Chemotherapy for endometrial cancer

Chemotherapy (often called “chemo”) is the use of cancer-fighting drugs given into a vein or by mouth. These drugs enter the bloodstream and reach throughout the body, making this treatment potentially useful for cancer that has spread beyond the endometrium. If this treatment is chosen, you may receive a combination of drugs. Combination chemotherapy sometimes works better than one drug alone in treating cancer.

Drugs used in treating endometrial cancer may include:

• Paclitaxel (Taxol^®)
• Carboplatin
• Doxorubicin (Adriamycin^®)
• Cisplatin

Most often, 2 or more drugs are combined for treatment. The most common combinations include carboplatin with paclitaxel and cisplatin with doxorubicin. Less often, paclitaxel and doxorubicin and cisplatin/paclitaxel/doxorubicin may be used.

For carcinosarcoma, the chemo drug ifosfamide, either alone or in combination with either carboplatin, cisplatin or paclitaxel, is often used. However, the combination of carboplatin and paclitaxel is also often being used for carcinosarcoma.

Side effects of chemotherapy

These drugs kill cancer cells but can also damage some normal cells, which in turn can cause side effects. Side effects of chemotherapy depend on the specific drugs, the amount taken, and the length of time you are treated. Common side effects include:

• Nausea and vomiting
• Loss of appetite
• Mouth and vaginal sores
• Hair loss

Also, most chemotherapy drugs can damage the blood-producing cells of the bone marrow. This can result in low blood cell counts, such as:

• Low white blood cells which increases the risk of infection
• Low platelet counts which can cause bleeding or bruising after minor cuts or injuries
• Low red blood cells (anemia) which can cause problems like fatigue and shortness of breath

Most of the side effects of chemotherapy stop when the treatment is over, but some can last a long time. Different drugs can cause different side effects. For example, the drug doxorubicin can damage the heart muscle over time. The chance of heart damage goes up as the total dose of the drug goes up, so doctors place a limit on how much doxorubicin is given. Cisplatin can cause kidney damage. Giving large amounts of fluid before and after chemotherapy can help protect the kidneys. Both cisplatin and paclitaxel can cause nerve damage (called neuropathy). This can lead to numbness, tingling, or even pain in the hands and feet. Ifosfamide can injure the lining of the bladder, causing it to bleed (called hemorrhagic cystitis). This can be prevented by giving large amounts of fluid and a drug called mesna along with the chemo. Before starting chemotherapy, be sure to discuss the drugs and their possible side effects with your health care team.

If you have side effects while on chemotherapy, remember that there are ways to prevent or treat many of them. For example, modern anti-nausea drugs can prevent or reduce nausea and vomiting. Be sure to talk with your doctor or nurse about any side effects you are having.