Physiotherapy in cervical cancer care

Cervical cancer is a type of cancer that starts in the cervix. The cervix is a hollow cylinder that connects the lower part of a woman’s uterus to her vagina (birth cancer). Most cervical cancers begin in cells on the surface of the cervix.

Symptoms of cervical cancer

Many women with cervical cancer don’t realize they have the disease early on, because it usually doesn’t cause symptoms until the late stages. When symptoms do appear, they’re easily mistaken for common conditions like menstrual periods and urinary tract infections (UTIs). Typical cervical cancer symptoms are:

• Unusual bleeding, such as in between periods, after sex, or after menopause.
• Vaginal discharge that looks or smells different than usual.
• Pain in the pelvis.
• Needing to urinate more often.
• Pain during urination.

Causes of cervical cancer

Most cervical cancer are caused by the sexually transmitted human papillomavirus (HPV). This same virus causes genital warts. There are about 100 different strains of HPV, only two types commonly cause cancer; HPV-16 and HPV-18. Being infected with a cancer-causing strain of HPV doesn’t mean you will get cervical cancer. The immune system can eliminate majority of the HPV infections often within two years. HPV can also cause other cancers in women and men. These includes:

• Vulvar cancer
• Vaginal cancer
• Penile cancer
• Anal cancer
• Rectal cancer
• Throat cancer

Complications of Cervical cancer

• Sexual dysfunction (vaginal dryness and decreased sexual desire)
• Chronic pelvic pain/ joint stiffness and fatigue.
• Decreased muscle strength and flexibility
• Lower limb lymphedema
• Pelvic floor weakness/ soft tissue tightness.
• Shortness of breath

Physiotherapy management

Women who have a current diagnosis of cervical cancer can benefit from physiotherapy services. Physiotherapy provides symptom relief by addressing impairments such as fatigue, sexual dysfunction, muscle weakness, and management of pain.  The primary role of physical therapy associated with cervical cancer is education.  Physiotherapy management includes:

• Pelvic floor muscle strengthening and exercises.
• Stretching, strengthening and aerobic exercises.
• Lymphatic drainage massage
• Behavioural training
• Aerobic exercises for endurance
• TENS for pain relief
• Manual stretching and myofascial therapy.

While treating patients with cancer, it is important for physiotherapists to review hematological values. Aerobic exercise is contraindicated for patients receiving chemotherapy treatments when lab values are low. Physical therapy exercises are clinically proven and effective in helping cancer patients improve their quality of life.