Therapy brings you to the light

 

Chemotherapy (chemotherapy) uses anti-cancer drugs that are injected into a vein or taken 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 chemotherapy, but there are a few situations in which chemotherapy may be recommended:

As part of the main treatment for cervical cancer

For some stages of cervical cancer, the preferred treatment is radiation and chemotherapy given together (so-called concurrent chemoradiation). Chemotherapy helps the radiation work better. Options for concurrent chemoradiation include:

Cisplatin administered weekly during radiation. This medicine is given into a vein (IV) before radiation. (If cisplatin is not a good choice, carboplatin can be used instead.)

Cisplatin plus 5-fluorouracil (5-FU) given every 3 weeks during radiation.

For cervical cancer that has spread or returned after treatment

Chemo can be used to treat cervical cancer that has spread to other organs and tissues (advanced cervical cancer). It may also be helpful when cervical cancer comes back after chemoradiation treatment (recurrent cervical cancer).

Chemotherapy drugs most commonly used to treat cervical cancer that has returned or spread to other areas include:

Cisplatin

carboplatin

Paclitaxel (Taxol)

topotecan

Combinations of these drugs are often used.

Certain other medications may also be used, such as docetaxel (Taxotere), ifosfamide (Ifex), 5-fluorouracil (5-FU), irinotecan (Camptosar), gemcitabine (Gemzar), and mitomycin.

Bevacizumab (Avastin), a targeted drug, can be added to chemotherapy.

How is chemotherapy given?

Chemotherapy drugs for cervical cancer are usually given into a vein (IV), either as an injection over several minutes or as an infusion into a vein over a longer period of time. This can be done in a doctor's office, infusion center, or 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 medications being used. For example, with some drugs, chemotherapy is given only on the first day of the cycle. For others, it is given several days in a row or once a week. Then, at the end of the cycle, the chemotherapy regimen is repeated to start the next cycle.

Sometimes a slightly larger and more rigid IV is required to administer the chemotherapy. They are known as central venous catheters (CVCs), central venous access devices (CVADs), or central lines. They are used to give medicines, blood products, nutrients or fluids directly into your blood. They can also be used to draw blood for testing.

There are many different types of central venous catheters (CVCs). The most common types are a PICC port and line.

Adverse effects of chemotherapy in cervical cancer

Chemo drugs kill cancer cells, but they also damage some normal cells, which can lead to certain side effects. Side effects depend on the type and dose of medication and the duration of treatment. Many side effects are short-term and go away after treatment is stopped, but some can last a long time or even be permanent. It is important to tell your healthcare team if you have any side effects, as there are often ways to reduce them.

Common short-term side effects of chemotherapy can include:

Nausea and vomiting

Loss of appetite

Hair loss

Mouth ulcers

fatigue (fatigue)

Because chemotherapy can damage the blood-producing cells of the bone marrow, the number of blood cells may decrease. This can result in:

Increased likelihood of infection due to lack of white blood cells (so-called neutropenia)

Bleeding or bruising after minor cuts or injuries due to a lack of platelets (so-called thrombocytopenia)

Shortness of breath or tiredness due to a low number of red blood cells (called anaemia)

When chemotherapy is given with radiation, the side effects are often more severe. Nausea, fatigue, diarrhea and problems with low blood counts are often worse.

Your healthcare team will monitor side effects and can give you medicines to help prevent them or treat them to help you feel better. For example, you may be given medicines to help prevent or reduce nausea and vomiting.

Long-term side effects of chemotherapy can include:

Menstrual changes: In younger women who have not had their uterus removed as part of the treatment, changes in their menstrual cycle are a common side effect of chemotherapy. But even if your periods stop during chemotherapy, you may still be able to get pregnant. Getting pregnant during chemotherapy is not safe as it could lead to birth defects and interfere with treatment. That's why it's important for premenopausal women who are sexually active to discuss birth control options with their doctor. Patients who have finished treatment (such as chemotherapy) can often have children, but it's important to talk to your doctor about when it's safe to do so.

Premature menopause (no periods) and infertility (inability to conceive) may occur, which may be permanent. This is more likely with some chemotherapy drugs than others. The older a woman is at the time of chemotherapy, the more likely she is to become infertile or go through menopause as a result. If this happens, there is an increased risk of bone loss and osteoporosis. Medicines are available that can treat or help prevent bone loss problems.

Neuropathy: Some drugs used to treat cervical cancer, including paclitaxel and cisplatin, can damage nerves outside the brain and spinal cord. The injury can sometimes lead to symptoms such as numbness, pain, burning or tingling sensations, sensitivity to cold or heat, or weakness, especially in the hands and feet. This is called peripheral neuropathy. In most cases, this will improve or even disappear once the treatment is stopped, but for some women it may take a long time.

Nephrotoxicity: Cisplatin, the main chemotherapy drug used to treat cervical cancer, can damage the kidneys (also called nephrotoxicity). Many times the damage is preventable and can be reversed, but sometimes the damage can be long term. There are often no symptoms, but the damage can be seen in blood tests routinely done when chemotherapy is given. If kidney damage occurs, cisplatin is usually discontinued and carboplatin can be used instead.

Other side effects are also possible. Some of them are more common with certain chemotherapy drugs. Ask your cancer care team to tell you about the possible side effects of the specific medications you are receiving.