Chemotherapy for Cervical Cancer

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:

As 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) before the radiation appointment. (If cisplatin is not a good option, carboplatin may be used instead.)
• Cisplatin plus 5-fluorouracil (5-FU) given every 3 weeks during radiation.

For cervical cancer that has spread or come back after treatment

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:

• Cisplatin
• Carboplatin
• Paclitaxel (Taxol)
• Topotecan

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.

How is chemotherapy given?

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.

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. 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:

• Nausea and vomiting
• Loss of appetite
• Hair loss
• 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 (called neutropenia)
• Bleeding or bruising after minor cuts or injuries because of a shortage of blood platelets (called thrombocytopenia)
• Shortness of breath or fatigue due to low red blood cell counts (called anemia)

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.