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Systemic 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.

When is chemotherapy used?

There are a few situations in which chemo may be recommended.

As a part of the main treatment: 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 come back after treatment or has spread: Chemo may also 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.

Drugs most often used to treat advanced cervical cancer include:

  • Cisplatin
  • Carboplatin
  • Paclitaxel (Taxol®),
  • Topotecan
  • Gemcitabine (Gemzar®)

Often combinations of these are used.

Some other drugs can be used as well, such as docetaxel (Taxotere®), ifosfamide (Ifex®), 5-fluorouracil (5-FU), irinotecan (Camptosar®, CPT-11), and mitomycin.

The targeted drug bevacizumab (Avastin®) may be added to chemo. This is discussed in the section about targeted therapy.

Side effects

Chemotherapy drugs kill cancer cells but also damage some normal cells, which can lead to certain side effects. Side effects depend on the type of drugs, the amount taken, 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 and fatigue are often worse. Diarrhea can also be a problem if chemo is given at the same time as radiation. Problems with low blood counts can also be worse. Your health care team will watch for side effects and can give you medicines to prevent them or help you feel better.

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. Even if your periods stop while you are on chemo, you might still be able to get pregnant. Getting pregnant while receiving chemo 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 using birth control with their doctor. Patients who have finished treatment (like chemo) can safely go on to have children, but it's not safe to get pregnant while on treatment.

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 do this than others. The older a woman is when she receives chemo, the more likely it is that she will become infertile or go through menopause as a result. When this happens, there is an increased risk of bone loss and osteoporosis. There are medicines that can treat or help prevent problems with bone loss.

Neuropathy: Some drugs used to treat cervical cancer, including paclitaxel and cisplatin, damage nerves outside of the brain and spinal cord. This (called peripheral neuropathy) can sometimes lead to symptoms (mainly in the hands and feet) like numbness, pain, burning or tingling sensations, sensitivity to cold or heat, or weakness. In most cases this gets better or even goes away once treatment is stopped, but it might last a long time in some women.

Increased risk of leukemia: Very rarely, certain chemo drugs can permanently damage the bone marrow, leading to blood cancers like myelodysplastic syndromes or even acute myeloid leukemia. If this is going to happen, it is usually within 10 years after treatment. In most women, the benefits of chemo in treating the cancer are likely to far exceed the risk of this serious but rare complication.

Other side effects are also possible. Some of these are more common with certain chemo drugs. Your cancer care team will tell you about the possible side effects of the specific drugs you are getting.

Many side effects are short-term and go away after treatment is finished, but some can last a long time or even be permanent. It's important to tell your health care team if you have any side effects, as there are often ways to lessen them. For example, you can be given drugs to help prevent or reduce nausea and vomiting.

For more information, please see the Chemotherapy section of our website, or our document A Guide to Chemotherapy.

Last Medical Review: 09/19/2014
Last Revised: 01/29/2016