Meningitis - Vaccination

There are a number of vaccines that can prevent many types of viral and bacterial meningitis.

The vaccines available include:

    the MMR vaccine (which protects against measles, mumps and rubella)
    the meningitis C vaccine
    the 5-in-1 vaccine – which provides protection against diphtheria, tetanus, whooping cough (pertussis), polio and Hib (Haemophilus influenzae type b)
    the pneumococcal vaccine
    the meningitis W vaccine

Children should receive most of these vaccines as part of the NHS vaccination schedule. Speak to your GP if you're not sure whether your vaccinations are up-to-date.

Meningitis B vaccine

In 2013, a new meningitis B vaccine called Bexsero was approved for use by the European Medicines Agency (EMA).

In March 2014, the government's Joint Committee on Vaccination and Immunisation (JCVI), recommended routine use of the meningitis B vaccine in the UK.

The JCVI has said that the vaccine should be offered to babies at 2, 4 and 12 months of age. However, a number of issues, such as cost and supply, still need to be addressed, so it's likely to be a number of months before the vaccine is introduced.

Meningitis W vaccine

Teenagers and university students are to be offered a vaccination to prevent meningitis W disease. This is because cases of meningitis and septicaemia (blood poisoning) caused by Men W bacteria are rising, because of a particularly deadly strain.

From August 2015, all 17 and 18-year-olds in school year 13 and first-time university students up to the age of 25 will be offered the Men ACWY vaccine as part of the NHS vaccination programme. The Men ACWY vaccine protects against four different causes of meningitis and septicaemia – meningococcal (Men) A, C, W and Y diseases.

tags: Meningitis - Vaccination, Meningitis, Vaccination, Meningitis W vaccine, Meningitis B vaccine, There are a number of vaccines that can prevent many types of viral and bacterial meningitis.

Meningitis - Complications

Bacterial meningitis can place tremendous strain on the body and the brain.

It's estimated that a quarter of people with meningococcal disease (meningitis or blood poisoning caused by Neisseria meningitidis) will have complications.

Complications can vary in severity from person to person, and can be temporary or permanent.

The more severe a meningitis infection is, the greater the likelihood of complications. Complications are more common after bacterial meningitis and rare after viral meningitis.

Possible complications include:

    hearing loss – which may be partial or total
    problems with memory and concentration
    co-ordination and balance problems
    learning difficulties and behavioural problems – which may be temporary or permanent
    epilepsy – a condition that causes repeated seizures (fits)
    cerebral palsy – a general term for a number of neurological conditions that affect movement and co-ordination
    speech problems
    vision loss – which may be partial or total

Hearing loss

As hearing loss is the most common complication of meningitis, people recovering from the condition will usually have a hearing test. The test should be carried out before you're discharged, or within four weeks of being well enough to have the test.

Children and young people should discuss the results of their hearing test with a paediatrician (a doctor who specialises in treating children). This should take place between four and six weeks after being discharged from hospital. In cases where hearing is severely affected, cochlear implants (small devices inserted into the ears to improve hearing) may be needed.

Gangrene

If bacteria have entered the blood, they can produce toxins that kill healthy tissue. If the tissue damage is severe, it will die and become gangrenous.

Gangrenous tissue will need to be surgically removed in a procedure called debridement. In the most severe cases, it may be necessary to amputate a whole body part such as a finger, toe or a limb (arm or leg).

Intensive care

Being treated in intensive care for several weeks can sometimes cause complications. Some common problems people have reported after leaving an intensive care unit include:

    feeling weak and tired
    having a weak voice
    feeling depressed 

Psychological effects

Having meningitis can be a traumatic experience, particularly for young children. People often experience psychological effects and behavioural changes.

Possible psychological effects include:

    becoming "clingy" and needing to be near a loved one – for example, a child may feel anxious when they're not with a parent
    bedwetting
    disturbed sleep
    nightmares
    moodiness
    aggression or irritability
    feeling dejected or hopeless
    temper tantrums
    developing a fear of doctors and hospitals

These effects should improve with time as you or your child recover, but some people may need additional therapy to cope.

Talk to your GP if you're anxious about your child's behaviour, or if you're having psychological problems.

They may be able to refer you to mental health services for treatment, such as counselling, or they may refer your child to a child psychologist (a specialist in assessing and treating mental health conditions in children).

tags: Meningitis - Complications, Meningitis, Complications, Psychological effects, Intensive care, Gangrene, Hearing loss, Bacterial meningitis can place tremendous strain on the body and the brain.

Meningitis - Treatment

Immediate hospital admission is required in cases of suspected meningitis or septicaemia (blood poisoning).

Bacterial meningitis

Someone with bacterial meningitis will require urgent treatment in hospital. If they have severe meningitis, they may need to be treated in an intensive care unit (ICU).

Antibiotics will be used to treat the underlying infection. These can be given intravenously (through a vein in your arm). At the same time, you may also be given:

    oxygen
    intravenous fluids
    steroids or other medication to help reduce the swelling around your brain

If the antibiotics are effective, you'll need to be in hospital for about a week. However, if you're severely ill, you may need to stay in hospital for several weeks or even months.

Meningococcal disease (either meningitis or septicaemia due to Neissaria meningitidis) can cause some long-term complications. 

Viral meningitis

Viral meningitis can either be mild or severe. The treatment for both severities is described below.

Mild viral meningitis

Most people with viral meningitis won't require hospital treatment. Viral meningitis is usually mild and can be treated at home with:

    plenty of rest
    painkillers for the headache
    anti-emetics (anti-sickness) medicine for the vomiting

Most people take between 5 and 14 days to recover.

Severe viral meningitis

If the symptoms of viral meningitis are severe enough to require hospital admission, antibiotics will be given until the cause of the symptoms is known.

However, once a diagnosis of viral meningitis has been confirmed, the antibiotics will be stopped, as they have no effect on viruses. However, intravenous fluids will be given to help the body recover.

In very severe cases, where someone is in hospital with viral meningitis, anti-viral medicines may be given.

Infection control

Most cases of meningitis are isolated, and the risk of the infection spreading is low.

However, if someone is thought to be at high risk of infection, they may be given a dose of antibiotics as a precautionary measure.

This could be, for example, a young child who has been in close contact with another child who has developed bacterial meningitis. 

tags: Meningitis - Treatment, Meningitis, Treatment, Infection control, Bacterial meningitis, Severe viral meningitis, Viral meningitis, Mild viral meningitis, Immediate hospital admission is required in cases of suspected meningitis or septicaemia (blood poisoning).

Meningitis - Diagnosis

Meningitis can be difficult to diagnose.

It usually comes on suddenly and can be confused with flu because many of the symptoms are the same.

Seek immediate medical help if you notice any of the signs and symptoms of meningitis, particularly in a young child.

This may mean going to your local accident and emergency (A&E) department in the middle of the night. Don't wait for the purple rash to appear, because not everyone gets a rash.

A suspected case of meningitis should always be treated seriously. If you're not sure whether it's meningitis, you can get more advice by calling:

    your GP, practice nurse or health visitor
    NHS 111
    the Meningitis Research Foundation on 080 8800 3344
    Meningitis Now on 0808 80 10 388

Both of the above charities run a 24-hour freephone helpline. The Meningitis Trust also have a free meningitis signs and symptoms iPhone app that you can download.

Confirming the diagnosis

If meningitis is suspected, treatment will usually begin before the diagnosis has been confirmed. This is because some of the tests can take several hours to complete, and it could be dangerous to delay treatment.

The doctors will carry out a physical examination to look for signs of meningitis or septicaemia (blood poisoning), such as a rash. They will also carry out tests to confirm the diagnosis.

Diagnostic tests for meningitis may include:

    a blood test – to check for the presence of bacteria or viruses that can cause meningitis
    a lumbar puncture – where a sample of cerebrospinal fluid (CSF) is taken from the base of the spine under local anaesthetic and checked for the presence of bacteria or viruses
    a computerised tomography (CT) scan – if there are any other suspected problems, such as brain damage
    a chest X-ray – to look for signs of infection

tags: Meningitis - Diagnosis, Meningitis, Diagnosis, Confirming the diagnosis,Meningitis can be difficult to diagnose.

Meningitis - Causes

Meningitis can be caused by bacteria or a virus.

Bacterial meningitis

Vaccination programmes have helped reduce the number of different types of bacteria that can cause meningitis.

However, there are currently a number of bacteria for which there currently aren't effective vaccines. Some bacterial causes are described below.

Neisseria meningitidis bacteria

Neisseria meningitidis bacteria are often referred to as meningococcal bacteria. There are several different types of meningococcal bacteria, called groups A, B, C, W, X, Y and Z.

There's a vaccination that protects against group C meningococcal bacteria. Read more about the Men C vaccination. There's also a quadruple vaccine that provides protection against group A, C, W and Y meningococcal bacteria.

In the UK, most cases of meningococcal meningitis are caused by the group B bacteria. A vaccine for group B bacteria has recently been developed and approved for use, but it isn't currently available on the NHS.

Streptococcus pneumoniae bacteria

Streptococcus pneumoniae bacteria are often referred to as pneumococcal bacteria.

Pneumococcal bacteria tend to affect babies and young children because their immune systems (the body's natural defence) haven't built up immunity (protection) to these bacteria.

Spreading the bacteria

The meningococcal bacteria that cause meningitis can't survive for long outside the body, so they're usually only spread through prolonged, close contact. Possible ways the bacteria are spread include:

    sneezing
    coughing
    kissing
    sharing utensils, such as cutlery
    sharing personal possessions, such as a toothbrush or cigarette

As most people, particularly adults aged over 25, have a natural immunity to the meningococcal bacteria, most cases of bacterial meningitis are isolated, single incidents.

However, there's a chance of a small outbreak of cases occurring in environments where many young people live in close proximity. For example:

    boarding schools
    university campuses
    military bases
    student housing

Pneumococcal bacteria are more easily spread than meningococcal bacteria, and are passed on through coughing and sneezing. However, in most cases, they only cause mild infections, such as a middle ear infection (otitis media). 

Viral meningitis

As in the case of bacterial meningitis, vaccination programmes have successfully eliminated the threat from many viruses that used to cause viral meningitis.

For example, the measles, mumps and rubella (MMR) vaccine provides children with immunity against mumps, which was once a leading cause of viral meningitis in children.

However, there are still a number of viruses that can cause viral meningitis. These include:

    enteroviruses – a group of viruses that usually only cause a mild stomach infection, and can be spread through coughing, sneezing or not washing your hands after touching a contaminated surface
    herpes simplex virus – which can cause genital herpes and cold sores 

During a meningitis infection

In most meningitis infections, bacteria or viruses spread through the blood. An infection can begin in one part of the body, such as your throat or lungs, before moving through the tissue and into the blood.

The brain is usually protected from infection by the blood-brain barrier, which is a thick membrane that filters out impurities from the blood before allowing it into the brain. However, in some people, the infection is able to pass through the blood-brain barrier and infect the meninges (brain membrane).

The immune system responds to the infection by causing the meninges to swell in an attempt to stop the spread of infection. The swollen meninges may then damage the brain and the rest of the nervous system (nerves and spinal cord).

Bacteria or viruses can also infect the cerebrospinal fluid (CSF) that surrounds and supports the brain and spinal cord. If the CSF becomes infected, it can cause the meninges to become more swollen, leading to increased pressure in the skull and pressing on the brain. This is known as intracranial pressure.

tags: Bacterial meningitis, Viral meningitis, Spreading the bacteria, During a meningitis infection, Neisseria meningitidis bacteria, Streptococcus pneumoniae bacteria, Meningitis can be caused by bacteria or a virus.

Meningitis - Symptoms

Every suspected case of meningitis should be treated as a medical emergency.

Bacterial meningitis can lead to septicaemia (blood poisoning), which can be fatal.

Bacterial meningitis

Bacterial meningitis is more serious than viral meningitis. The symptoms usually begin suddenly and get worse rapidly.

If you suspect bacterial meningitis, dial 999 immediately and ask for an ambulance.

Babies and young children

Babies and young children under five years of age are most at risk of developing bacterial meningitis.

A baby or young child with meningitis may:

    have a high fever, with cold hands and feet
    vomit and refuse to feed
    feel agitated and not want to be picked up
    become drowsy, floppy and unresponsive
    grunt or breathe rapidly
    have an unusual high-pitched or moaning cry
    have pale, blotchy skin, and a red rash that doesn't fade when a glass is rolled over it (see below)
    have a tense, bulging soft spot on their head (fontanelle)
    have a stiff neck and dislike bright lights
    have convulsions or seizures

The above symptoms can appear in any order, and some may not appear at all.

The rash can be harder to see on dark skin, in which case check for spots on paler areas like the palms of the hands, soles of the feet, on the tummy, inside the eyelids and on the roof of the mouth.

However, don't wait for a rash to develop. If your child is unwell and getting worse, seek medical help immediately.

In older children, teenagers and adults, the symptoms of meningitis can include:

    a fever, with cold hands and feet
    vomiting
    drowsiness and difficulty waking up
    confusion and irritability
    severe muscle pain
    pale, blotchy skin, and a distinctive rash (although not everyone will have this)   
    a severe headache
    stiff neck
    sensitivity to light (photophobia)
    convulsion or seizures

Again, these symptoms can appear in any order, and not everyone will get all of them.

Don't wait for a rash to develop. If someone is unwell and has symptoms of meningitis, seek medical help immediately.

The glass test

If you press the side of a clear glass firmly against the skin and the rash doesn't fade, it's a sign of meningococcal septicaemia.

A person with septicaemia may have a rash of tiny "pin pricks" that later develops into purple bruising.

A fever with a rash that doesn't fade under pressure is a medical emergency, and you should seek immediate medical help.

Viral meningitis

Most people with viral meningitis will have mild flu-like symptoms, such as:

    headaches
    fever (see above)
    generally not feeling very well

In more severe cases of viral meningitis, your symptoms may include:

    neck stiffness
    muscle or joint pain
    nausea and vomiting
    diarrhoea
    sensitivity to light (photophobia)

Unlike bacterial meningitis, viral meningitis doesn't usually lead to septicaemia (blood poisoning). 

Bacterial or viral meningitis?

It's not possible to tell the difference between bacterial and viral meningitis from the symptoms alone.

Clinical tests are needed to distinguish between the two types of meningitis. Therefore, every case of suspected meningitis should be treated as a medical emergency.

tags: Bacterial meningitis, The glass test, Viral meningitis, Bacterial or viral meningitis?, Babies and young children, Every suspected case of meningitis should be treated as a medical emergency.

Meningitis

 Meningitis is an infection of the protective membranes that surround the brain and spinal cord.

This infection causes these membranes (the meninges) to become inflamed, which in some cases can damage the nerves and brain.

Signs and symptoms of meningitis

Anyone can get meningitis, but babies and young children under five years of age are most at risk. A baby or young child with meningitis may:

    have a high fever, with cold hands and feet
    vomit and refuse to feed
    feel agitated and not want to be picked up
    become drowsy, floppy and unresponsive
    grunt or breathe rapidly
    have an unusual high-pitched or moaning cry
    have pale, blotchy skin, and a red rash that doesn't fade when a glass is rolled over it
    have a tense, bulging soft spot on their head (fontanelle)
    have a stiff neck and dislike bright lights
    have convulsions or seizures

The above symptoms can appear in any order, and some may not appear at all.

The rash can be harder to see on dark skin, in which case check for spots on paler areas like the palms of the hands, soles of the feet, on the tummy, inside the eyelids and on the roof of the mouth.

However, don't wait for a rash to develop. If your child is unwell and getting worse, seek medical help immediately.

In older children, teenagers and adults, the symptoms of meningitis can include:

    a fever, with cold hands and feet
    vomiting
    drowsiness and difficulty waking up
    confusion and irritability
    severe muscle pain
    pale, blotchy skin, and a distinctive rash (although not everyone will have this) 
    a severe headache
    stiff neck
    sensitivity to light (photophobia)
    convulsion or seizures

Again, these symptoms can appear in any order, and not everyone will get all of them.

Don't wait for a rash to develop. Seek immediate medical help if someone is unwell and displays the symptoms of meningitis.

The glass test

If you press the side of a clear glass firmly against the skin and the rash doesn't fade, it's a sign of meningococcal septicaemia.

A person with septicaemia may have a rash of tiny "pin pricks" that later develops into purple bruising.

A fever with a rash that doesn't fade under pressure is a medical emergency, and you should seek immediate medical help.

Types of meningitis

There are two types of meningitis. They are:

    bacterial meningitis – caused by bacteria such as Neisseria meningitidis or Streptococcus pneumoniae and through close contact
    viral meningitis – caused by viruses that can be spread through coughing, sneezing and poor hygiene

Bacterial meningitis

Bacterial meningitis is very serious and should be treated as a medical emergency. If the bacterial infection is left untreated, it can cause severe brain damage and infect the blood (septicaemia).

In 2011-12, there were around 2,350 cases of bacterial meningitis and septicaemia in the UK. The number of cases has dropped since the introduction of vaccines that protect against many of the bacteria that can cause meningitis, including the meningitis C vaccine, MMR vaccine and pneumococcal vaccine.

It's essential to know the signs and symptoms, and to get medical help if you're worried.

Bacterial meningitis most commonly affects children under five years of age, particularly babies under the age of one. It's also common among teenagers aged 15 to 19. 

Viral meningitis

Viral meningitis is the most common, and less serious, type of meningitis. It's difficult to estimate the number of viral meningitis cases, because symptoms are often so mild that they're mistaken for flu.

Viral meningitis is most common in children and more widespread during the summer.

Read more about the causes of meningitis.

Diagnosing meningitis

Diagnosing meningitis can be difficult because it often comes on quickly and can be easily mistaken for flu, as many of the symptoms are the same.

However, it's very important to seek immediate medical help if you notice any of the symptoms of meningitis, particularly in a young child.

This may mean going to the accident and emergency (A&E) department of your local hospital in the middle of the night.

Don't wait for a purple rash to appear, because not everyone with meningitis gets one.

If meningitis is suspected, treatment will usually be started before the diagnosis is confirmed. This is because some of the tests can take several hours to complete, and it could be dangerous to delay treatment.

The doctors will carry out a physical examination to look for signs of meningitis (see above) or signs of septicaemia, such as a rash. They will also carry out a number of other tests to confirm the diagnosis.

Read more about how meningitis is diagnosed.

Treating meningitis

Viral meningitis usually gets better within a couple of weeks, with plenty of rest, painkillers for the headache and anti-sickness medication for the vomiting.

Bacterial meningitis is treated with intravenous antibiotics (delivered through a vein in the arm). Admission to hospital will be needed, with severe cases treated in intensive care, so the body's vital functions can be monitored and supported.

If antibiotics don't work, you will need to be in hospital for a week or less. If the infection is more severe, you may need to stay in for longer.

Read more about how meningitis is treated.

Outlook

Several decades ago, the outlook for bacterial meningitis wasn't good, and almost everyone who had the condition would die.

Nowadays, most deaths are caused by septicaemia (blood poisoning) rather than meningitis. Meningococcal disease, meningitis or septicaemia caused by Neisseria meningitidis bacteria results in about 1 death in every 10 cases.

Up to a quarter of people may experience complications of meningitis, such as hearing loss, after having bacterial meningitis.

Vaccination

Children

The best way to prevent meningitis is by ensuring vaccinations are up-to-date. Children in the UK should receive the available vaccines as part of the childhood vaccination programme.

Read more about meningitis vaccination.

Teenagers and adults

Teenagers and university students are to be offered a vaccination to prevent meningitis W disease. This is because cases of meningitis and septicaemia (blood poisoning) caused by Men W bacteria are rising, because of a particularly deadly strain.

From August 2015, all 17 and 18-year-olds in school year 13 and first-time university students up to the age of 25 will be offered the Men ACWY vaccine as part of the NHS vaccination programme. The Men ACWY vaccine protects against four different causes of meningitis and septicaemia – meningococcal (Men) A, C, W and Y diseases.

tags: Meningitis, Signs and symptoms of meningitis, The glass test, Types of meningitis, bacterial meningitis, viral meningitis, Bacterial meningitis, Viral meningitis, Diagnosing meningitis, Treating meningitis, Outlook, Vaccination, Children, Teenagers and adults, Meningitis is an infection of the protective membranes that surround the brain and spinal cord.

Chronic kidney disease - Prevention

In most cases, chronic kidney disease (CKD) cannot be completely prevented, although you can take steps to reduce the chances of the condition developing.

Managing your condition

If you have a chronic (long-term) condition, such as diabetes, that could potentially cause chronic kidney disease, it is important it is carefully managed.

Follow the advice of your GP and keep all appointments relating to your condition. People with diabetes are advised to have their kidney function tested every year.

Read more about Type 1 diabetes and Type 2 diabetes.

Smoking

Smoking increases your risk of cardiovascular disease, including heart attacks or strokes, and it can increase the likelihood that any existing kidney problems will get worse.

If you stop smoking, you will improve your general health and reduce your risk of developing other serious conditions, such as lung cancer and heart disease. 

Diet

A healthy diet is important for preventing chronic kidney disease. It will lower the amount of cholesterol in your blood and keep your blood pressure at a healthy level. Eat a balanced diet that includes plenty of fresh fruit and vegetables (5 A DAY) and whole grains.

Limit the amount of salt in your diet to no more than 6g (0.2oz) a day. Too much salt will increase your blood pressure. One teaspoonful of salt is equal to about 6g.

Avoid eating foods high in saturated fat because this will increase your cholesterol level.

Foods high in saturated fat include:

    meat pies
    sausages and fatty cuts of meat
    butter
    ghee (a type of butter often used in Indian cooking)
    lard
    cream
    hard cheese
    cakes and biscuits
    foods that contain coconut oil or palm oil

Eating some foods that are high in unsaturated fat can help decrease your cholesterol level. Foods high in unsaturated fat include:

    oily fish
    avocados
    nuts and seeds
    sunflower oil
    rapeseed oil
    olive oil

Read more about healthy food and diet.

Alcohol

Drinking excessive amounts of alcohol will cause your blood pressure to rise, as well as raising cholesterol levels in your blood. Therefore, sticking to the recommended alcohol consumption limits is the best way to reduce your risk of developing high blood pressure (hypertension) and CKD.

The recommended limits for alcohol are:

    3-4 units of alcohol a day for men
    2-3 units of alcohol a day for women

A unit of alcohol is equal to about half a pint of normal strength lager, a small glass of wine or a pub measure (25ml) of spirits. 

Exercise

Regular exercise should help lower your blood pressure and reduce your risk of developing CKD.

At least 150 minutes (2 hours and 30 minutes) of moderate-intensity aerobic activity (such as cycling or fast walking) every week, is recommended. 

Painkillers

Kidney disease can be caused by the improper use (such as taking too many) of non-steroidal anti-inflammatories (NSAIDs), such as aspirin and ibuprofen.

If you need to take painkillers, make sure you follow the instructions. This can help to avoid kidney damage.

tags: Managing your condition, Chronic kidney disease - Prevention, Chronic kidney disease, kidney disease, Prevention, Smoking, Diet, Alcohol, Exercise, Painkillers, In most cases, chronic kidney disease (CKD) cannot be completely prevented, although you can take steps to reduce the chances of the condition developing.

Chronic kidney disease - Living with

A diagnosis of kidney disease can be worrying for you and your family, but it does not have to take over your life.

Although it is not possible to repair the damage that has already happened to your kidneys, it does not mean your kidney disease will definitely get worse. Less than 1% of people with stage three kidney disease develop kidney failure.

By leading a healthy lifestyle and following your doctor’s advice on treatment for high blood pressure and other conditions, it is possible to live without symptoms or further deterioration of your kidney function. At all stages of kidney disease, you can help reduce the chances of your kidneys getting worse and your risk of cardiovascular disease by living a healthier lifestyle.

Looking after your kidneys

The following steps can help keep your kidneys as healthy as possible:

    do not smoke 
    maintain a healthy blood pressure (neither too high nor too low). You can do this by eating a varied diet (particularly avoiding added salt), living an active lifestyle (for example, doing gentle exercise and avoiding stress) and taking medication prescribed by your GP
    reduce the amount of cholesterol in your diet. Cholesterol increases blood pressure and can impair kidney function
    people with diabetes should make sure their blood sugar levels are kept under control

Self care

Self care is an integral part of daily life. It means you take responsibility for your own health and wellbeing, with support from the people involved in your care. Self care includes the things you do each day to stay fit, maintain good physical and mental health, prevent illness or accidents, and effectively deal with minor ailments and long-term conditions. People living with long-term conditions can benefit enormously if they receive support for self care. They can live longer, have less pain, anxiety, depression and fatigue, have a better quality of life, and be more active and independent.

Regular reviews

Because kidney disease is a long-term condition, you will be in regular contact with your healthcare team. A good relationship with your team means you can easily discuss your symptoms or concerns. The more the team knows, the more they can help you.

Keeping well

Everyone with a long-term condition such as kidney disease is encouraged to get a flu jab each autumn to protect against flu (influenza). They are also recommended to get an anti-pneumoccocal vaccination. This is a one-off injection that protects against a specific serious chest infection called pneumococcal pneumonia.

Healthy eating and exercise

Regular exercise and a healthy diet are recommended for everyone, not just people with kidney disease. They can help prevent many conditions, including heart disease and some forms of cancer. Exercising regularly can help relieve stress and reduce fatigue. Try to eat a balanced diet, containing all the food groups, to give your body the nutrition it needs. You will be advised by a dietitian if you need to follow a special diet. The advice you are given will depend on how well your kidneys are working, your blood test results and your own preferences about what you normally eat and drink.

tags: Chronic kidney disease - Living with, Living with, Living with Chronic kidney disease, kidney disease, Chronic kidney disease, Healthy eating and exercise, Regular reviews, Keeping well, Looking after your kidneys, Self care, Regular reviews, A diagnosis of kidney disease can be worrying for you and your family, but it does not have to take over your life.

Chronic kidney disease - Treatment

Although there is no cure for kidney disease, treatment can help relieve symptoms, slow or prevent progression of the condition, and reduce the risk of developing related problems.

Your treatment will depend on the stage of your chronic kidney disease (CKD). Stages one, two and three CKD can usually be treated by your GP.

Treatment involves making changes to your lifestyle and, in some cases, taking medication to control your blood pressure and lower your blood cholesterol levels. This should help prevent further damage to your kidneys and circulation.

If you have stage four or stage five CKD, you will usually be referred to a specialist. In addition to the treatments above, you may also be given several medications to control or prevent the symptoms of CKD.

Kidney failure, also called established renal failure or ERF, occurs when you have lost nearly all your kidney function and the condition has become life threatening. About 1% of people with stage three CKD develop ERF at some point.

If you have kidney failure, you will need to decide on the next stage of treatment. Your choice will be whether to have treatment with dialysis (a means of artificially replacing some functions of the kidney), a kidney transplant, or other treatment options that involve less intervention, also known as supportive or conservative care. 

tags: Chronic kidney disease - Treatment, Treatment, kidney disease, Chronic kidney disease, Although there is no cure for kidney disease, treatment can help relieve symptoms, slow or prevent progression of the condition, and reduce the risk of developing related problems.

Chronic kidney disease - Causes

Kidney disease is most often caused by other conditions that put a strain on the kidneys.

High blood pressure (hypertension) and diabetes are the most common causes of kidney disease. The evidence indicates that high blood pressure causes just over a quarter of all cases of kidney failure. Diabetes has been established as the cause of around a quarter of all cases.

High blood pressure

Blood pressure is a measure of the pressure your heart generates in your arteries with each pulse. Too much pressure can damage your body's organs, leading to heart disease, stroke and worsening of kidney function.

The cause of around 90% of cases of high blood pressure is unknown, although there appears to be a link between the condition and a person’s general health, diet, and lifestyle.

Known risk factors for high blood pressure include:

    age (the risk of developing high blood pressure increases as you get older)
    family history of high blood pressure (the condition seems to run in families)
    being of African-Caribbean or south Asian origin
    obesity
    lack of exercise
    smoking
    excessive alcohol consumption
    high amount of salt in your diet
    high-fat diet
    stress

Hypertension causes damage by putting strain on the small blood vessels in the kidneys. This prevents the filtering process from working properly.

Diabetes

Diabetes is a condition in which the body produces no – or too little – insulin (type 1 diabetes) or has become unable to make effective use of insulin (type 2 diabetes).

Insulin is needed to regulate levels of glucose (sugar) in your blood, preventing the levels going too high after a meal and too low between meals.

If diabetes is poorly controlled, too much glucose can build up in your blood. The glucose can damage the tiny filters in the kidneys, which affects the ability of your kidneys to filter out waste products and fluids.

It is estimated that 20-40% of people with type 1 diabetes will develop kidney disease before they reach 50 years of age. Around 30% of people with type 2 diabetes also show signs of developing kidney damage.

The first sign of diabetic kidney disease is the appearance of low levels of protein in the urine. Therefore, your GP will ask for an annual urine test so any kidney disease can be detected as early as possible.

All people with diabetes should have a kidney check every year. Early detection of kidney dysfunction in diabetes is important because it identifies people at risk or complications, such as eye problems and impotence.

Other causes

There are many other conditions that less commonly cause CKD, including:

    glomerulonephritis (inflammation of the kidney)
    pyelonephritis (infection in the kidney)
    polycystic kidney disease (an inherited condition where both kidneys are larger than normal due to the gradual growth of masses of cysts)
    failure of normal kidney development in an unborn baby while developing in the womb
    systemic lupus erythematosus (a condition of the immune system where the body attacks the kidney as if it were foreign tissue)
    long-term, regular use of medicines, such as lithium and non-steroidal anti-inflammatory drugs (NSAIDs), including aspirin and ibuprofen  
    blockages, for example due to kidney stones or prostate disease

tags: Chronic kidney disease - Causes, Chronic kidney disease, kidney disease, Causes, disease, kidney, Chronic, High blood pressure, Diabetes, Other causes, Kidney disease is most often caused by other conditions that put a strain on the kidneys.

Chronic kidney disease - Diagnosis

Chronic kidney disease (CKD) is most frequently diagnosed through blood and urine tests.

Screening

If you are in a high-risk group for developing CKD, it is important to be regularly screened for the condition. People who are not in a high-risk group are not normally screened for CKD.

Annual screening is recommended for the following groups:

    people with high blood pressure (hypertension)
    people with diabetes
    people with acute kidney injury caused by medications such as lithium or NSAIDs such as ibuprofen, kidney stones or an enlarged prostate
    people with cardiovascular disease (conditions that affect the heart, arteries and veins, such as coronary heart disease or heart failure)
    people with a family history of stage five CKD (see below for more information about staging) or an inherited kidney disease
    people with diseases that affect several parts of the body and may affect the kidneys, such as systemic lupus erythematosus
    people with blood in the urine (haematuria) or protein in the urine (proteinuria) where there is no known cause

Your GP can advise you about whether or not you should be screened for CKD.

Most often, the diagnosis of kidney disease is made because a routine blood or urine test indicates the kidneys may not be functioning normally. If this happens, the test is usually repeated to confirm the diagnosis.

Glomerular filtration rate (GFR)

An effective way of assessing how well your kidneys are working is to calculate your glomerular filtration rate (GFR). GFR is a measurement of how many millilitres (ml) of waste fluid your kidneys can filter from the blood in a minute (measured in ml/min). A healthy pair of kidneys should be able to filter more than 90ml/min.

It is difficult to measure the GFR directly, so it is estimated using a formula. The result is called the estimated GFR or eGFR. Calculating your eGFR involves taking a blood sample and measuring the levels of a waste product called creatinine and taking into account your age, gender and ethnic group. The result is similar to the percentage of normal kidney function. For example, an eGFR of 50ml/min equates to 50% kidney function.

The following tests are used to detect proteinuria (protein in the urine)

    urine tests – used to see whether there is blood or protein in your urine
    albumin and creatinine testing – this is another urine test which compares the amounts of albumin (a protein) and creatinine in your urine. The ratio of the two (the albumin:creatinine ratio or ACR) can be used with eGFR to give doctors a more accurate idea of how the kidneys are functioning

Staging

A six-stage system, based on eGFR levels, is used to describe the progression of CKD. The higher the stage, the more severe the CKD. The six stages are described below.

    Stage one (sometimes called G1): the eGFR is normal (above 90 or more), but other testing shows evidence of kidney damage.
    Stage two (G2): the eGFR has decreased slightly (60–89), but is still considered to be in the normal range for a young adult.

If you have stage one or two CKD, it is recommended you have annual eGFR tests so the progression of the condition can be carefully monitored.

    Stage three is divided into two – stage 3a (G3a) and 3b (G3b).
    In stage 3a, the eGFR has decreased mildly (45–59) and this is termed a mild to moderate decrease in kidney function and should be checked annually. In stage 3b (G3b) it has decreased moderately (30–44) and is termed a moderate to severe reduction in kidney function and should be checked every six months.
    Stage four (G4): the eGFR has reduced severely (15-29). By this time, it is possible you will be experiencing symptoms of CKD. Further testing should be carried out every six months. 
    Stage five (G5): the kidneys have lost almost all of their function (an eGFR of below 15), which is known as established renal failure. Further testing should be carried out every three months.

However, over time, GFR can fluctuate, so one abnormal test result does not automatically mean you have CKD. A diagnosis of CKD is usually only confirmed if repeated eGFR tests show your eGFR is consistently lower than normal over three months. 

Other tests

A number of other tests are also used to assess the levels of damage to your kidneys. These are outlined below:

    kidney scans, such as an ultrasound scan, a magnetic resonance imaging (MRI) scan or a computerised tomography (CT) scan – used to find out whether there are any unusual blockages in your urine flow. In cases of advanced kidney disease, the kidneys are shrunken and have an uneven shape
    kidney biopsy – a small sample of kidney tissue is taken so that the cells can be examined under a microscope for damage

tags: Chronic kidney disease - Diagnosis, Chronic kidney disease, kidney disease, Chronic, kidney, Diagnosis, Screening, Other tests, Glomerular filtration rate (GFR), Staging, Chronic kidney disease (CKD) is most frequently diagnosed through blood and urine tests.

Chronic kidney disease - Symptoms

Most people with CKD have no symptoms because the body can tolerate even a large reduction in kidney function.

In other words, we are born with a lot more kidney function than is necessary for survival. Kidney function is often sufficient if only one kidney is working. That is why people can give a kidney to someone needing a kidney transplant.

A change in kidney function is usually discovered through a routine blood or urine test. If you are diagnosed with kidney disease, your kidney function will be monitored with regular blood and urine tests, and treatment aims to keep any symptoms to a minimum.

If the kidneys continue to lose function and there is progression towards kidney failure (established renal failure or ERF), this will usually be tracked by blood tests and monitoring. If kidney failure does occur, the symptoms may include:

    weight loss and poor appetite
    swollen ankles, feet or hands (due to water retention)
    shortness of breath
    blood or protein in your urine (protein in your urine is not something you will notice as it can only be detected during a urine test)
    an increased need to urinate, particularly at night
    insomnia
    itchy skin
    muscle cramps
    high blood pressure (hypertension)
    nausea
    erectile dysfunction in men (an inability to get or maintain an erection)

These are general symptoms and can be caused by many less serious conditions. Many of the symptoms above can be avoided if treatment begins at an early stage, before any symptoms appear.

If you are worried by any of the symptoms above, arrange to see your GP.

tags: Chronic kidney disease - Symptoms, Chronic kidney disease, kidney disease, Chronic, kidney, Symptoms, Most people with CKD have no symptoms because the body can tolerate even a large reduction in kidney function.

Chronic kidney disease

 Chronic kidney disease (CKD) is a long-term condition where the kidneys do not work effectively.

CKD does not usually cause symptoms until it reaches an advanced stage. It is usually detected at earlier stages by blood and urine tests. Main symptoms of advanced kidney disease include:

    tiredness
    swollen ankles, feet or hands (due to water retention)
    shortness of breath
    nausea
    blood in the urine

Read more about the symptoms of chronic kidney disease.

Chronic kidney disease is most frequently diagnosed through blood and urine tests.

If you are at a high risk of developing CKD, you may be screened annually. Screening may be recommended if you have:

    high blood pressure (hypertension)
    diabetes
    a family history of CKD

Read more about diagnosing chronic kidney disease.

Why does it happen?

The kidneys are two bean-shaped organs, the size of your fist, located on either side of the body, just beneath the ribcage. The main role of the kidneys is to filter waste products from the blood before converting them into urine. The kidneys also:

    help maintain blood pressure
    maintain the correct levels of chemicals in your body which, in turn, will help heart and muscles function properly
    produce the active form of vitamin D that keeps bones healthy
    produce a substance called erythropoietin, which stimulates production of red blood cells

Chronic kidney disease is the reduced ability of the kidney to carry out these functions in the long-term. This is most often caused by damage to the kidneys from other conditions, most commonly diabetes and high blood pressure.

Read more about the causes of chronic kidney disease.

Who is affected?

CKD is common and mainly associated with ageing. The older you get, the more likely you are to have some degree of kidney disease.

It is estimated that about one in five men and one in four women between the ages of 65 and 74 has some degree of CKD.

CKD is more common in people of south Asian origin (those from India, Bangladesh, Sri Lanka and Pakistan) and black people than the general population. The reasons for this include higher rates of diabetes in south Asian people and higher rates of high blood pressure in African or Caribbean people. 

Treating chronic kidney disease

There is no cure for chronic kidney disease, although treatment can slow or halt the progression of the disease and can prevent other serious conditions developing.

People with CKD are known to have an increased risk of a heart attack because of changes that occur to the circulation.

In a minority of people, CKD may cause kidney failure, also known as established renal failure (ERF) or end-stage kidney disease. In this situation, the usual functions of the kidney stop working.

To survive, people with ERF may need to have artificial kidney treatment, called dialysis, or a kidney transplant.

Read more about treating chronic kidney disease.

Being diagnosed with chronic kidney disease can be worrying, but support and advice are available to help you cope.

Read more about living with chronic kidney disease.

Preventing chronic kidney disease

The main way to reduce the chances of CKD developing is to ensure any existing conditions, such as diabetes and high blood pressure, are carefully managed.

Some lifestyle changes can also reduce the risk of CKD developing, these include:

    having a healthy diet
    avoiding drinking excessive amounts of alcohol
    exercising regularly
    avoiding medicines that can damage the kidney

Read more about preventing chronic kidney disease.

tags: Chronic kidney disease, Chronic, disease, kidney, kidney disease, Preventing chronic kidney disease, Treating chronic kidney disease, Who is affected?, Why does it happen?, Chronic kidney disease (CKD) is a long-term condition where the kidneys do not work effectively.

Cervical cancer - Complications

 Complications of cervical cancer can occur as a side effect of treatment or as the result of advanced cervical cancer.

Side effects

Early menopause

If your ovaries are surgically removed or they're damaged during treatment with radiotherapy, it will trigger an early menopause (if you haven't already had it). Most women experience the menopause in their early fifties.

The menopause is caused when your ovaries stop producing the hormones oestrogen and progesterone. This leads to the following symptoms:

    you no longer have monthly periods or your periods become much more irregular
    hot flushes
    vaginal dryness
    loss of sex drive
    mood changes
    stress incontinence (leaking urine when you cough or sneeze)
    night sweats
    thinning of the bones, which can lead to brittle bones (osteoporosis)

These symptoms can be relieved by taking a number of medications that stimulate the production of oestrogen and progesterone. This treatment is known as hormone replacement therapy (HRT).

Narrowing of the vagina

Radiotherapy to treat cervical cancer can often cause your vagina to become narrower, which can make having sex painful or difficult.

There are two main treatment options if you have a narrowed vagina. The first is to apply hormonal cream to your vagina. This should increase moisture within your vagina and make having sex easier.

The second is to use a vaginal dilator, which is a tampon-shaped device made of plastic. You insert it into your vagina and is designed to help make it more supple. It's usually recommended that you insert the dilator for 5 to 10 minutes at a time on a regular basis during the day over the course of 6 to 12 months.

Many women find discussing the use of a vaginal dilator embarrassing, but it's a standard and well-recognised treatment for narrowing of the vagina. Your specialist cancer nurse or radiographers in the radiotherapy department should be able to give you more information and advice.

You may find that the more times you have sex, the less painful it becomes. However, it may be several months before you feel emotionally ready to be intimate with a sexual partner.

Lymphoedema

If the lymph nodes in your pelvis are removed, it can sometimes disrupt the normal workings of your lymphatic system.

One of the functions of the lymphatic system is to drain away excess fluid from the body's tissue. A disruption to this process can lead to a build-up of fluid in the tissue known as lymphoedema. This can cause certain body parts to become swollen – usually the legs, in cases of cervical cancer.

There are exercises and massage techniques that can reduce the swelling. Wearing specially designed bandages and compression garments can also help.

Emotional impact

The emotional impact of living with cervical cancer can be significant. Many people report experiencing a "rollercoaster" effect.

For example, you may feel down when you receive a diagnosis, but feel better when removal of the cancer has been confirmed. You may then feel down again as you try to come to terms with the after-effects of your treatment.

This type of emotional disruption can sometimes trigger depression. Typical signs of depression include feeling sad, hopeless and losing interest in things you used to enjoy.

Contact your GP if you think you may be depressed. There are a range of effective treatments available, including antidepressant medication and talking therapies, such as cognitive behavioural therapy (CBT).

You may also find Jo's Cervical Cancer Trust a useful resource. It's the UK's only charity dedicated to women affected by cervical cancer.

Local cancer support groups may also be available in your area for women affected by cancer. Your specialist cancer nurse should be able to provide contact details.

Advanced cervical cancer

Some of the complications that can occur in advanced cervical cancer are discussed below.

Pain

If the cancer spreads into your nerve endings, bones or muscles, it can often cause severe pain.

A number of effective painkilling medications can usually be used to control the pain. Depending on the levels of pain, they can range from paracetamol and non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, to more powerful opiate-based painkillers, such as codeine and morphine.

Tell your care team if the painkillers you're prescribed aren't effective in reducing your pain. You may need to be prescribed a stronger medication. A short course of radiotherapy may also be effective in controlling the pain.

Macmillan nurses, who work both in hospitals and in the community, can also provide expert advice about pain relief.

Kidney failure

Your kidneys remove waste material from your blood. The waste is passed out of your body in urine through tubes called the ureters. Kidney function can be monitored by a simple blood test called serum creatinine level.

In some cases of advanced cervical cancer, the cancerous tumour can press against the ureters, blocking the flow of urine out of the kidneys. The build-up of urine inside the kidneys is known as hydronephrosis and can cause the kidneys to become swollen and stretched.

Severe cases of hydronephrosis can cause the kidneys to become scarred, which can lead to loss of most or all of the kidneys' functions. This is known as kidney failure.

Kidney failure can cause a wide range of symptoms, including:

    tiredness
    swollen ankles, feet or hands, caused by water retention
    shortness of breath
    feeling sick
    blood in your urine (haematuria)

Treatment options for kidney failure associated with cervical cancer include draining urine out of the kidneys using a tube inserted through the skin and into each kidney (percutaneous nephrostomy). Another option is to widen the ureters by placing a small metal tube called a stent inside them.

Blood clots

As with other types of cancer, cervical cancer can make the blood "stickier" and more prone to forming clots. Bed rest after surgery and chemotherapy can also increase the risk of developing a clot.

Large tumours can press on the veins in the pelvis, which slows the flow of blood and can lead to a blood clot developing in the legs.

Symptoms of a blood clot in your legs include:

    pain, swelling and tenderness in one of your legs (usually your calf)
    a heavy ache in the affected area
    warm skin in the area of the clot
    redness of the skin, particularly at the back of your leg, below the knee

A major concern in these cases is that the blood clot from the leg vein will travel up to the lungs and block the supply of blood. This is known as a pulmonary embolism and can be fatal.

Blood clots in the legs are usually treated using a combination of blood-thinning medication, such as heparin or warfarin, and compression garments designed to help encourage the flow of blood through the limbs.

Bleeding

If the cancer spreads into your vagina, bowel or bladder, it can cause significant damage, resulting in bleeding. Bleeding can occur in your vagina or rectum (back passage), or you may pass blood when you urinate.

Minor bleeding can often be treated using a medication called tranexamic acid, which encourages the blood to clot and stop the bleeding. Radiotherapy can also be highly effective in controlling bleeding caused by cancer.

Major bleeding may be treated temporarily by vaginal packing (using gauze to stem the bleeding) and later by surgery, radiotherapy or by cutting off blood supply to the cervix.

Fistula

A fistula is an uncommon but distressing complication that occurs in around 1 in 50 cases of advanced cervical cancer.

A fistula is an abnormal channel that develops between two sections of the body. In most cases involving cervical cancer, the fistula develops between the bladder and the vagina. This can lead to a persistent discharge of fluid from the vagina. A fistula can sometimes develop between the vagina and rectum.

Surgery is usually required to repair a fistula, although it's often not possible in women with advanced cervical cancer, because they're usually too frail to withstand the effects of surgery.

In such cases, treatment often involves using medication, creams and lotions to reduce the amount of discharge and protect the vagina and surrounding tissue from damage and irritation.

Vaginal discharge

Another uncommon, but distressing, complication of advanced cervical cancer is an unpleasant-smelling discharge from your vagina.

The discharge can occur for a number of reasons, such as the breakdown of tissue, the leakage of bladder or bowel contents out of the vagina, or a bacterial infection of the vagina.

Treatment options for vaginal discharge include an antibacterial gel called metronidazole and wearing clothing that contains charcoal. Charcoal is a chemical compound that's very effective in absorbing unpleasant smells.

Palliative care

If your doctors can't do any more to treat your cancer, your care will focus on controlling your symptoms and helping you to be as comfortable as possible. This is called palliative care.

Palliative care also includes psychological, social and spiritual support for you and your family or carers.

There are different options for terminal care in the late stages of cancer. You may want to think about whether you'd like to be cared for in hospital, in a hospice or at home, and discuss these issues with your doctor. Some organisations who provide care for people with cancer include:

    Macmillan Cancer Support – which has specially trained nurses who help to look after people with cancer at home. To be referred to a Macmillan nurse, ask your hospital doctor or GP, or call 0808 808 00 00.
    Marie Curie Cancer Care – have specially trained nurses who help to look after people with cancer at home. They also run hospices for people with cancer.
    Hospice UK – provides information about hospice care and how to find a hospice.
 

tags:  Cervical cancer - Complications, Complications, Cervical cancer, Cervical, cancer, Side effects, Palliative care, Vaginal discharge, Fistula, Bleeding, Blood clots, Kidney failure, Advanced cervical cancer, pain, Emotional impact, Lymphoedema, Narrowing of the vagina, Complications of cervical cancer can occur as a side effect of treatment or as the result of advanced cervical cancer.

Cervical cancer - Treatment

 Treatment for cervical cancer depends on how far the cancer has spread.

As cancer treatments are often complex, hospitals use multidisciplinary teams (MDTs) to treat cervical cancer and tailor the treatment programme to the individual.

MDTs are made up of a number of different specialists (see below) who work together to make decisions about the best way to proceed with your treatment.

Your cancer team will recommend what they think the best treatment options are, but the final decision will be yours. In most cases, the recommendations will be:

    early cervical cancer – surgery to remove some or all of the womb, radiotherapy, or a combination of the two
    advanced cervical cancer – radiotherapy and/or chemotherapy, although surgery is also sometimes used

The prospect of a complete cure is good for cervical cancer diagnosed at an early stage, although the chances of a complete cure decrease the further the cancer has spread.

In cases where cervical cancer isn't curable, it's often possible to slow its progression, prolong lifespan and relieve any associated symptoms, such as pain and vaginal bleeding. This is known as palliative care.

The different treatment options are discussed in more detail below.

Removing abnormal cells

If your screening results show that you don't have cervical cancer, but there are biological changes that could turn cancerous in the future, a number of treatment options are available. These include:

    large loop excision of the transformation zone (LLETZ) – the abnormal cells are cut away using a fine wire and an electrical current
    cone biopsy – the area of abnormal tissue is removed during surgery
    laser therapy – a laser is used to burn away the abnormal cells 

Surgery

There are three main types of surgery for cervical cancer. They are:

    radical trachelectomy – the cervix, surrounding tissue and the upper part of the vagina are removed, but the womb is left in place
    hysterectomy – the cervix and womb are removed; depending on the stage of the cancer, it may also be necessary to remove the ovaries and fallopian tubes
    pelvic exenteration – a major operation in which the cervix, vagina, womb, bladder, ovaries, fallopian tubes and rectum are removed

Radical trachelectomy

A radical trachelectomy is usually only suitable if cervical cancer is diagnosed at a very early stage. It's usually offered to women who want to preserve their child-bearing potential.

During the procedure, the surgeon will make a number of small incisions (cuts) in your abdomen. Specially designed instruments will be passed through the incisions and used to remove your cervix and the upper section of your vagina. Lymph nodes from your pelvis may also be removed. Your womb will then be reattached to the lower section of your vagina.

Compared with a hysterectomy or pelvic exenteration, the advantage of this type of surgery is that your womb remains intact, which means that you may still be able to have children. However, it's important to be aware that the surgeons carrying out this operation can't guarantee you'll still be able to have children.

If you do have children after the operation, your child would have to be delivered by caesarean section. It's also usually recommended that you wait 6 to 12 months after having surgery before trying for a baby, so that your womb and vagina have time to heal.

Radical trachelectomy is a highly skilled procedure. It's only available at a number of specialist centres in the UK, so it may not be available in your area and you may have to travel to another city to be treated.

Hysterectomy

A hysterectomy is usually recommended for early cervical cancer. This may be followed by a course of radiotherapy to help prevent the cancer coming back.

Two types of hysterectomies are used to treat cervical cancer. They are:

    simple hysterectomy – where the cervix and womb are removed and, in some cases, the ovaries and fallopian tubes are also removed; this is only appropriate for very early stage cervical cancers
    radical hysterectomy – where the cervix, womb, surrounding tissue and lymph nodes, ovaries and fallopian tubes are all removed; this is the preferred option in advanced stage one and some early stage two cervical cancers

Short-term complications of a hysterectomy include infection, bleeding, blood clots and accidental injury to your ureter, bladder or rectum.

The risk of long-term complications is small, but they can be troublesome. They include:

    the risk that your vagina can become shortened and drier, which can make sex painful
    urinary incontinence
    swelling of your arms and legs, caused by a build-up of fluid (lymphoedema)
    your bowel becomes obstructed because of a build-up of scar tissue – this may require further surgery to correct

As your womb is removed during a hysterectomy, you'll no longer be able to have children.

If your ovaries are removed, it will also trigger the menopause if you haven't already experienced it.

Pelvic exenteration

A pelvic exenteration is a major operation that's usually only recommended when cervical cancer returns after what was thought to be a previously successful course of treatment. It's offered if the cancer returns to the pelvis, but hasn't spread beyond this area.

A pelvic exenteration involves two phases of treatment:

    the cancer is removed, plus your bladder, rectum, vagina and the lower section of your bowel
    two holes called stomas are created in your abdomen – the holes are used to pass urine and faeces out of your body into collection pouches called colostomy bags

Following a pelvic exenteration, your vagina can be reconstructed using skin and tissue taken from other parts of your body. This means you'll be able to have sex after the procedure, although it may be several months until you feel well enough to do so.

Radiotherapy

Radiotherapy may be used on its own or combined with surgery for early stage cervical cancer. It may be combined with chemotherapy for advanced cervical cancer, where it can be used to control bleeding and pain.

There are two ways that radiotherapy can be delivered. These are:

    externally – a machine beams high-energy waves into your pelvis to destroy cancerous cells
    internally – a radioactive implant is placed inside your vagina and cervix

In most cases, a combination of internal and external radiotherapy will be used. A course of radiotherapy usually lasts for around five to eight weeks.

As well as destroying cancerous cells, radiotherapy can sometimes also harm healthy tissue. This means it can cause significant side effects many months, and even years, after treatment.

However, the benefits of radiotherapy often tend to outweigh the risks. For some people, radiotherapy offers the only hope of getting rid of the cancer.

Side effects of radiotherapy are common and can include:

    diarrhoea
    pain when urinating
    bleeding from your vagina or rectum
    feeling very tired (fatigue)
    feeling sick (nausea)
    sore skin in your pelvis region similar to sunburn
    narrowing of your vagina, which can make having sex painful
    infertility
    damage to the ovaries, which will usually trigger an early menopause (if you haven't already experienced it)
    bladder and bowel damage, which could lead to incontinence

Most of these side effects will resolve within about eight weeks of finishing treatment, although in some cases they can be permanent. It's also possible to develop side effects several months, or even years, after treatment has finished.

If infertility is a concern for you, it may be possible to surgically remove eggs from your ovaries before you have radiotherapy, so that they can be implanted in your womb at a later date. However, you may have to pay for this.

It may also be possible to prevent an early menopause by surgically removing your ovaries and replanting them outside the area of your pelvis that will be affected by radiation. This is known as an ovarian transposition.

Your MDT can provide more information about the possible options for treating infertility and whether you're suitable for an ovarian transposition.

Chemotherapy

Chemotherapy can be combined with radiotherapy to try to cure cervical cancer, or it can be used as a sole treatment for advanced cancer to slow its progression and relieve symptoms (palliative chemotherapy).

Chemotherapy involves using either a single chemotherapy medication called cisplatin or a combination of different chemotherapy medications to kill the cancerous cells.

Chemotherapy is usually given using an intravenous drip on an outpatient basis, so you'll be able to go home once you've received your dose.

As with radiotherapy, these medications can also damage healthy tissue. Side effects are therefore common and can include:

    nausea and vomiting
    diarrhoea
    feeling tired all the time
    reduced production of blood cells, which can make you feel tired and breathless (anaemia) and vulnerable to infection because of a lack of white blood cells
    mouth ulcers
    loss of appetite
    hair loss – your hair should grow back within three to six months of your course of chemotherapy being completed, although not all chemotherapy medications cause hair loss

Some types of chemotherapy medication can damage your kidneys, so you may need to have regular blood tests to assess the health of your kidneys.

Follow-up

After your treatment has been completed and the cancer has been removed, you'll need to attend regular appointments for testing. This will usually involve a physical examination of your vagina and cervix (if it hasn't been removed).

As there's a risk of cervical cancer returning, these examinations will be used to look for signs of this. If anything suspicious is found, a further biopsy can be carried out.

If cervical cancer does return, it usually returns around 18 months after a course of treatment has been completed.

Follow-up appointments are usually recommended every four months after treatment has been completed for the first two years, and then every six to 12 months for a further three years.
Your multidisciplinary team (MDT)

Members of your MDT may include:

    a surgeon
    a clinical oncologist (a specialist in chemotherapy and radiotherapy)
    a medical oncologist (a specialist in chemotherapy only)
    a pathologist (a specialist in diseased tissue)
    a radiologist (a specialist in imaging scans)
    a gynaecologist (a doctor who specialises in treating conditions that affect the female reproductive system)
    a social worker
    a psychologist
    a specialist cancer nurse, who'll usually be your first point of contact with the rest of the team

tags: Cervical cancer - Treatment, Cervical cancer, cancer, Cervical, Treatment, Follow-up, Chemotherapy, Radiotherapy, Pelvic exenteration, Hysterectomy, Radical trachelectomy, Removing abnormal cells, Surgery, Treatment for cervical cancer depends on how far the cancer has spread.