By Malinda Wright
Every year over 70,000 American women are diagnosed with gynecological cancer, according to the CDC. A diagnosis of gynecological cancer can be devastating, but, as medical technology and research advances, more and more women with this diagnosis are becoming cancer survivors. Although surviving cancer is an amazing feat, many of these women are left with a decreased quality of life due to adverse side effects of the cancer treatment. It is common for gynecological cancer survivors to report one or more of the following: urinary dysfunction, bowel dysfunction, sexual impairments, pelvic pain, cancer related fatigue, and lymphedema. What many women – and sometimes their medical practitioners – do not realize is that their pelvic floor impairments and lymphedema can often be treated by a physical therapist.
Before we dive into physical therapy treatment, I want to first talk about what gynecological cancer is. Gynecological cancer refers to cancer within the female reproductive system. There are 5 main types of gynecological cancer: vulvar, vaginal, cervical, uterine, and ovarian. The signs and symptoms for each of these cancers differ; the CDC has put together an information booklet to help distinguish them. Medical treatment for gynecological cancer may include surgery, radiation therapy, chemotherapy, and/or hormonal therapy. Studies have shown that these treatments can have an adverse side effect on the pelvic floor. However, research has also shown that physical therapy can help ease these adverse side effects.1
One of the things we treat most often here at PHRC is muscle tension. Since gynecological cancer assaults our most private and vulnerable areas, muscle guarding during medical treatment is very common. Guarding occur when we tense up, and when we draw everything in to protect ourselves. Although it is a natural response to pain, guarding can increase pain and discomfort over time by causing muscle tension and spasms, as well as myofascial trigger points. Additionally, even after medical treatment has ended, muscle guarding may still continue as a response to discomfort such as with post-op surgical pain. Radiation therapy can also contribute towards muscle tightness, as there can be changes to the elasticity of the muscles that have been exposed to radiation. If these complications occur, patients may complain of tightness within the pelvis, abdomen, inner thighs, hips, and buttock muscles. Once present, the increased muscle tone and myofascial trigger points can also contribute towards pain with sexual intercourse, urinary and bowel impairments such as difficulty emptying the bladder, urinary and bowel frequency and urgency, and constipation. This is where therapy comes in. At PHRC, we can treat muscle tension by using manual physical therapy to release any muscle tightness and myofascial trigger points, and thus help ease discomfort within the pelvic region.
Another adverse side effect common with gynecological cancer treatment is scar tissue restriction. The development of scar tissue is a biologic response; scar tissue forms to heal the body from a wound. Surgery, such as hysterectomy or vulvectomy, naturally creates scar tissue as a part of the healing process after the surgical procedure. Scar tissue can commonly cause pain and discomfort due to lack of mobility or hypersensitivity along the scar. Pelvic radiation therapy can also create scar tissue. Radiation therapy, such as external beam radiation and brachytherapy, affects all tissues within the field of treatment, including muscles, tendons, ligaments, and skin. It is not uncommon for women to experience vaginal stenosis, narrowing of the vaginal canal, due to scar tissue forming from pelvic radiation. This can cause pain with sexual intercourse. Manual physical therapy helps to stretch, mobilize and desensitize the scar tissue, making the patient feel better.
Chemotherapy and radiation therapy are gruelling ordeals, inducing cancer-related fatigue in the vast majority of cases. Cancer-related fatigue can be described as extraordinary exhaustion disproportionate to one’s activity or exertion. It is not relieved by rest or sleep and disrupts quality of life. The keys to managing cancer-related fatigue are energy management, frequent rest breaks, and a well-designed and individualized exercise program. It may be hard for patients with cancer-related fatigue to be motivated to exercises, however research shows that physical activity is important with reducing the risk of cancer recurrence and mortality.2 Exercise is important for increasing strength and mobility, reducing pain and helping to prevent osteoporosis. Bone density can decrease when we go through menopause and many gynecological cancer patients go through abrupt menopause due to having their ovaries removed. A decrease in bone density can lead to osteoporosis and an increased risk of fractures. Physical therapy helps patients to maintain strong bones, mobility, balance, and everyday function all the while being cognitious of cancer-related fatigue.
Another risk to be mindful of is lymphedema. Lymphedema is when excess fluid collects in tissue causing swelling, also known as edema. Depending on the stage of the cancer, some gynecological cancer patients may have lymph nodes removed, mainly from the groin area. Lymph nodes are important for carrying lymph fluid, nutrients and waste. When lymph nodes have been removed from the groin, fluid may collect and cause swelling in the pelvis, abdomen, and/or leg. This swelling is called lymphedema. Not all gynecological patients develop lymphedema, however if lymph nodes have been removed, then the patient has a lifetime risk of developing lymphedema. Physical therapy intervention consists of patient education on how to prevent lymphedema and to decrease lymphedema if it has occurred through manual lymphatic drainage therapy.
Accepting a decreased quality of life after surviving gynecological cancer is not obligatory. Physical therapy treatment is available to ease the discomfort commonly associated with cancer treatment. Surviving cancer warrants a happy and celebratory life.
If you have any questions or comments regarding this topic, please do not hesitate to leave them in the comment section below.
Malinda Wright, MPT
Malinda received her undergraduate degree from Dominican University of California in International Management. She attended graduate school for physical therapy at Royal College of Surgeons Ireland, and has been fortunate to travel to some wonderful countries including Scotland, Egypt, and Brazil. Malinda has always had a flair for adventure so when she isnt treating patients in our Los Gatos office, she enjoys snow skiing and hiking. However, Malinda believes that there is nothing like spending time with family in beautiful California.
- Yang, E.J., et al. Effect of a pelvic floor muscle training program on gynecological cancer survivors with pelvic floor dysfunction: A randomized controlled trial. Gynecology Oncology 2012; 125:705-711.