiation may come from a machine outside the body (external beam radiotherapy) or inside the body (internal beam radiotherapy). This involves a radioactive substance being inserted (under anaesthetic or sedation) into your body for a period of time (similar to a large tampon being inserted into the vagina).

    The type of radiotherapy and length of time will be planned and decided individually between the doctor and yourself (see Clatterbridge Cancer Centre radiotherapy booklet for more information).

    Chemotherapy

    Depending on the type and stage of your cancer, your doctor may suggest chemotherapy treatment (see CCC booklet & specific information sheets).

    Hormone Therapy

    In some cases your doctor might want to give you hormone therapy as some cancers of the uterus can be sensitive to hormones such as progesterone.

    Life and Relationships

    • Most people feel overwhelmed when they are told they have cancer.
    • Many different emotions arise which can cause confusion.
    • Reactions differ from one person to another.
    • There is no right or wrong way to feel.
    • You may experience the whole range of personal emotions and reactions both similar and different from family and friends.
    • Support and guidance is available in coping with these feelings.
    • Many people find great comfort in their faith and/or religious and spiritual beliefs.

    Following the diagnosis of cancer and your subsequent treatment, you may experience physical changes. There may be some issues/concerns you wish to raise/explore, i.e.

    • Body Image
    • Weight Gain/loss
    • Sexual Health
    • Menopause Symptoms
    • Others

    Your Clinical Nurse Specialist will be able to support you by explaining about the issue/concern and provide advice and information if required. This may help you adjust/cope with these changes. This may include involvement of other members of the Health Care Team (HCT) i.e.

    • Dietician
    • Lymphoedema Practitioner
    • Genetisist
    • Physiotherapist
    • Occupational Therapist via the GP, Primary Health Care Team (PHCT), General Practitioner (GP), District Nurse (DN), Community Specialist Palliative Care CNS.

    You may not be aware of who can help with changes in social and financial matters, but your support nurse can put you in touch with the relevant people who can provide guidance and advice in these and other aspects, including childcare, how to tell the children and practical day to day issues.ie. Macmillan/Welfare Benefits advice

    You may wish to explore information and coping methods to help yourself. Therefore, the following booklets may be helpful, (there are many others) from Macmillan Cancer Support.

    • Adjusting to life after cancer
    • Close relationships & cancer
    • Life with cancer
    • Sexuality & Cancer
    • Body image and sexuality

    Complementary Therapies

    Complementary therapies may be helpful to you and your family. There are many different types i.e.

    • Reflexology
    • Massage
    • Relaxation

    Plus many others. Your Clinical Nurse Specialist can advise you by providing information regarding the appropriateness for you and how to access them.

    Your Follow up Care

    This will be tailored to your specific needs. Your Clinical Nurse Specialist will also be able to offer you and your family advice, information and support, regarding your cancer, subsequent treatment and associated health issues. 

    Equal Opportunities

    The hospital is committed to promoting an environment which provides equal opportunities for all patients, visitors and staff. If you have special requirements such as dietary needs, interpreter services, disability needs or a preference for a female doctor, please do not hesitate to discuss this with a member of staff who will try to help you.

    Support Networks Available Locally

    Further information, advice and support is available for you/partner family from:

    Knowsley

    Lyndale Cancer Support Centre

    Tel: 0151 489 3538

    Sefton Cancer Support Group

    Tel: 01704 879352

    www.seftoncancersupport.org.uk

    St Helens Cancer Support Group

    Tel: 01744 21831

    Warrington & District Cancer Self-Help Group

    Tel: 01925 453139

    The Wirral Holistic Care Services

    Tel: 0151 652 9313

    www.wirralholistic.org.uk 

    Widnes & Runcorn Cancer Support Group

    Tel: 0151 423 5730

    Isle of Man

    Manx Cancer Help Association

    Tel: 01624 679554

    www.manxcancerhelp.org

    Liverpool Sunflowers

    Liverpool Cancer Support

    Tel: 0151 726 8934

    E.V.O.C.

    Gynaecological Support Group

    0151 702 4186

    Website information may be obtained from your hospital (www.lwh.nhs.uk), local and national support networks above.

    National Resource Organisations for Gynae Oncology Patients

    Macmillan Cancer Support

    89 Albert Embankment London SE1 7UQ

    Cancerline: 0808 8080000

    Mon-Fri 9am-8pm

    www.macmillan.org.uk

    A National Organisation providing support and written information for anyone affected by any cancer type.

    The Daisy Chain Network

    For additional information send an SAE to: The Daisy Chain Network, PO Box 183, Rossendale, Lancashire, BB4 6WZ

    Email: membership&media@daisynetwork.org.uk  www.daisynetwork.org.uk

    The Daisy network is a premature menopause support group which offers advice, information and support for women throughout the UK.

    Menopause Matters

    www.menopausematters.co.uk

    For accurate up to date information about the menopause and its treatment options “An easy to use, independent, clinician-led website”.

    Gynae C

    1 Bollingbroke Road, Swindon 5N2 2L8

    Tel: 01793 302005

    www.communicate.co.uk/wilts.gynaec

    A support group/helpline run by Helen Jackson for women (and their family or friends) who have any gynaelogical cancer.

    Womb Cancer Support UK

    www.facebook.com/womb-cancer-support.uk 

    References

    Nordin A (1999) Patient Pictures - Gynaecology, Health Press Ltd, Oxford.

    Office for National Statistics

    Cancer Statistics Registration 2014. www.statistics.gov.uk

    Blake P, Lambert H, Crawford R (1998) Gynaecological Oncology: A guide to clinical management, Oxford University Press

    Royal College of Nursing (2014) Gynaecological Cancer

    Publication code 002 S18

    Macmillan (2014) Symptoms of womb cancer

  • Cancer of the Cervix

    The leaflet is detailed below, or you can download the 'Cancer of the Cervix' leaflet in PDF.

    This leaflet has been written to help you understand about cancer of the Cervix (Cervical Cancer), its diagnosis, treatment and support available. You may wish to discuss some aspects with your doctor or Clinical Nurse Specialist.

    What is Cancer?

    The organs of the body are made up of cells. Cancer is a disease of these cells. The cells normally divide in an orderly manner. Sometimes the cells divide out of control - developing into a lump/tumour. A tumour which is malignant consists of cancer cells which have the ability to spread beyond the original site, destroying surrounding tissue. Sometimes they can break away and spread to other parts of the body.

    The Cervix

    The cervix is the lower part of the uterus, often called the neck of the womb. Most of the cervix is visible from the vagina. It is from a small opening in the centre of the cervix (cervical os) that smears are taken.

    Situated close to the cervix is a collection of small glands called lymph nodes. The lymph nodes make up part of the lymphatic system, which is one of the body’s defence systems.

    How Does Cancer Of The Cervix Develop?

    In almost all cases, cervical cancer is the result of a change in the cell DNA caused by Human Papilloma Virus (HPV). Some types of HPV don’t cause any symptoms and some are linked to increased risk of cervical cancer and can take many years to develop. There are two main types of cervical cancer, one (squamous) forms on the outside of the cervix and this is the one detected by the smear test, the other (adeno) is found deeper in the cervix and is more difficult to detect.

    Approximately 3224 women each year are diagnosed as having cervical cancer, in England and Wales (O.N.S. 2014). More than 99% of cases occur in women who have been infected with HPV. Other risk factors can affect a women’s chance of developing cervical cancer. These include: smoking, weakened immune system, taking the OCP. (Jo’s Trust, 2017)

    What Are The Signs And Symptoms?

    • Bleeding between periods or after intercourse
    • Bleeding any time after your menopause
    • Increased or unusual vaginal discharge, which may be offensive
    • Back pain
    • Blood in your urine
    • Pain when passing urine
    • Rectal bleeding
    • Swelling of the legs
    • Discomfort or pain during sexual intercourse
    • Increased frequency passing urine

    These symptoms may also be due to other conditions. You should seek a medical opinion. (RCN, 2014).

    Diagnosing Cancer of the Cervix

    A full medical history will be undertaken and a number of other tests may be carried out before a definite diagnosis can be mode. This may include:

    • Cervical screening test
    • Vaginal examination
    • Colposcopy (looking at the cervix with a small microscope)
    • Biopsy, (a small piece of tissue taken from the cervix for further examination under a microscope)
    • Examination under anaesthetic (eua), to examine the cervix, uterus, rectum and bladder while you are asleep
    • MRI scan. (see Clatterbridge Cancer Centre (CCC) leaflet).

    Other investigations may be added to these to allow the doctor to determine the site and stage of the cancer, in order to plan your treatment.

    Stages of Cancer

    Staging is a process of investigations which may be used to determine type/size of the tumour and if there is any spread. Staging is important to help decide treatment options.

    Stages of Cancer of the Cervix

    The following stages are used for cancer of the cervix.

    Stage 1 - Cancer found only in the cervix

    Stage 2 - Cancer extends beyond the cervix into the upper part of the vagina

    Stage 3 - Cancer extends to the pelvic wall and lower third of the vagina

    Stage 4 - Cancer extends beyond the pelvis into other organs, i.e. bladder, rectum

    Recurrent Disease – means the cancer has come back (recurred) after it has been treated.

    Treatment Options

    There are four main treatment options for cancer of the cervix, it may be that one or a combination of treatments will be recommended to you.

    • Surgery
    • Radiotherapy
    • Chemotherapy
    • Radiotherapy and Chemotherapy combined

    The type of treatment that is best for you will be decided by your consultant in discussion with yourself.

    Clinical Trials

    Clinical trials are research studies involving patients which compare a different type of medical care with the best treatment currently available. You may be approached regarding a clinical trial which your consultant or specialist nurse will be able to discuss with you. Macmillan Cancer Support, produce a booklet which may be helpful to you.

    Surgery

    Surgical treatment involves the removal of the cervix, uterus, tubes and lymphnodes (Radical Hysterectomy). On occasion the ovaries will also be removed.  This can either be performed laparoscopically or a midline incision,(see radical hysterectomy leaflets)

    A Radical Trachelectomy is an operation removing the cervix - which may help preserve fertility. Lymph –nodes may also be removed at the same time or at a later date. This is a possible option for early stage disease. (See leaflet Trachelectomy’).

    Radiotherapy

    Radiotherapy treatment is given from the outside from a machine called a linear accelerator. Treatment can also be internal. This is given by placing a tube containing a radiotherapy treatment source in the Vagina (under sedation or anesthetics) for a period of time, similar to a large tampon.

    The type of radiotherapy and length of time will be planned and decided individually between the doctor and yourself. (see CCC radiotherapy booklet for more information).

    Following radiotherapy you may suffer from vaginal dryness and narrowing. Scar tissue may slowly develop in the vagina resulting in either narrowing or shortening of the vagina. Your doctor, nurse or therapy radiographer may advise you to use a vaginal dilator and will discuss this with you. In some cases Chemotherapy and Radiotherapy together may be a treatment option.

    Chemotherapy

    Depending on the type and stage of your cancer, your doctor may suggest chemotherapy or chemotherapy and radiotherapy combined. (see CCC booklet & specific information sheets).

     

    Life and Relationships

    • Most people feel overwhelmed when they are told they have cancer.
    • Many different emotions arise which can cause confusion.
    • Reactions differ from one person to another.
    • There is no right or wrong way to feel.
    • You may experience the whole range of personal emotions and reactions both- similar or different from family and friends.
    • Support and guidance is available in coping with these feelings.
    • Many people find great comfort in their faith and/or religious and spiritual beliefs.

    Following the diagnosis of cancer and your subsequent treatment, you may experience physical changes. There may be some issues/concerns you wish to raise /explore, i.e.

    • Body Image
    • Weight Gain/loss
    • Sexual Health
    • Menopause Symptoms
    • Fertility Issues
    • Others

    Your Clinical Nurse Specialist will be able to support you by explaining about the issue/concern and provide advice and information if required. This may help you adjust/cope with these changes. This may include involvement of other members of the Health Care Team (HCT) i.e.

    • Dietician
    • Lymphoedema Practitioner
    • Occupational Therapist via your GP
    • Physiotherapist
    • Primary Health Care Team (PHCT)
    • General Practitioner (GP), District Nurse (DN), Community Macmillan Nurse (CM)

    You may not be aware of who can help with changes in social and financial matters, but your Clinical Nurse Specialist can put you in touch with the relevant people who can provide guidance and advice in these and other aspects, including childcare, how to tell the children and practical day to day issues.ie. Macmillan/Welfare Benefits advice.

    You may wish to explore information and coping methods to help yourself. Therefore, the following booklets may be helpful, (there are many others) from Macmillan Cancer Support.

    • Adjusting to life after cancer
    • Close relationships & cancer
    • Life with cancer
    • Sexuality & Cancer
    • Body image and sexuality

    Complementary Therapies

    Complementary therapies may be helpful to you and your family. There are many different types i.e.

    • Reflexology
    • Massage
    • Relaxation

    Plus many others. Your support nurse can advise you by providing information regarding the appropriateness for you and how to access them.

    Your Follow up Care

    This will be tailored to your specific needs. Your Clinical Nurse Specialist will also be able to offer you and your family advice, information and support, regarding your cancer, subsequent treatment and associated health issues.

    Equal Opportunities

    The hospital is committed to promoting an environment which provides equal opportunities for all patients, visitors and staff. If you have special requirements such as dietary needs, interpreter services, disability needs or a preference for a female doctor, please do not hesitate to discuss this with a member of staff who will try to help you.

    Support Networks Available Locally

    Further information, advice and support is available for you/partner family from:

    Knowsley

    Lyndale Cancer Support Centre

    Tel: 0151 489 3538

    Sefton Cancer Support Group

    Tel: 01704 879352

    www.seftoncancersupport.org.uk

    St Helens Cancer Support Group

    Tel: 01744 21831

    Warrington & District Cancer

    Self-Help Group

    Tel: 01925 453139

    The Wirral Holistic Care Services

    Tel: 0151 652 9313

    www.wirralholistic.org.uk

    Widnes & Runcorn Cancer

    Support Group Tel: 0151 423 5730

    Isle of Man

    Manx Cancer Help Association

    Tel: 01624 679554

    www.manxcancerhelp.org

    Liverpool Sunflowers

    Liverpool Cancer Support

    Tel: 0151 726 8934

    National Resource Organisations for Gynae Oncology Patients

    Macmillan Cancer Support

    89 Albert Embankment London SE1 7UQ

    Cancerline: 0808 8080000

    Mon-Fri 9am-8pm

    www.macmillan.org.uk

    The Daisy Chain Network

    For additional information send an SAE to: The Daisy Chain Network, PO Box 183, Rossendale, Lancashire, BB4 6WZ

    Email: membership&media@daisynetwork.org.uk  www.daisynetwork.org.uk

    The Daisy network is a premature menopause support group which offers advice, information and support for women throughout the UK.

    Menopause Matters

    www.menopausematters.co.uk

     

    For accurate up to date information about the menopause and its treatment options “An easy to use, independent, clinician-led website”.

    Gynae C

    1 Bollingbroke Road, Swindon 5N2 2L8

    Tel: 01793 491116

    Email: GynaeC@yahoo.com

    www.communicate.co.uk/wilts.gynaec

    A support group/helpline run by Helen Jackson for women (and their family or friends) who have any gynaecological cancer.

    Jo’s Trust

    www.jotrust.co.uk

    Established in June 1999 Jo’s Trust is a registered charity dedicated to women and their families and friends affected by pre-cancer and cancer of the cervix. The trust’s principal activity is the provision of good information, confidential medical advice and support about every aspect of this illness through its website.

    Ask your support nurse for a free copy of The Cancer Guide which can guide, support and inform you through your cancer experience.

    References

    Nordin A (1999) Patient Pictures - Gynaecology, Health Press Ltd, Oxford.

    Office for National Statistics (2014) Cancer Statistics Registration (2014. www.statistics.gov.uk

    Blake P, Lambert H, Crawford R (1998) Gynaecological Oncology: A guide to clinical management, Oxford University Press

    Royal College of Nursing (2014) Gynaecological Cancer

    Publication code 002 S18

    Macmillan (2014) Understanding Cancer of the Cervix

    www.nhs.uk (2017) cervical cancer

    Jo’s Trust.org.uk (2017) Symptoms of cervical cancer

  • Cancer of the Ovary

    The leaflet is detailed below, or you can download the 'Cancer of the Ovary' leaflet in PDF.

    This leaflet has been written to help you understand about cancer of the Ovary, its diagnosis, treatment and support available. You may wish to discuss some aspects with your doctor or Clinical Nurse Specialist.

    What is Cancer?

    The organs of the body are made up of cells. Cancer is a disease of these cells. The cells normally divide in an orderly manner. Sometimes the cells divide out of control - developing into a lump/tumour. A tumour which is malignant consists of cancer cells which have the ability to spread beyond the original site, destroying surrounding tissue. Sometimes they can break away and spread to other parts of the body.

    The Ovaries

    The ovaries are two small oval shaped organs in the female pelvis. They form part of the female reproductive system. Each month, in women of childbearing age, an egg is released from the ovary and travels to the womb. If the egg is not fertilised by sperm it passes out of the womb and the lining of the womb sheds - this is a period.

    The ovaries also produce the female hormones, oestrogen and progesterone. In the menopause these hormones decrease and periods gradually stop.

    How Does Cancer Of The Ovary Develop?

    There are approximately 7378 new cases per year in the UK. (Cancer Research 2014)

    We may not know the exact cause of your cancer. However, it is more common in women who have not had children. There is evidence to suggest that women who take the contraceptive pill are less likely to develop this sort of cancer. An inherited gene in the family causes a small percentage of ovarian cancers. It may be necessary to obtain a profile of your family to decide if a genetic referral is appropriate. Please ask your Clinical Nurse Specialist if you are concerned about this.

    What Are The Signs & Symptoms?

    Unfortunately, most women with cancer of the ovary have vague symptoms only and the disease may be advanced before diagnosis is made. Some symptoms may include.

    • Loss of appetite and or feeling full quickly
    • Vague indigestion, nausea, bloating
    • Swelling of the abdomen
    • Pain in the lower abdomen
    • Vaginal bleeding - although this is rare.
    • Persistent bloating
    • Unexplained weight loss
    • Extreme fatigue

    (Targetovariancancer.org.2017)

    These symptoms may also be due to other conditions - you should seek a medical opinion.

    Diagnosing Cancer of the Ovary

    A full medical history will be undertaken and a number of other tests may be carried out before a definite diagnosis can be mode. This may include: vaginal examination. Sometimes, the doctor may wish to examine your back passage.

    The doctor may arrange a chest x-ray, blood test, including a tumour marker CAl25 and a CT scan. All these investigations will be explained to you. (See hospital information leaflets). 

    Stages of Cancer

    Staging is a process of investigations which may be used to determine type/size of the tumour and if there is any spread. Staging is important to help decide treatment options. 

    Stages of Cancer of the Ovary

    The following stages are used for cancer of the ovary.

    Stage 1 - Cancer is limited to the ovary.

    Stage 2 - Cancer cells have spread to the pelvis.

    Stage 3 - Cancer cells have spread outside the ovaries, and spread outside the pelvis.

    Stage 4 - Cancer cells have spread beyond the pelvis to other parts of the body including the liver or lungs.

    Recurrent Disease - Recurrent disease means the cancer has come back (recurred) after it has been treated.

    Treatment Options

    There are two main treatment options for cancer of the ovary;

    • Surgery
    • Chemotherapy

    The best option for you will be decided by your consultant following discussion with you.

    Clinical Trials

    Researching new methods of treating cancer of the ovary are developing all the time. You may be asked to consider taking part in a clinical trial.

    Clinical trials are research studies involving patients which compare a different type of medical care with the best treatment currently available. You may be approached regarding a clinical trial which your consultant or specialist nurse will be able to discuss with you.

    Macmillan Cancer Support, produce a booklet which may be helpful to you. The type of treatment will be decided by the consultant in discussion with you.

    Surgery

    Surgical treatment involves the removal of the uterus (womb), ovaries, cervix and the fallopian tubes: also removed will be a curtain of fat from the abdomen called the omentum. During the surgery the surgeon will examine the lymph nodes in the pelvis and will remove any that feel abnormal. This is called a Laparotomy - Total Abdominal Hysterectomy Bilateral Salpingo Oophorectomy, (TAH + BSO) and Infa-colic Omentectomy. To ensure the surgeon can operate effectively you will need to have a mid- line incision. (See hospital information leaflets).

    Chemotherapy

    Chemotherapy means drug treatment. In ovarian cancer it can be used to destroy or control cancer cells. The treatment is given in specialist units or a cancer centre and your nurse specialist will tell you where your treatment will be. The chemotherapy can be given before or after surgery and your management plan will be discussed with you before treatment begins. Chemotherapy may in some cases be given in a tablet form. (See Clatterbridge Cancer Centre (CCC) booklet & specific information sheets).

    Life and Relationships

    • Most people feel overwhelmed when they are told they have cancer.
    • Many different emotions arise which can cause confusion.
    • Reactions differ from one person to another.
    • There is no right or wrong way to feel.
    • You may experience the whole range of personal emotions and reactions both- similar or different from family and friends.
    • Support and guidance is available in coping with these feelings.
    • Many people find great comfort in their faith and/or religious and spiritual beliefs.

    Following the diagnosis of cancer and your subsequent treatment, you may experience physical changes. There may be some issues/concerns you wish to raise /explore, i.e.

    • Body Image
    • Weight Gain/loss
    • Sexual Health
    • Menopause Symptoms
    • Others

     

    Your Clinical Nurse Specialist will be able to support you by explaining about the issue/concern and provide advice and information if required. This may help you adjust/cope with these changes. This may include involvement of other members of the Health Care Team (HCT) i.e.

    • Dietician
    • Lymphoedema Practitioner
    • Genetist
    • Physiotherapist
    • Occupational Therapist via your GP and your Primary Health Care Team (PHCT), General Practitioner (GP), District Nurse (DN).

    You may not be aware of who can help with changes in social and financial matters, but your Clinical Nurse Specialist can put you in touch with the relevant people who can provide guidance and advice in these and other aspects, including childcare, how to tell the children and practical day to day issues. i.e. Macmillan/Welfare Benefits advice.

    You may wish to explore information and coping methods to help yourself. Therefore, the following booklets may be helpful, (there are many others) from Macmillan Cancer Support.

    • Adjusting to life after cancer
    • Close relationships & cancer
    • Life with cancer
    • Sexuality & Cancer
    • Body image and sexuality

    Complementary Pensions

    Complementary therapies may be helpful to you and your family. There are many different types i.e.

    • Reflexology
    • Massage
    • Relaxation

    Plus many others. Your Clinical Nurse Specialist can advise you by providing information regarding the appropriateness for you and how to access them.

    Your Follow up Care

    This will be tailored to your specific needs. Your Clinical Nurse Specialist will also be able to offer you and your family advice, information and support, regarding your cancer, subsequent treatment and associated health issues.

    Equal Opportunities

    The hospital is committed to promoting an environment which provides equal opportunities for all patients, visitors and staff. If you have special requirements such as dietary needs, interpreter services, disability needs or a preference for a female doctor, please do not hesitate to discuss this with a member of staff who will try to help you.

    Support Networks Available Locally

    Further information, advice and support is available for you/partner family from:

    Knowsley

    Lyndale Cancer Support Centre

    Tel: 0151 489 3538

    Sefton Cancer

    Support Group

    Tel: 01704 879352

    www.seftoncancersupport.org.uk

    St Helens Cancer Support Group

    Tel: 01744 21831

    Warrington & District Cancer Self-Help Group

    Tel: 01925 453139

    The Wirral Holistic Care Services

    Tel: 0151 652 9313

    www.wirralholistic.org.uk

    Widnes & Runcorn Cancer Support Group

    Tel:0151 423 5730

    Isle of Man

    Manx Cancer Help Association

    Tel: 01624 679554

    www.manxcancerhelp.org

    Liverpool Sunflowers

    Liverpool Cancer Support

    Tel: 0151 726 8934

    National Resource Organisations for Gynae Oncology Patients

    Macmillan Cancer Support

    89 Albert Embankment London SE1 7UQ

    Cancerline: 0808 8080000

    Mon-Fri 9am-8pm

    www.macmillan.org.uk

    The Daisy Chain Network

    For additional information send an SAE to: The Daisy Chain Network, PO Box 183, Rossendale, Lancashire, BB4 6WZ

    Email: membership&media@daisynetwork.org.uk www.daisynetwork.org.uk

    The Daisy network is a premature menopause support group which offers advice, information and support for women throughout the UK.

    Menopause Matters

    www.menopausematters.co.uk

    For accurate up to date information about the menopause and its treatment options “An easy to use, independent, clinician-led website”.

    Gynae C

    1 Bollingbroke Road, Swindon 5N2 2L8

    Tel: 01793 302005

    www.communicate.co.uk/wilts.gynaec

    A support group/helpline led from Helen Jackson, for women (and their family or friends) who have any gynaecological cancer.

    Target Ovarian Cancer

    2 Angelgate, London EL1 2PT

    Tel: 02079 235470

    www.targetovariancancer.org.uk .

    The national ovarian cancer charity working to save lives and help women diagnosed live their lives to the full.

    Ovacome

    Tel: 0845 3710554

    www.ovacome.org.uk

    A national Support Group for all those concerned with ovarian cancer.

    Ask your support nurse for a free copy of The Cancer Guide which can guide, support and inform you through your cancer experience.

    References

    Nordin A (1999) Patient Pictures - Gynaecology, Health Press Ltd, Oxford.

    Office for National Statistics

    Cancer Statistics Registration 2014. www.statistics.gov.uk

    Blake P, Lambert H, Crawford R (1998) Gynaecological Oncology: A guide to clinical management, Oxford University Press

    Royal College of Nursing (2014) Gynaecological Cancer Publication code 002 S18

    www.targetovariancancer.org.uk (2017) Ovarian Cancer Symptoms

  • Cancer of the Vulva

    The leaflet is detailed below, or you can download the 'Cancer of the Vulva' leaflet in PDF.

    This leaflet has been written to help you understand about cancer of the Vulva, its diagnosis, treatment and support available. You may wish to discuss some aspects with your doctor or Clinical Nurse Specialist.

    What is Cancer?

    The organs of the body are made up of cells. Cancer is a disease of these cells. The cells normally divide in an orderly manner. Sometimes the cells divide out of control - developing into a lump/tumour. A tumour which is malignant consists of cancer cells which have the ability to spread beyond the original site, destroying surrounding tissue. Sometimes they can break away and spread to other parts of the body.

    The Vulva

    The vulva is the area of skin between a woman’s legs and it is made up of all the visible sex organs. The vulva consists of two outer lips (labia majora) and two inner lips (labia minora). The clitoris (a very small structure which can be an area of sexual climax) lies at the top of the vulva. Below this is the urethra (a tube through which urine passes) and just next to this is the vagina (birth canal). The anus (back passage) is separate from the vulva but is in the same area.

    Lymph glands are situated in the groin area at the top of each leg.

    Lymph glands are part of the lymphatic system which acts as the body’s natural defence against infection and disease.

    How does Cancer of the Vulva Develop?

    We may not know the exact cause of your cancer, but some wart virus infections (Human Papilloma Virus) have been linked to vulva cancer. This is an uncommon cancer, approximately 1313 cases per year in the UK (ONS 2014). It usually affects women between the ages of 55 and 75 but it can occur in younger women and the more elderly.

     

    What Are The Signs & Symptoms?

    The most common symptoms include soreness or an itchy area on the vulva. Other symptoms include:

    • A lump or swelling on the vulva
    • A mole on the vulva that changes colour or shape
    • Thickened raised red, white or dark patch on the skin of the vulva
    • Burning sensation when passing urine
    • Lasting itch (Cancer Research.uk)
    • All these symptoms can be a sign of many conditions other than cancer of the vulva. You should seek medical advice.

    Diagnosing Cancer of the Vulva

    A full medical history will be undertaken and a number of other tests may be carried out before a definite diagnosis can be made. This may include:

    • Examination of the vulva, vagina and rectum.
    • Biopsy will be needed - a minor operation done under local or general anaesthetic. The doctor will take a small sample of tissue from the vulva (for further examination under a microscope).

    If the biopsy shows you do have cancer, the doctor may wish you to have:

    • Further biopsies from the vulva and perineum (known as mapping).
    • Blood tests
    • Chest X-Ray
    • ECG Electrocardiograph (tracing of your heart)
    • An MRI scan, at Clatterbridge Cancer Centre may be needed to determine if the cancer has spread to other areas.

    Stages of Cancer

    Staging is a process of investigations which may be used to determine type/size of the tumour and if there is any spread. Staging is important to help decide treatment options. If the cancer is diagnosed at early stage, the treatment may be more successful.

    Stage 1 - Cancer is found only in the vulva and is less than 2cm in size.

    Stage 2 - Cancer is found only in the vulva but it is greater than 2cm in size.

    Stage 3 - Cancer cells have spread outside the vulva and/or the lymph nodes in the groin.

    Stage 4 - Cancer cells have spread beyond the vulva to the bladder (sac that holds urine) or the bowel or other distant parts of the body.

    Recurrent Disease - Recurrent disease means the cancer has come back (recurred) after it has been treated.

    Treatment Options

    There are three main treatment options for cancer of the vulva;

    • Surgery
    • Radiotherapy
    • Chemotherapy

    The type of treatment best for you will be decided by your consultant in discussion with yourself.

    Clinical Trials

    Clinical trials are research studies involving patients which compare a different type of medical care with the best treatment currently available. You may be approached regarding a clinical trial which your consultant or specialist nurse will be able to discuss with you. Macmillan cancer support produce a booklet which may be helpful to you.

    Surgery

    Surgery is the main treatment. It may be used alone or with radiotherapy. Your doctor will discuss with you the type of surgery required to remove the cancer. This can vary from:

    • Removing the cancer tumour and a small amount of surrounding tissue.
    • Removing the cancer tumour and a larger area of surrounding tissue.
    • Removing the above and the lymph glands in the groin. (At the same time or separately).
    • Removing the whole of the vulva and the lymph glands. (At the same time or separately).
    • In some situations the doctor may wish to assess the lymph nodes. This is carried out by ultrasound scan (USS) and fine needle aspiration (FNA) every 3 months.

    Your doctor will discuss with you whether remaining skin can be stitched back together or if a skin graft will be needed. (For further information about surgery and your hospital stay, see the hospital information leaflets).

    Radiotherapy

     

    Radiotherapy is the use of high energy X Rays (like having an X-Ray) to destroy cancer cells. Radiation comes from a machine outside the body. (External Beam Radiotherapy). This may be offered pre-operatively or postoperatively. The type of radiotherapy and length of time will be planned and decided individually between the doctor and yourself. (see CCC radiotherapy booklet, for more information).

    Chemotherapy

    Depending on the type and stage of your cancer/tumour, your doctor may suggest chemotherapy treatment. (see CCC booklet & specific information sheets).

    Life and Relationships

    • Most people feel overwhelmed when they are told they have cancer.
    • Many different emotions arise which can cause confusion.
    • Reactions differ from one person to another.
    • There is no right or wrong way to feel.
    • You may experience the whole range of personal emotions and reactions both similar or different from family and friends.
    • Support and guidance is available in coping with these feelings.
    • Many people find great comfort in their faith and/or religious and spiritual beliefs.

    Following the diagnosis of cancer and your subsequent treatment, you may experience physical changes. There may be some issues/concerns you wish to raise /explore, i.e.

    • Body Image
    • Weight Gain/loss
    • Vaginal Dryness
    • Menopause Symptoms
    • Others

    Your Clinical Nurse Specialist will be able to support you by explaining about the issue/concern and provide advice and information if required. This may help you adjust/cope with these changes. This may include involvement of other members of the Health Care Team (HCT) i.e.

    • Lymphoedema Practitioner
    • Dietician
    • Physiotherapist
    • Occupational Therapist via GP, Primary Health Care Team (PHCT), General Practitioner (GP), District Nurse (DN), specialist Palliative Care Nurses SPC CNS.

    You may not be aware of who can help with changes in social and financial matters, but your Clinical Nurse Specialist  can put you in touch with the relevant people who can provide guidance and advice in these and other aspects, including childcare, how to tell the children and practical day to day issues. i.e. Macmillan/Welfare Benefits Advisor.

    You may wish to explore information and coping methods to help yourself. Therefore, the following booklets may be helpful, (there are many others) from Macmillan Cancer Support.

    • Adjusting to life after cancer
    • Close relationships & cancer
    • Life with cancer
    • Sexuality & Cancer
    • Body image and sexuality

    Complementary Therapies

    Complementary therapies may be helpful to you and your family. There are many different types i.e.

    • Reflexology
    • Massage
    • Relaxation

    Plus many others. Your Clinical Nurse Specialist can advise you by providing information regarding the appropriateness for you and how to access them.

    Your Follow up Care

    This will be tailored to your specific needs. The doctors will see you on a regular basis in the outpatient department (OPD). If you develop any further symptoms the doctor will see you promptly and may start further investigations.

    Your Clinical Nurse Specialist will also be able to offer you and your family advice, information and support, regarding your cancer, subsequent treatment and associated health issues. A copy of the Cancer Guide Booklet, can also support and inform you through your cancer experience.

    Equal Opportunities

    The hospital is committed to promoting an environment which provides equal opportunities for all patients, visitors and staff. If you have special requirements such as dietary needs, interpreter services, disability needs or a preference for a female doctor, please do not hesitate to discuss this with a member of staff who will try to help you.

    Support Networks Available Locally

    Further information, advice and support is available for you/partner family from:

    Knowsley

    Lyndale Cancer Support Centre

    Tel: 0151 489 3538

    Sefton Cancer Support Group

    Tel: 01704 879352

    www.seftoncancersupport.org.uk

    St Helens Cancer Support Group

    Tel: 01744 21831

    Warrington & District Cancer

    Self-Help Group

    Tel: 01925 453139

    The Wirral Holistic Care Services

    Tel: 0151 652 9313

    www.wirralholistic.org.uk

    Widnes & Runcorn Cancer Support Group

    Tel: 0151 423 5730

    Isle of Man

    Manx Cancer Help Association

    Tel: 01624 679554

    www.manxcancerhelp.org

    Liverpool Sunflowers

    Liverpool Cancer Support

    Tel: 0151 726 8934

    E.V.O.C.

    Gynaecological Support Group

    0151 702 4186

    Liverpool

    VACO

    Vulva Awareness Campaign Organisation

    Tel: 0161 7475911

    www.vaco.co.uk

    Help,support and friendly advice co-ordinated by a patient - Carol Jones.

    Website information may be obtained from your hospital (www.lwh.nhs.uk), local and national support networks above.

    Ask your support nurse for a free copy of The Cancer Guide which can guide, support and inform you through your cancer experience.

    National Resource Organisations for Gynae Oncology Patients

    Macmillan Cancer Support

    89 Albert Embankment London SE1 7UQ

    Cancer line: 0808 8080000 Mon-Fri 9am-8pm

    www.macmillan.org.uk

    Gynae C

    1 Bollingbroke Road, Swindon 5N2 2L8

    Tel: 01793 302005

    www.communicate.co.uk/wilts.gynaec

    A support group/helpline run by Helen Jackson for women (and their family or friends) who have any gynecological cancer.

    References

    Macmillan 2014 Understanding Cancer of the Vulva

    Office for National Statistics (2014) Cancer Statistics Registration. www.statistics.gov.uk

    RCN Gynaecological Cancer 2014

    www.cancerreserach.org.uk (2017) Vulval cancer symptoms

  • Taking Opioids to Manage Pain in Palliative Care

    The leaflet is detailed below, or you can download the 'Taking Opioids to Manage Pain in Palliative Care' leaflet in PDF.

    Introduction

    The doctors and nurses looking after you have recommended that you try opioids (morphine – type medication) to help to relieve your pain. This information leaflet may help answer some questions you may have regarding the medication prescribed to you.

    People living with serious illness (such as cancer, heart disease, kidney disease and lung disease) may experience pain as part of their illness. There are many different types and strengths of painkillers suitable for different types of pain e.g. paracetamol, codeine. Sometimes strong pain relieving medication is required and in this situation strong opioids such as morphine or morphine type medicines (e.g. oxycodone, fentanyl, diamorphine, and buprenorphine) may be recommended.

    Common Concerns or Worries about Using Strong Opioids

    • Some people worry that they may become addicted to or dependent on strong opioids. However when strong opioids, prescribed for pain, are monitored correctly this is unlikely to happen
    • Others worry about the potential harmful side effects. The team looking after you will monitor you carefully for any side effects
    • Occasionally people think that they are coming to the end of their life if strong opioids are being prescribed. Strong opioids may be prescribed at any stage of someone’s illness if they have pain or other symptoms such as breathlessness which are severe enough to require them.

    Starting Treatment with Strong Opioids

    There are many types of strong opioids that can be given in different ways. The first opioid you should be offered is morphine. Morphine can be taken by mouth in the form of tablets, capsules, liquids or powder.

    You will be offered one of the two types of morphine:

    • Immediate Release: A short acting type that you may need to take several times a day (this begins to work after about 30 minutes and lasts for 4 hours)
    • Sustained / Modified Release: a slow release type that is taken less frequently (usually releases slowly over 12 hours)

    If you are taking sustained release morphine you should also be offered a supply of immediate release morphine which you can take as needed to help you manage any breakthrough pain.

    There is no standard dose of strong opioids the amount needed to control pain varies between individuals. Over the first few days the amount of morphine you are taking will be monitored and adjusted to find the lowest dose that controls your pain with the fewest side effects.

    Managing Pain with Strong Opioids

    Your pain will be different from other people’s pain, even if you have the same type of illness. When you feel pain, and how much pain you feel will vary from day to day and from hour to hour. Often how ‘bad’ a pain is depends on many different factors, for example how tired you are, how active you have been the day before, and whether you are bored or enjoying what you are doing. This means that the same dose of medicine each day may not ‘match’ your pain fully. When you start taking strong opioids you should be offered regular reviews of your pain control and any side effects. This should happen throughout your treatment, but is particularly important at the beginning when your dose may need to be adjusted.

    Pain Relief Is Usually Given For Two Main Types Of Pain:

    • Background Pain: This is pain which is present nearly all the time, at a predictable level. It is treated with a regular long acting strong opioid at a set dose.
    • Breakthrough Pain: This is when your pain levels suddenly increase. For these occasions you will be prescribed a short acting ‘immediate release’ opioid which will add to your ‘background’ dose for a few hours to cover the extra pain you are experiencing.

    Take only the amount of breakthrough medication prescribed for you. If you need more than three breakthrough doses a day, you must contact your healthcare professional who may need to adjust your regular long acting medicine.

    Managing Side Effects

    All medicines may cause side effects and these can vary from person to person:

    • Constipation (when stools become painful or difficult to pass or are less frequent): This is the most common side effect as opioids slow down the movements of the gut. You will be given laxatives to relieve any constipation. Laxatives work by making the stool looser or by stimulating the bowel to move. They do not work immediately, it is important to continue to take them on a regular basis.
    • Nausea (Feeling Sick): Usually occurs when starting opioids and wears off after a few days. You may be given anti-sickness medication to help with this.
    • Drowsiness: Some people experience drowsiness or problems with concentration when starting strong opioids or when the dose is increased. This may affect your ability to carry out certain manual tasks such as driving. If you experience drowsiness that is severe or to long-lasting you should report this to the person who prescribed your medication

    Someone who has taken too much strong opioid may become drowsy, unable to stay awake and may develop twitching or jerking movements or feel muddled. If this happens the medications should be discussed with a health care professional as soon as possible, with your GP in normal working hours or the emergency / out of hours service.

    Driving With Strong Opioids

    When you first start taking strong painkillers, they can sometimes make you feel tired and drowsy. You may not be able to concentrate and your reactions may be slow. If this happens, you should not drive or operate machinery.

    Don’t

    • Drive for the first 5 days after you first start taking strong painkillers
    • Drive for the first 5 days if the dose has been increased
    • If drowsy you should not operate machinery

    Do

    • Keep your first drive short
    • Take a driver with you in case you feel drowsy while you’re out
    • Ask your doctor for advice if you’re worried whether you’re safe to drive
    • It is a good idea to carry a copy of your prescription and the packaging the painkillers come in

    It is an offence to drive with certain drugs above certain limits in your body. This includes some prescription medicines. However, most people taking strong painkillers will not be breaking the law as long as:

    • The painkillers are not affecting your ability to drive safely
    • The painkillers have been prescribed to treat a medical problem
    • You have followed the instructions you were given by the prescriber or the information that came with the painkillers

    The police can stop drivers and use tests to check whether they have taken any drugs. This may include a blood or urine test at the police station. So it’s a good idea to carry a copy of your prescription and the packaging the painkillers come in.

    Remember, you aren’t breaking the law as long as you have taken the painkillers as they have been prescribed and are driving safely. If you are not sure if you’re able to drive, you should not drive and speak to your doctor, specialist nurse or pharmacist for advice.

    What If I Can’t Swallow My Tablets

    If you cannot take your strong opioids by mouth and your pain is fairly stable, you may be offered an opioid patch that sticks to the skin and releases the medication through the skin. These are changed every few days or once a week depending upon the type of patch used. If your pain is unstable or fluctuating, subcutaneous injections (injecting into the skin) may be considered.

    What If I Miss A Dose Of Medications?

    Do not take an extra dose of your long acting strong opioid. Use your ‘breakthrough’ medicine as necessary to manage your pain until the next dose of your long acting medicine is due. (If you are using opioid patches which last several days you should discuss what to do with the healthcare professional responsible for your care).

    Alcohol and Strong Opioids

    The effect of drinking alcohol i.e. sleepiness and poor concentration, will add to any side effects experienced from your strong opioids.

    You should avoid alcohol when you first start taking opioids or when there has been an increase in opioids. If you are taking strong opioids you should avoid alcohol if you are going to drive or use tools or machines. Once established on a steady dose you should be able to drink alcohol in moderation without getting any extra side effects.

    Taking Other Medications with Strong Opioids

    The doctor or nurse prescribing your strong opioids will check what other medicines you are taking. Most people can take strong opioids alongside their other medicines without any problems. If there are potential interactions your health care professional will advise you.

    Storage

    Store medications in the containers in which they are given to you. Store them in a cool, safe place out of sight of children and vulnerable adults. Any medicine that you do not use should be returned to the pharmacy for safe disposal. 

    Follow Up and Future Prescription

    Details of the medicine you have been prescribed will be shared between your hospital teams, your GP and community teams. If you are an inpatient your hospital team will renew your medicines and change prescriptions as needed. When you are at home, the GP is responsible for your prescriptions and will renew them, alongside other health care professionals involved in your care on a regular basis.

     

    Who to Contact

    If you have any further questions relating to strong opioids or if you are having problems controlling your pain you should contact the person responsible for your care. For example your GP, hospital doctor or palliative care nurse specialist.

    Useful Contact Details

    Palliative Care Team

    Phone: 0151 702 4186.

  • Patient Syringe Driver

    The leaflet is detailed below, or you can download the 'Patient Syringe Driver' leaflet in PDF.

    What Is A Syringe Driver?

    A syringe driver is a small portable battery-operated device. The device is attached to a syringe, which gives you medication continuously (over 24 hours) through a small needle under the skin. The syringe driver is small enough to be carried in a pouch/bag, a shoulder holster or large pocket.

    Why Do I Need One?

     Sometimes it is easier for you to have some of your medications this way. There are several reasons why you might have a syringe driver:

    • If you are finding it difficult to swallow medication
    • If you are feeling sick and/or vomiting frequently and you are unable to keep tablets in the stomach long enough for them to work
    • If you are struggling with the amount of tables that you need to take
    • If your symptoms are difficult to control with tablets alone

    Instead of having repeated injections the syringe driver can provide a simpler more comfortable way to receive medication continuously. Starting a syringe driver doesn’t mean that your medications have stopped working or aren’t strong enough, only that this is a more effective way of getting the medications in to the body.

    Syringe drivers can be used across all care settings e.g. hospital, hospice and at home and can be used at any point during your illness.

    Using a Syringe Driver

    The syringe is attached to a thin piece of tubing that has a fine needle attached to the end. The nurse will insert the needle just under the skin on your chest, tummy, upper arm or leg and will secure it in place with a clear dressing. Once the needle is in place it can stay in place for a number of days. The nurses looking after you will refill the syringe in syringe driver every day. If you are at home, the district nurses will attend your home to do this. At the same time the nurses will:

    • Check the pump is working properly
    • Check the needle site
    • Review your symptoms
    • Replace the needle every few days

    How Long Will I Need The Syringe Driver For?

    You may only need it for a couple of days / weeks. Your symptoms and the need for a syringe driver will be reviewed on a regular basis.

    Some Do’s And Don’ts

    Do

    • Tell the nurse if your skin is red or sore where the needle is in place
    • Tell the nurse if the needle comes out, the alarm is sounding or if you have any concerns regarding the syringe driver medication
    • Keep all medication in a safe place away from children preferably in a locked cupboard
    • Keep the syringe contents out of direct sunlight

    Don’t

    • Immerse the syringe driver in water. You can have a bath or shower but keep the needle site dry and keep the machine out of water by placing on a nearby stool/table. Your nurse can give you advice on this
    • Do not attempt to change the settings on the syringe driver or press the buttons
    • Do not drop the syringe driver
    • Do not place the syringe driver at a higher level than the needle/tubing

    In the event of any of these happening please contact the nurse in charge of your care / district nurses

    How Will I Know The Syringe Driver Is Working?

    The nurse will check the syringe driver at least daily to ensure it is working. A small light above the ON/OFF button will flash green regularly. If it turns red you should inform the nurse in charge of your care / district nurses as soon as possible. There is an alarm on the syringe that will beep if there is a problem. The alarm usually beeps for two reasons:

    • Blockage of flow of medication caused by a kink in the tubing
    • The syringe is empty. If the alarm sounds contact the nurse in charge / district nurses.

    If you have any queries or concerns please phone:

    Liverpool Women’s NHS Foundation Trust

    Mon – Fri 9am to 5pm.

    0151 708 9988 Ext 4334 tr speak to the Rapid Access Clinic Trackers

    Or

    Speak to the nursing staff in the Emergency Room on 0151 702 4140

    Or

    Telephone your GP

  • Radical Hysterectomy

    The leaflet is detailed below, or you can download the 'Radical Hysterectomy' leaflet in PDF.

    Radical Hysterectomy

    This leaflet has been written and produced to inform you, your partner and family in order to assist and support you, if you are considering or have been recommended to have this surgery. It is not intended to replace verbal information with your surgeon and specialist nurse. You can access other information via websites available – see end of leaflet.

    Benefits and Reasons for having a Radical Hysterectomy

    The aim of this surgery is to give the best possible outcome of your treatment management. You may want to know whether your treatment will work or whether you can stay well without treatment.

    Your doctor will have explained that you have an early stage cancer of the cervix. See leaflet ‘Cancer of the Cervix’.

    Your partner and carer may also have concerns and questions about how they can help you, and how your condition and treatment will affect them.

    Try to find out as much as you can about your treatment options and make a list of questions you may want to ask your doctor.  (See information resources at back of leaflet).

    Treatment Options & Choices

    The treatment option will be discussed with you, with your consultant, and you may find the leaflet regarding understanding cancer of the cervix helpful.

    What is a Radical Hysterectomy?

    Hysterectomy is surgery to remove the Uterus (womb).

    A radical hysterectomy means also removing a small part of the top of the vagina, some of the tissue either side of the neck of the womb, and lymph nodes. The operation takes 2 ½ - 3 ½ hours. Inpatient stay is approximately 3-4 days.

    Your consultant will discuss with you whether to take your ovaries out or leave them behind. The incision (cut) in your abdomen (tummy) may be vertical (up & down), transverse (across) or laparoscopic (keyhole). Your consultant will discuss with you which is the most appropriate way in your circumstances.

    Laparoscopic Radical Hysterectomy

    A Laparoscopic Radical Hysterectomy involves removal of the same tissues as above, but the operation is done through four small cuts in the abdomen instead of an open incision. The operation takes longer (approximately 4 hours) than open surgery, but causes less pain and discomfort afterwards, has less blood loss during the surgery and leaves smaller scars on the abdomen. Because of the benefits, it means you can get back to normal several weeks sooner. Inpatient stay is approximately 2 days.

    What Happens Before The Operation?

    You will attend Pre-operative Clinic the same day as Outpatients or shortly before the operation. During this visit the staff will discuss the type of operation you will be having and what to expect before and after.  You will have the opportunity to ask any questions that you may have.

    The staff will ask you to complete a health questionnaire and written and verbal information about the Enhanced Recovery programme will also be given to you.  It would also be helpful if you would make a list of all the medicines and drugs you are currently taking. The staff may seek advice from an anaesthetist or physician before your operation.  A few tests may be performed such as blood pressure, urine test, blood tests and sometimes a chest x-ray or heart tracing.  You may need to see an anaesthetist for assessment before your operation.  The pre op staff will discuss with you blood thinning injections when you go home after your operation; there is a risk of blood clots after any surgery (and particularly after surgery for cancer), and the injections (for up to 4 weeks after the operation) will minimise this risk. 

    If you have any special requirements (physical/practical) for your admission such as a special diet or religious/cultural needs please let the staff know during your visit so that all necessary arrangements can be made.

    By attending the pre-operative clinic your future care can be jointly planned according to your individual needs, and all necessary steps taken to make your stay as comfortable as possible.  If you feel you may need help following surgery please discuss this with your GP or the nurse at the pre-operative clinic.

    In Hospital – Before Your Operation

    You will be admitted to the hospital on the day of your operation or the day before.  As soon as you know you need an operation, try and get yourself into the best possible physical shape so that you can recover more quickly.

    Stop smoking, eat a healthy diet and if able, take regular exercise.  If possible make plans with your family for while you are in hospital and arrange for some extra help at home for your first couple of weeks at home. 

    You will be shown to your bed by a member of the team.  The nurse will introduce herself and show you the ward layout. 

    Before you go into the operating theatre you will not be allowed to eat or drink for several hours before your operation.  If you are in hospital the night before you will be asked to shower the morning of the operation, if coming in on the day please do this prior to admission.

    There is usually an opportunity to meet the anaesthetist prior to surgery to discuss any concerns.

    You may be given support stockings to wear during and after your surgery and you will also be prescribed an injection to reduce the risk of blood clots in the post-operative period.  This is given as prescribed by the doctor.  A member of the ward team will escort you to theatre and they will complete a checklist prior to you leaving the ward.  The nurse will stay with you until the theatre reception staff takes over. 

    On arrival in theatre, you will meet the anaesthetist who will put you to sleep with an injection given via a small needle in the back of the hand.  When you wake up the operation will have been completed and you will be in the recovery room which is alongside theatre.  Here you will remain for a short while for observation, before being brought back to your bed on the ward.

    After Your Operation

    You may feel some discomfort when you wake, and you will be given painkillers as required (see leaflet).  You will have a drip in your arm and a catheter or small tube to drain urine from your bladder.

    Your surgeon will visit to explain exactly what happened during the operation and will be able to tell you when you can start to drink and get out of bed.

    A slight discharge or slight bleeding from the vagina is normal but if this becomes heavy you should tell your nurse straight away. You may get griping wind pains caused by bowel and stomach gas, but there are medicines which can help. You will be given a laxative to aim to avoid constipation causing pain after the operation.

    Your stitches are usually dissolvable so do not need removing. Occasionally the surgeons will use clips and these will be removed by either the ward nurse or the district nurse and you will be informed when this will happen.

    Once home you will receive an enhanced recovery phone call from a nurse to check on your progress.

    Any tissue taken at the time of your operation will be sent for examination and you will be informed of the result, this usually takes 2-3 weeks in clinic.  Following investigation the tissue will be disposed of in accordance with health and safety. You may be asked if a fragment of any tissue removed to be kept as part of our ongoing commitment to research for future treatments into cancer. This would only be done with your agreement.

    Possible Complications

    Although we try to make sure that any problems are kept to a minimum, no surgical operation can be guaranteed free of complications. The operation itself or the general anaesthetic may occasionally give rise to difficulties, which will make your stay in hospital longer or your recovery slower.

    The risk of developing complications after surgery is increased in some patients.  If you smoke you are more at risk of a chest infection.  If you are overweight or diabetic you are more at risk of developing wound infection.

    Frequency and Pain on Passing Urine

    Occasionally, after a hysterectomy you may feel the need to pass urine more frequently.  This is a result of slight bruising and swelling of the bladder.  Pain relief such as paracetamol is recommended.  It is also beneficial to exclude a urine infection if this persists.

     

    Retention of Urine

    There is an increased risk of retention after a radical hysterectomy (open or laparoscopic) than compared to a standard hysterectomy. Because of this we usually leave the catheter in the bladder for 6-7 days after the operation. Most women are ready to go home before the catheter is ready for removal, so we would usually aim to send you home with the catheter in place with a small leg bag under your trousers, with a plan to return for a Trial without Catheter (TWOC) a few days later. When you return and your catheter has been removed, you have an ultrasound scan on the ward.  This will look at whether you are emptying your bladder completely.  It is important not to retain urine in your bladder, as it will become infected.  If the scan shows you are retaining urine a catheter will be put back in and left for 1-2 weeks.  This will allow your bladder time to go back to normal.  Should you still be not emptying completely we will show you how to pass a small temporary catheter yourself.  Again this is only usually needed for a short period of time.

    ‘Wind Pain’ / Delayed Bowel Function

    The operation can affect your bowel function and cause increased wind pain.  This can cause pain in the abdomen, shoulder and back.  Eating small quantities, especially of fruit and vegetables, and drinking plenty of fluid will help to re-establish your normal bowel movements. Painkillers and moving about will also ease the discomfort.

    Occasionally the bowel can ‘go on strike’.  This is known as an ileus.  This can cause abdominal pain and distension, vomiting and constipation.  If this happens you will have a drip and not be allowed to eat until your symptoms settle, usually within a couple of days.

    Constipation

    It usually takes time for your bowels to return to their normal pattern; you will be offered laxatives to take after the operation to minimise any potential problems with bowel function.

    Vaginal Bleeding / Discharge

    Some women have a small bloodstained vaginal discharge after the operation.

    Occasionally you can bleed quite heavily.  This may be a sign that the wound inside your vagina is not healing, or that there is infection or a blood collection developing.  If you are concerned about your bleeding please tell the nurse looking after you and she will assess if it is normal.

    If this becomes a heavy loss or an unpleasant smelling discharge when you go home, you are advised to contact your GP or the gynaecology ward.

    Lymphoedema

    Lymphoedema is swelling due to excess accumulation of fluid in the tissue. There is a risk of developing lymphoedema when pelvic nodes are removed. Secondary lymphoedema may develop in one or both legs.  This will require specific ongoing management including the use of special hosiery, massage; skin care and exercises (see separate information leaflet). If you are at risk of developing lymphoedema you will meet with the lymphoedema practitioner who will help with your management.

    Lymphocysts are collections of lymphatic fluid which may occasionally form in the pelvis following pelvic node dissection.  Only a small proportion of lymphocysts require treatment which is usually done by aspirating the cyst in symptoms develop.

    Infection

    With any invasive operation there is a risk of infection.  Already mentioned are urine and vaginal infection.  There is also a Risk of developing a chest infection particularly if you have breathing related illnesses or you smoke.  It is important to do deep breathing exercises after your operation.  If necessary you may be referred for physiotherapy, or need a course of antibiotics.

    Another potential area of infection is the abdominal wound (cut on your tummy).This can cause symptoms, such as redness around the wound; leakage from the wound or your temperature is raised.  A member of the nursing staff will check your dressing each day.  Please tell them if you are worried.  It is also possible to develop a blood collection behind the wound; this would cause extreme bruising and tenderness.

    Bleeding

    It has already been mentioned that there can be bleeding from the vagina and the abdominal wound.  Very occasionally patients bleed heavily during surgery and it is necessary to have a blood transfusion.  If you have any concerns regarding this please speak with your Consultant or Specialist Nurse.

    Damage to the Bowel or Bladder

    Due to the nature of your surgery and the anatomy inside the pelvis there is a small risk of damage to either the bladder, the ureters (tubes to the kidney) or the bowel. The surgeon doing your operation would explain beforehand if you were at an increased risk. 

    If there are any problems during the operation these would be dealt with appropriately and you would be informed after your surgery.

    Adhesions/Hernia

    Almost all patients undergoing surgery on their abdomen will develop some adhesions. This is scar tissue which sticks together.  They usually cause no symptoms and you are not aware of them. Rarely can they cause persistent pain or problems with bowel function.  A hernia is a defect in the scar that can develop, occasionally this requires corrective surgery.

    Developing a Clot

    It is well recognised that having major surgery can cause patients to develop Deep Vein Thrombosis (blood clot in the leg) or Pulmonary Embolism (blood clot in the Lung), and this also is increased for gynaecological cancer surgery.  As this is a known risk, all patients having major surgery are advised to wear anti embolism stockings until fully mobile, and blood thinning therapy (fragmin) is given each day for four weeks after your operation.

    All the above are possible complication which will be discussed with you prior to signing your consent form.  If you have any concerns please speak to a member of the nursing team.

    Returning To Work

    Recovery time is variable for patients; a degree of tiredness is experienced for some time. Return to work depends on the nature of your job.  You must feel comfortable at work and be able to cope. You will probably feel tired at first.  You will need to refrain from work for at least 8-12 weeks after open surgery, and at least 6-10 weeks after a laparoscopic operation. Your GP may advise you when to return, or when you attend for your gynaecology outpatient appointment you may discuss this with the doctor.

    Your Questions Answered

    When Should I Stop Taking The Oral Contraceptive Pill?

    You should stop taking it as soon as possible before your operation and use a barrier method instead.  After the operation you will no longer be able to become pregnant.

    How Does Having A Hysterectomy Bring About The Menopause?

    The menopause happens when your ovaries stop producing eggs and therefore the hormones oestrogen and progestogen which control your monthly menstrual cycle are reduced. 

    You may already have experienced the menopause naturally.  If your ovaries are removed during your laparotomy and you have not already gone through the menopause then you will have your menopause straight away.

    What Are The Symptoms Of The Menopause?

    Hot flushes and night sweats are the most common.  These can be embarrassing, uncomfortable and can disturb your sleep.  Dryness in the vagina can cause pain and discomfort when making love.  Other problems are mood changes, tiredness, anxiety and loss of concentration.  Hair and skin can become dry and joints may be painful.  In time, low oestrogen levels can cause osteoporosis (thinning bones) and heart disease.

    How Can Hormone Replacement Therapy Help?

    Hormone replacement therapy (HRT) relieves menopausal symptoms and can prevent osteoporosis.  As the name suggests, this treatment replaces the oestrogen your ovaries no longer produce.  There are many different types and strengths of HRT available.  HRT can be given either as tablets to be taken every day or as skin patches which you change twice a week.  Your doctor should be able to find a form of HRT to suit you.

    When Should You Start HRT?

    Your consultant will decide when and whether it is appropriate for you to start taking HRT.

    Are There Any Side Effects With HRT?

    Some women have nausea, breast tenderness or leg cramps at first, but this normally settles down quickly within the first three months.  Others find that their skin becomes sensitive to skin patches.  Occasionally headaches can become a problem.  HRT does not cause you to put on weight.

    What about Breast Cancer?

    Breast cancer is a common disease in older women and 1 in 8 women in the UK will suffer from it.  Studies show that taking HRT for up to 5 years does not appear to change the risk of getting the disease.  Experts believe that if you have had your ovaries removed you can take HRT up to the time you would have had your menopause and then for an additional five years before there is any likelihood of change in risk.

    There are also alternatives therapies/supplements to help with menopausal symptoms. These can be discussed with your nurse specialist.

    Driving

    Your movement and strength must be able to cope with an emergency stop before you return to driving.  You should feel comfortable behind the wheel, with a seat belt over your abdomen. Recommended guidelines suggest 4-6 weeks.  Or you could check with your insurance company.

    Sex

    It is advisable to refrain from intercourse for at least 6 weeks after an open radical hysterectomy, and for 8-12 weeks after a laparoscopic radical hysterectomy.  This is to prevent infection and to reduce trauma.  Resuming sexual intercourse will depend on the type and extent of surgery you have had and if you are worried about this then please speak to a member of staff before you are discharged.

    Emotional Health

    What Will I Feel Like?

    After your operation, as after any big operation, you may feel depressed and tearful.  This is a normal reaction, which the doctors and nurses understand.  You may find it helps to talk with the staff caring for you so don’t bottle up your feelings.

    As time passes, you will begin to feel better but you may still have ‘up’ days and ‘down’ days.  It may take 6-12 months before you feel you have really adjusted physically and emotionally to what has happened.  This is also normal.  Some women find it helps to talk to their doctor, a specialist nurse or to one of the organisations listed at the back of this booklet.  Please feel free to discuss your concerns.

    Follow Up Appointment 

    You will be given a follow up appointment for approximately 3 weeks after your operation; this will be sent out to you.  At this appointment your doctor will have the report from the laboratory about the tissue from the operation.  Depending on these results, you may need further treatment with radiotherapy (x-ray treatment) or chemotherapy (drugs).  If this is recommended, your surgeon will discuss the treatment individually with you.

    Will I Come Back For Check-Ups?

    Yes, after your hysterectomy the doctors will ask you to attend hospital at regular intervals.  You will be given an appointment for the outpatient clinic and as time passes the appointments will probably become less frequent.  The follow up appointments will involve regular clinical assessment and vaginal examinations. (See - What to expect during your follow up care leaflet).

    Your family doctor will have received details of your operation, so if you feel that things are not gradually returning to normal when you are at home, you might like to discuss this with him/her. Well-meaning friends, relatives and even other patients can give inaccurate and sometimes alarming information.  Although many women are sometimes embarrassed to talk about themselves after this operation, it may be helpful for you to share your concerns with your family doctor or practice nurse.  If you are still worried you may wish to contact the hospital.

    Equal Opportunities

    The hospital is committed to promoting an environment, which provides equal opportunities for all patients, visitors and staff.  If you have any special requirements such as dietary needs, interpreter services, disability needs or a preference for a female doctor do not hesitate to discuss this with a member of staff who will try to help you. 

    Where Can I Get Help?

    If you have queries or problems regarding your illness or operation, or experience any unexpected problems, please contact:

    • Your hospital doctor (Consultant)
    • or one of their team
    • or specialist nurse
    • or your family doctor/ practice nurse / community nurse

    Both National and local leaflets/information are available on all aspects of your recovery. Please ask your nurse specialist for further links to this information.

    Further Help

    The staffs on the ward are always available to discuss these and any other issues with you fully, please do not hesitate to ask.

    A cancer information service is also provided by these organisations:

    • Gynae C

    Tel: 01793 302005

    www.communigate.co.uk/wilts/gynae

    • Jo’s Trust

    www.jotrust.org.uk

    • The Daisy Network (Menopause issues)

    PO Box 183

    Rossendale

    Lancs

    BB4 6WZ

    www.daisynetwortk.org.uk

    • Macmillan Cancer Support

    Cancer Support Line: 0808 808 0000

    www.macmillan.org.uk

    • Menopause Matters

    www.menopausematters.co.uk

    • Lymphoedema Support Network

    Tel: 020 7351 4480

    www.lymphoedema.org.lsn

    References:

    Gynaecology

    Shaw, Southler & Stanton

    Published by Churchill Livingstone

    Natural Alternatives to HRT

    Marilyn Glenville.

    Published by Kyle Cathie Ltd, 1997.

    ISBN 1-8-5626-254-5

    Hysterectomy –

    The emotional aspects,

    Published by Dennerstein, Wood & Burrows

    Hysterectomy – What it is and how to cope with it successfully

    Suzie Hayman – Sheldon Press,

    ISBN -0-859-69-870X,

    Biddles Press Ltd.

    www.biddles.co.uk

    Our Bodies Ourselves

    Jill Rakusen & Angela Phillips

    Published by Penguin

    A Woman’s Guide to Hysterectomy –

    Expectations  Options

    Published by Celestial Arts,

    ISBN 1-58761-105-8

    The Menopause

    Rosetta Reitta

    Published by Penguin

  • Laparotomy

    The leaflet is detailed below, or you can download the 'Laparotomy' leaflet in PDF.

    Laparotomy with or without Hysterectomy, Bilateral Salpingo-Oophorectomy

    This leaflet has been written and produced to inform you, your partner and family in order to assist and support you if you are considering or have been recommended to have this surgery. It is not intended to replace verbal information with your surgeon and specialist nurse.  You can access other information via websites available – see end of leaflet.

    What is a Laparotomy?

    A laparotomy means an operation to look inside the abdomen. Usually the ovaries and fallopian tubes and the Uterus (womb) are removed.  Samples from other tissues such as the lymph glands and the omentum (a fatty layer) may also be taken. It may sometimes be necessary to remove a small piece of bowel and rejoin the ends or form a stoma (where a piece of bowel comes through the skin onto the abdomen).  Occasionally if it is not possible to carry out the full operation, samples of tissue (Biopsies) will be taken and sent away for examination.

    The incision (cut) in your abdomen (tummy) will be vertical (up & down).  This allows your consultant to assess thoroughly for any signs of the disease spreading.  A sample of fluid (peritoneal washings) may also be taken from the area in the operation. Inpatient stay is approximately 3-4 days.

    Benefits & Reasons for Having a Laparotomy

    The aim of this surgery is to give the best possible outcome of your treatment management.

    Your doctor will have explained that you may have or suspect that you have cancer of the ovaries.  The operation can be performed for diagnosis and/or treatment.  It may also be performed after you have had some chemotherapy treatment. See leaflet (Cancer of the Ovary).

    Your partner and carer may also have concerns and questions about how they can help you, and how your condition and treatment will affect them.

    Try to find out as much as you can about your treatment options and make a list of questions you may want to ask your doctor.  (See information resources at back of leaflet).

    What Happens Before The Operation?

    You will attend Pre-operative Clinic either the same day or visit on another date before the operation. During this visit the staff will discuss the type of operation you will be having and what to expect before and after.  You will have the opportunity to ask any questions that you may have.

    The staff will ask you to complete a health questionnaire and written and verbal information about the Enhanced Recovery programme will also be given to you.  It would also be helpful if you would make a list of all the medicines and drugs you are currently taking. The staff may seek advice from an anaesthetist or physician before your operation.  A few tests may be performed such as blood pressure, urine test, blood tests and sometimes a chest x-ray or heart tracing.  You may need to see an anaesthetist for assessment before your operation.  The pre op staff will discuss with you blood thinning injections when you go home after your operation; there is a risk of blood clots after any surgery (and particularly after surgery for cancer), and the injections (for up to 4 weeks after the operation) will minimise this risk.

    If you have any special requirements or needs (physical or practical) for your admission such as a special diet or religious/cultural needs please let the staff know during your visit so that all necessary arrangements can be made.

    By attending the pre-operative clinic your future care can be jointly planned according to your individual needs, and all necessary steps taken to make your stay as comfortable as possible.  If you feel you may need help following surgery please discuss this with your GP or the nurse at the pre-operative clinic.

    In Hospital – Before your Operation

    You will be admitted to the hospital on the day of your operation or the day before.  As soon as you know you need an operation, try and get yourself into the best possible physical shape so that you can recover more quickly.

    Stop smoking, eat a healthy diet and if able, take regular exercise.  If possible make plans with your family for while you are in hospital and arrange for some extra help at home for your first couple of weeks at home. 

    You will be shown to your bed by a member of the team.  The nurse will introduce herself and show you the ward layout.  

    Before you go into the operating theatre you will not be allowed to eat or drink for several hours before your operation.  If you are in hospital the night before you will be asked to shower the morning of the operation, if coming in on the day please do this prior to admission.

    There is usually an opportunity to meet the anaesthetist prior to surgery to discuss any concerns.

    You may be given support stockings to wear during and after your surgery and you will also be prescribed an injection to reduce the risk of blood clots in the post-operative period.  This is given as prescribed by the doctor.  A member of the ward team will escort you to theatre and they will complete a checklist prior to you leaving the ward.  The nurse will stay with you until the theatre reception staff takes over. 

    On arrival in theatre, you will meet the anaesthetist who will put you to sleep with an injection given via a small needle in the back of the hand.  When you wake up the operation will have been completed and you will be in the recovery room which is alongside theatre.  Here you will remain for a short while for observation, before being brought back to your bed on the ward.

     

    After Your Operation

    You will probably feel some discomfort when you wake, and you will be given painkillers as required (see leaflet).  You may have a drip in your arm and a catheter or small tube to drain urine from your bladder. 

    Your surgeon will visit to explain exactly what happened during the operation and will be able to tell you when you can start to drink and get out of bed.

    A slight discharge or slight bleeding from the vagina is normal but if this becomes heavy you should tell your nurse straight away.  You may get griping wind pains caused by bowel and stomach gas, but there are medicines which can help. You will be given a laxative to aim to avoid constipation causing pain after the operation.

    Your stitches are usually dissolvable so do not need removing. Occasionally the surgeons will use clips and these will be removed by either the ward nurse or the district nurse and you will be informed when this will happen.

    You will normally stay in hospital for 3-4 days. Once home you will receive an enhanced recovery phone call from a nurse to check on your progress.

    Any tissue taken at the time of your operation will be sent for examination and you will be informed of the result in clinic, this usually takes 3 weeks. Following investigation the tissue will be disposed of in accordance with health and safety. You may be asked if a fragment of any tissue removed to be kept as part of our ongoing commitment to research for future treatments into cancer. This would only be done with your agreement.

    Possible Complications

    Although we try to make sure that any problems are kept to a minimum, no surgical operation can be guaranteed free of complications.  The operation itself or the general anaesthetic may occasionally give rise to difficulties, which will make your stay in hospital longer or your recovery slower.

    The risk of developing complications after surgery is increased in some patients.  If you smoke you are more at risk of a chest infection.  If you are overweight or diabetic you are more at risk of developing wound infection.

    Frequency and Pain in Passing Urine

    Occasionally, after a hysterectomy you may feel the need to pass urine more frequently.  This is a result of slight bruising and swelling of the bladder.  Pain relief such as paracetamol is recommended.  It is also beneficial to exclude a urine infection if this persists.

    ‘Wind Pain’ / Delayed Bowel Function                                           

    The operation can affect your bowel function and cause increased wind pain.  This can cause pain in the abdomen, shoulder and back.  Eating small quantities, especially of fruit and vegetables, and drinking plenty of fluid will help to re-establish your normal bowel movements. Painkillers and moving about will also ease the discomfort.

    Occasionally the bowel can ‘go on strike’.  This is known as an Ileus.  This can cause abdominal pain and distension, vomiting and constipation.  If this happens you will have a drip and not be allowed to eat until your symptoms settle, usually within a couple of days.

    Constipation

    It usually takes time for your bowels to return to their normal pattern; you will be offered laxatives to take after the operation to minimise any potential problems with bowel function. 

    Vaginal Bleeding / Discharge

    Some women have a small bloodstained vaginal discharge after the operation.

    Occasionally you can bleed quite heavily.  This may be a sign that the wound inside your vagina is not healing, or that there is infection or a blood collection developing.  If you are concerned about your bleeding please tell the nurse looking after you and she will assess if it is normal.

    If this becomes a heavy loss or an unpleasant smelling discharge when you go home, you are advised to contact your GP or the gynaecology ward.

    Infection

    With any invasive operation there is a risk of infection.  Already mentioned are urine and vaginal infection.  There is also a Risk of developing a chest infection particularly if you have breathing related illnesses or you smoke.  It is important to do deep breathing exercises after your operation.  If necessary you may be referred for physiotherapy, or need a course of antibiotics.

    Another potential area of infection is the abdominal wound (cut on your tummy). For example, redness around the wound or your temperature is raised.  A member of the nursing staff will check your dressing each day.  Please tell them if you are worried.  It is also possible to develop a blood collection behind the wound; this would cause extreme bruising and tenderness.

    Bleeding

    It has already been mentioned that there can be bleeding from the vagina and the abdominal wound.  Very occasionally patients bleed heavily during surgery and it is necessary to have a blood transfusion.  If you have any concerns regarding this please speak with your Consultant or Specialist Nurse.

    Damage to the Bowel or Bladder

    Due to the nature of your surgery and the anatomy inside the pelvis there is a small risk of damage to either the bladder, the ureters (tubes to the kidney) or the bowel. The surgeon doing your operation would explain beforehand if you were at an increased risk.  If there are any problems during the operation these would be dealt with appropriately and you would be informed after your surgery.

    Adhesions / Hernia

    Almost all patients undergoing surgery on their abdomen will develop some adhesions.  This is scar tissue which sticks together.  They usually cause no symptoms and you are not aware of them.  Rarely can they cause persistent pain or problems with bowel function.  A hernia is a defect in the scar that can develop, occasionally this requires corrective surgery.

    Developing a Clot

    It is well recognised that having major surgery can cause patients to develop Deep Vein Thrombosis is (blood clot in your leg) or Pulmonary Embolism, (blood clot in your lung) and this also is increased for gynaecological cancer surgery.  As this is a known risk, all patients having major surgery are advised to wear anti embolism stockings until fully mobile, (fragmin) a blood thinning therapy is given each day depending on your risk score ( see separate leaflet). 

    All the above are possible complication which will be discussed with you prior to signing your consent form.  If you have any concerns please speak to a member of the nursing team.

    Your Questions Answered

    When Should I Stop Taking The Oral Contraceptive Pill?

    You should stop taking it as soon as possible before your operation and use a barrier method instead.  After the operation you will no longer be able to become pregnant.

    How Does Having A Laparotomy Bring About The Menopause?

    The menopause happens when your ovaries stop producing eggs and therefore the hormones oestrogen and progestogen which control your monthly menstrual cycle are reduced.  You may already have experienced the menopause naturally.  If your ovaries are removed during your laparotomy and you have not already gone through the menopause then you will have your menopause straight away.

    What Are The Symptoms Of The Menopause?

    Hot flushes and night sweats are the most common.  These can be embarrassing, uncomfortable and can disturb your sleep.  Dryness in the vagina can cause pain and discomfort when making love.  Other problems are mood changes, tiredness, anxiety and loss of concentration.  Hair and skin can become dry and joints may be painful.  In time, low oestrogen levels can cause osteoporosis (thinning bones) and heart disease.

    How Can Hormone Replacement Therapy Help?

    Hormone replacement therapy (HRT) relieves menopausal symptoms and can prevent osteoporosis.  As the name suggests, this treatment replaces the oestrogen your ovaries no longer produce.  There are many different types and strengths of HRT available.  HRT can be given either as tablets to be taken every day, as implants which are inserted under the skin every 6 months or so or as skin patches which you change twice a week.  Your doctor should be able to find a form of HRT to suit you.

    Can I Have HRT and When Should You Start HRT?

    Your consultant will advise you based on your results if it is appropriate for you to consider HRT and if so when to start.

    Returning To Work

    Recovery time is variable for patients; a degree of tiredness is experienced for some time. Return to work depends on the nature of your job.  You must feel comfortable at work and be able to cope. You will probably feel tired at first.  You will need to refrain from work for at least 8-12 weeks but your GP will give you advice, or if you are attending for a gynaecology out-patient appointment you may discuss this with the doctor.

     

    Driving

    Your movement and strength must be able to cope with an emergency stop before you return to driving.  You should feel comfortable behind the wheel, with a seat belt over your abdomen. Recommended guidelines suggest 4-6 week, or you could check with your insurance company.

    Sex

    It is advisable to refrain from intercourse for at least 6 weeks.  This is to prevent infection and to reduce trauma.  Resuming sexual intercourse will depend on the type and extent of surgery you have had and if you are worried about this then please speak to a member of staff before you are discharged. 

    Emotional Health

    What will I feel like?

    After your operation, as after any big operation, you may feel depressed and tearful.  This is a normal reaction, which the doctors and nurses understand.  You may find it helps to talk with the staff caring for you so don’t bottle up your feelings.

    As time passes, you will begin to feel better but you may still have ‘up’ days and ‘down’ days.  It may take 6-12 months before you feel you have really adjusted physically and emotionally to what has happened.  This is also normal.  Some women find it helps to talk to their doctor, a specialist nurse or to one of the organisations listed at the back of this booklet.  Please feel free to discuss your concerns.

    Follow up appointment

    Yes, you will be given a follow up appointment for approximately 3 weeks after your operation.  At this appointment your doctor will have the report from the laboratory about the tissue from the operation.  Depending on these results, you may need further treatment with chemotherapy (drugs).  If this is recommended, your surgeon will discuss the treatment individually with you.

    Will I come back for check-ups?

    Usually, after your hysterectomy the doctors will ask you to attend hospital at regular intervals.  You will be given an appointment for the outpatient clinic and as time passes the appointments will probably become less frequent.  The follow up appointments will involve regular clinical assessment and vaginal examinations. (See - What to expect during your follow up care leaflet).

    Your family doctor will have received details of your operation, so if you feel that things are not gradually returning to normal when you are at home, you might like to discuss this with him/her. Well-meaning friends, relatives and even other patients can give inaccurate and sometimes alarming information.  Although many women are sometimes embarrassed to talk about themselves after this operation, it may be helpful for you to share your concerns with your family doctor or practice nurse.  If you are still worried you may wish to contact the hospital.

    Equal Opportunities

    The hospital is committed to promoting an environment, which provides equal opportunities for all patients, visitors and staff.  If you have any special requirements such as dietary needs, interpreter services, disability needs or a preference for a female doctor do not hesitate to discuss this with a member of staff who will try to help you.

    Where can I get help?

    If you have queries or problems regarding your illness or operation, or experience any unexpected problems, please contact:

    • Your hospital doctor (Consultant)
    • one of their team
    • specialist nurse
    • your family doctor/ practice nurse / community nurse

    Both National and local leaflets/information are available on all aspects of your recovery. Please ask your nurse specialist for further links to this information.

    Further Help

    The staffs on the ward are always available to discuss these and any other issues with you fully, please do not hesitate to ask.

    A cancer information service is also provided by these organisations:

    The Daisy Network

    PO Box 183

    Rossendale

    Lancs

    BB4 6WZ

    www.daisynetwork.org.uk

    Ovacome

    Po Box 6294

    London

    W1A 7WJ

    Ovacome Support Line:  0845 371 0554

    Email:  ovacome@ovacome.org.uk

    http://www.ovacome.org.uk

    Gynae C

    Tel:  01793 302005      

    www.communigate.co.uk/wilts/gynae

    Menopause Matters

    www.menopausematters.co.uk 

    Macmillan Cancer Support

    Cancer Support Line:  0808 808 0000

    www.macmillan.org.uk

    Eve Appeal

    www.eveappeal.org.uk

    References

    Gynaecology

    Shaw, Southler & Stanton

    Published by Churchill Livingstone

    Hysterectomy –

    The emotional aspects,

    published by

    Dennerstein, Wood & Burrows

    Natural Alternatives to HRT

    Marilyn Glenville

    Published by Kyle Cathie Ltd

    ISBN -1 -8 5626- 254- 5

    Our bodies Ourselves

    Jill Rakusen & Angela Phillips

    Published by Penguin

    The Menopause

    Rosetta Reitta

    Published by Penguin

    A Woman’s Guide to Hysterectomy – Expectations & Options

    A Hass & S Puretz

    Published by Celestial Arts

    ISBN 1-58761 - 105 - 8

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