Complications of Cervical Cancer Treatment: What Every Patient Needs to Know

Surgical Complications

Surgery is the primary treatment for early-stage cervical cancer (stages IA1 through IB2–IIA1). The standard operation is a radical hysterectomy with pelvic lymph node dissection. While it is a well-established procedure with excellent cure rates, it carries specific risks both during and after the operation. Surgical complications can broadly be understood in three stages: complications that may occur during surgery, early complications that develop in the days to weeks after surgery, and late complications that may appear months to years later.

Radiation Therapy Complications

Radiation is used as either primary treatment (in locally advanced disease, stages IIB–IVA) or as adjuvant therapy after surgery when high-risk features are found. It involves external beam radiation (EBRT) to the pelvis and intracavitary brachytherapy (internal radiation). Radiation therapy complications can broadly be understood in two stages: acute side effects that occur during or immediately after treatment, and late complications that may develop months to years later.

• 1. Acute Radiation Side Effects
• 2. Late Radiation Complications

Chemotherapy, Immunotherapy & Targeted Therapy Complications

Chemotherapy is used in several contexts, including before surgery, together with radiation, after surgery in high-risk cases, and as palliative treatment in metastatic disease. The most commonly used drugs are cisplatin, carboplatin, and paclitaxel. When cisplatin chemotherapy is given simultaneously with radiation, it is called concurrent chemoradiotherapy (CCRT), which can amplify treatment-related toxicity. Chemotherapy complications vary depending on the drug used. Cisplatin may cause nausea and vomiting, kidney damage, peripheral neuropathy, hearing loss, low blood counts, and electrolyte disturbances. Paclitaxel may cause hypersensitivity reactions, peripheral neuropathy, hair loss, joint and muscle pain, and myelosuppression. Carboplatin is generally better tolerated than cisplatin, with less nausea and nephrotoxicity but more myelosuppression, particularly thrombocytopenia. CCRT can cause increased haematological, gastrointestinal, and renal toxicity. It can also increase the risk of pelvic insufficiency fractures and serious infection. Regular blood count and kidney function monitoring, hydration, and supportive treatment are important during therapy. Pembrolizumab immunotherapy can cause immune-related adverse events involving different organs. These include skin toxicity, thyroid dysfunction, pneumonitis, hepatitis, colitis, and adrenal insufficiency. Rare but serious complications such as encephalitis, myocarditis, and HLH have also been reported. New symptoms can occur during treatment or months after stopping. Molecular targeted therapies can also cause specific complications. Bevacizumab may cause hypertension, proteinuria, impaired wound healing, arterial thromboembolic events, gastrointestinal perforation or fistula, and epistaxis. Tisotumab vedotin can cause ocular toxicity including conjunctivitis, dry eyes, keratoconjunctivitis, and ulcerative keratitis. Patients receiving tisotumab vedotin require ophthalmologist assessment before each cycle and should report new eye symptoms immediately. Across these treatments, early reporting of symptoms, regular monitoring, multidisciplinary care, and appropriate preventive measures are important for managing complications and maintaining quality of life.

• Chemotherapy
• Concurrent Chemoradiotherapy (CCRT)
• Immunotherapy — Pembrolizumab
• Molecular Targeted Therapy

How Are Cervical Cancer Treatment Complications Managed?

Across all treatment modalities, several principles guide good complication management. Most serious complications are easier to manage when caught early, so patients should not minimise new symptoms. Managing complications may require multidisciplinary care. Depending on the complication, care may involve a gynaecologic oncologist, endocrinologist, neurologist, gastroenterologist, or surgical team. Preventive measures are also an important part of treatment. Vaginal dilators can help prevent vaginal stenosis, anti-emetics help control nausea, eye drops help prevent keratitis, compression stockings and anticoagulation help prevent DVT, and calcium and vitamin D support bone health. Quality of life should also be considered during survivorship care, including the physical, psychological, and sexual consequences of treatment.

• Early reporting of symptoms
• Multidisciplinary care
• Preventive measures and prophylaxis
• Quality-of-life focused follow-up