Chemotherapy for Cervical Cancer

Chemotherapy (chemo) drugs given intravenously (into a vein) or by mouth are called systemic chemotherapy. The drugs enter the bloodstream and reach throughout the body, making this treatment useful for cancers that have spread.

Chemo drugs commonly used to treat cervical cancer

Treatment choices are made based on each person's needs. Drugs that have been used include:

•  Cisplatin
•  Carboplatin
•  Bevacizumab (Avastin)
•  Paclitaxel (Taxol®)
•  Topotecan (Hycamtin)
•  Docetaxel (Taxotere)
•  Fluorouracil (5-FU)

These drugs can be given:

• At the same time as radiation (for cancer that has not spread to other parts of the body)
• Alone (if cancer has already spread to other parts of the body)

Chemo side effects

Chemo works by attacking cells that are rapidly dividing. This is helpful in killing cancer cells, but can also affect normal cells, leading to some side effects. Side effects of chemo depend on the type of drugs, the amount taken, and the length of time you are treated.

Common side effects of chemotherapy include:

•  Hair loss
•  Mouth sores
•  Loss of appetite
•  Diarrhea
•  Nausea and vomiting
•  Changes in the menstrual cycle, premature menopause, and infertility (inability to become pregnant)

Chemo can also affect the blood-forming cells of the bone marrow, lowering the blood cell counts. This can cause:

•  Increased chance of infections (from low white blood cells)
•  Easy bruising or bleeding (from low blood platelets)
•  Fatigue (caused by low red blood cells)

Most side effects are temporary and stop when the treatment is over, but some can be long-lasting or even permanent.

Long-term side effects of chemotherapy

Menstrual changes: If you have not had your 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 getting chemo, you might still be able to get pregnant. Getting pregnant while receiving chemo is not safe, as it might lead to birth defects and interfere with treatment. This is why it’s important to discuss birth control options with your doctor if you are pre-menopausal and sexually active before treatment. 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. This 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 is called peripheral neuropathy. In most cases it gets better or even goes away once treatment stops, but it might last a long time in some people.

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 it may be long-lasting. Often, there are no symptoms, but the damage can be seen on bloodwork done routinely while chemo is given. If the kidneys are damaged, the cisplatin is usually stopped and carboplatin may be used instead. 

Other side effects are also possible. Ask your cancer care team about the chemo you will receive and what side effects you can expect.