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Chemotherapy (chemo) uses anti-cancer drugs that are injected into a vein or given by mouth. These drugs enter the bloodstream and can reach almost all areas of the body, making this treatment useful for killing cancer cells in most parts of the body.
Not all women with cervical cancer will need chemo, but there are a few situations in which chemo may be recommended:
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:
Chemo may be used to treat cervical cancer that has spread to other organs and tissues (advanced cervical cancer). It can also be helpful when cervical cancer comes back after treatment with chemoradiation (recurrent cervical cancer).
The chemo drugs most often used to treat cervical cancer that has come back or spread to other areas include:
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), gemcitabine (Gemzar)and mitomycin.
Bevacizumab (Avastin), a targeted drug, may be added to chemo.
Chemo drugs for cervical cancer are typically given into a vein (IV), either as an injection over a few minutes or as an infusion in a vein over a longer period of time. This can be done in a doctor’s office, infusion center, or in a hospital setting.
Chemo is given in cycles, followed by a rest period to give you time to recover from the effects of the drugs. Cycles are most often weekly or 3 weeks long. The schedule varies depending on the drugs used. For example, with some drugs, the chemo is given only on the first day of the cycle. With others, it is given for a few days in a row, or once a week. Then, at the end of the cycle, the chemo schedule repeats to start the next cycle.
Sometimes, a slightly larger and sturdier IV is required to give chemo. These are known as central venous catheters (CVCs), central venous access devices (CVADs), or central lines. They are used to put medicines, blood products, nutrients, or fluids right into your blood. They can also be used to take blood for testing.
There are many different kinds of central venous catheters (CVCs). The most common types are the port and the PICC line.
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. 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.
Common short term side effects of chemotherapy can include:
Because chemotherapy can damage the blood-producing cells of the bone marrow, the blood cell counts might become low. This can result in:
When chemo is given with radiation, the side effects are often more severe. The nausea, fatigue, diarrhea, and problems with low blood counts are often worse.
Your health care team will watch for side effects and can give you medicines to help prevent them or treat them to help you feel better. For example, you can be given drugs to help prevent or reduce nausea and vomiting.
Long-term side effects of chemotherapy can include:
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 that can treat or help prevent problems with bone loss are available.
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 stops, but it might last a long time in some women.
Nephrotoxicity: Cisplatin, the main chemo drug used to treat cervical cancer, can damage the kidneys (also called nephrotoxicity). Many times the damage is preventable and reversible, but sometimes the damage may be long-lasting. Often, there are no symptoms, but the damage can be seen on bloodwork done routinely while chemo is given. If kidney damage happens, the cisplatin is usually stopped and carboplatin may be used instead.
Other side effects are also possible. Some of these are more common with certain chemo drugs. Ask your cancer care team to tell you about the possible side effects of the specific drugs you are getting.
Our team is made up of doctors and oncology certified nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing.
Eifel P, Klopp AH, Berek JS, and Konstantinopoulos A. Chapter 74: Cancer of the Cervix, Vagina, and Vulva. In: DeVita VT, Lawrence TS, Rosenberg SA, eds. DeVita, Hellman, and Rosenberg’s Cancer: Principles and Practice of Oncology. 11th ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 2019.
Jhungran A, Russell AH, Seiden MV, Duska LR, Goodman A, Lee S, et al. Chapter 84: Cancers of the Cervix, Vulva, and Vagina. In: Niederhuber JE, Armitage JO, Doroshow JH, Kastan MB, Tepper JE, eds. Abeloff’s Clinical Oncology. 6th ed. Philadelphia, Pa: Elsevier; 2020.
National Cancer Institute. Physician Data Query (PDQ). Cervical Cancer Treatment – Health Professional Version. 2019. https://www.cancer.gov/types/cervical/hp/cervical-treatment-pdq. Updated February 6, 2019. Accessed on October 22, 2019.
National Comprehensive Cancer Network (NCCN). Clinical Practice Guidelines in Oncology: Cervical Cancer. Version 5.2019. Accessed at https://www.nccn.org/professionals/physician_gls/pdf/cervical.pdf on December 12, 2019.
Last Revised: January 3, 2020
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