Chemotherapy (chemo) uses anti-cancer drugs that are injected into a vein or given by mouth. These drugs enter the bloodstream and can reach all areas of the body, making this treatment useful for killing cancer cells in most parts of the body. Chemo is often given in cycles, with each period of treatment followed by a recovery period. There are a few situations in which chemo may be recommended for cervical cancer.
As a part of the main treatment for cervical cancer
For some stages of cervical cancer, the preferred treatment is radiation and chemo given together (called concurrent chemoradiation). The chemo helps the radiation work better. Options for concurrent chemoradiation include:
- Cisplatin given weekly during radiation. This drug is given into a vein (IV) about 4 hours before the radiation appointment.
- Cisplatin plus 5-fluorouracil (5-FU) given every 4 weeks during radiation.
Sometimes chemo is also given (without radiation) before and/or after chemoradiation.
To treat cervical cancer that has spread or come back after treatment
Chemo may be used to treat cancers that have spread to other organs and tissues. It can also be helpful when cancer comes back after treatment with chemoradiation.
The chemo drugs most often used to treat advanced cervical cancer include:
- Paclitaxel (Taxol®),
- Gemcitabine (Gemzar®)
Combinations of these drugs are often used.
Some other drugs can be used as well, such as docetaxel (Taxotere®), ifosfamide (Ifex®), 5-fluorouracil (5-FU), irinotecan (Camptosar®), and mitomycin.
The targeted drug bevacizumab (Avastin®) may be added to chemo. This is discussed in the section about targeted therapy.
Side effects of chemotherapy for cervical cancer
Chemo drugs kill cancer cells but also damage some normal cells, which can lead to certain side effects. Side effects depend on the type and dose of the drugs and the length of time you are treated. Common side effects of chemotherapy can include:
- Nausea and vomiting
- Loss of appetite
- Loss of hair
- Mouth sores
- Fatigue (tiredness)
Because chemotherapy can damage the blood-producing cells of the bone marrow, the blood cell counts might become low. This can result in:
- An increased chance of infection (from a shortage of white blood cells)
- Bleeding or bruising after minor cuts or injuries (because of a shortage of blood platelets)
- Shortness of breath (due to low red blood cell counts)
When chemo is given with radiation, the side effects are often more severe. The nausea, fatigue, and problems with low blood counts are often worse. Diarrhea can also be worse if chemo is given at the same time as radiation.
Menstrual changes: For younger women who have not had their uterus removed as a part of treatment, changes in menstrual periods are a common side effect of chemo. But even if your periods stop while you are on chemo, you might still be able to get pregnant. Getting pregnant while receiving chemo is not safe, as it could lead to birth defects and interfere with treatment. This is why it’s important that women who are pre-menopausal before treatment and are sexually active discuss with their doctor the options for birth control. Patients who have finished treatment (like chemo) can often go on to have children, but it’s important to talk to your doctor about when it is safe to do so.
Premature menopause (not having any more menstrual periods) and infertility (not being able to become pregnant) may occur and may be permanent. Some chemo drugs are more likely to cause this than others. The older a woman is when she gets chemo, the more likely it is that she will become infertile or go through menopause as a result. If this happens, there is an increased risk of bone loss and osteoporosis. Medicines can treat or help prevent problems with bone loss.
Neuropathy: Some drugs used to treat cervical cancer, including paclitaxel and cisplatin, can damage nerves outside of the brain and spinal cord. The injury can sometimes lead to symptoms like numbness, pain, burning or tingling sensations, sensitivity to cold or heat, or weakness, mainly in the hands and feet. This called peripheral neuropathy. In most cases this gets better or even goes away once treatment is stopped, but it might last a long time in some women.