Chemotherapy for Endometrial Cancer

Chemotherapy (chemo) is the use of drugs that kill cancer cells. They're given into a vein or taken by mouth as pills. These drugs go into the bloodstream and reach throughout the body. Because of this, chemo is often part of the treatment when endometrial cancer has spread beyond the endometrium to other parts of the body and surgery can't be done.

While chemo is not usually used to treat (early) stage I and II endometrial cancers, chemo is commonly used for high grade cancers, which grow and spread quickly, and cancer that comes back after treatment. This can include early stage cancers of the high grade type.

In most cases, a combination of chemo drugs is used. Combination chemotherapy tends to work better than one drug alone.

Chemo is often given in cycles: a period of treatment, followed by a rest period. The chemo drugs may be given on one or more days in each cycle.

Chemo drugs used to treat endometrial cancer may include:

• Paclitaxel (Taxol^®)
• Carboplatin
• Doxorubicin (Adriamycin^®) or liposomal doxorubicin (Doxil^®)
• Cisplatin
• Docetaxel (Taxotere^®)

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

For carcinosarcoma, the chemo drug ifosfamide (Ifex^®) is often used, either alone or along with either cisplatin or paclitaxel. The targeted drug called trastuzumab (Herceptin^®) might be added for carcinosarcomas that are HER2 positive. (HER2 is a protein that helps some cancer cells grow and spread faster. You can learn more about it at Breast Cancer HER2 Status. )

Sometimes chemo is given for a few cycles, followed by radiation. Then chemo is given again. This is called sandwich therapy. It's sometimes used for endometrial papillary serous cancer and uterine carcinosarcoma.

Another treatment option is to give chemo with radiation (called chemoradiation). The chemo can help the radiation work better, but it can be harder on the patient because the combination causes more side effects.

Side effects of chemotherapy

These drugs kill cancer cells but can also damage some normal cells, which in turn causes side effects. Side effects of chemotherapy depend on the drugs used, the amount taken, and how long treatment is given. Common side effects include:

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

Also, most chemo 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 get better over time when treatment ends, but some can last a long time. Different drugs can cause different side effects. For instance, 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 put a limit on how much doxorubicin a person can get.

Cisplatin can cause kidney damage, so you'll be given lots of IV fluids before and after chemo to 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). To prevent this, you might be given large amounts of IV fluids 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 most of them. For instance, there are many anti-nausea drugs that can help prevent or reduce nausea and vomiting. Be sure to tell your health care team about any side effects you have. Treating them right away can often keep them from getting worse.