Chemotherapy for cervical cancer
Chemotherapy uses anti-cancer (cytotoxic) drugs to destroy cancer cells. There are several chemotherapy drugs that can be used to treat cervical cancer.
The most commonly used drug is cisplatin, which is often given in combination with radiotherapy or in combination with other chemotherapy drugs. The drugs are usually given intravenously (by injection into a vein).
Early-stage and locally advanced cervical cancer
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Chemotherapy may be used to treat larger tumours that are just in the cervix or those that have spread locally (to the surrounding area). It’s commonly combined with radiotherapy to make the radiotherapy more effective – this is called chemoradiation. Usually the chemotherapy is given once a week during the course of radiotherapy.
Chemotherapy may also be given to women whose cancer has spread to other parts of the body. It’s used in this situation to try to shrink and control the cancer and relieve symptoms, to prolong a good quality of life. In some women the chemotherapy will achieve this. Unfortunately for others the chemotherapy will not shrink the cancer, and in this situation the treatment will be stopped to avoid the side effects it may cause. It’s helpful to discuss the pros and cons of chemotherapy in your particular situation with your cancer specialist.
Chemotherapy can cause side effects, which may be slightly worse when it’s given alongside radiotherapy. We’ve listed some of the side effects you may experience.
Lowered resistance to infection (neutropenia)
Chemotherapy can temporarily reduce the production of white blood cells in your bone marrow, making you more prone to infection.
This effect can begin about seven days after treatment has been given, and your resistance to infection usually reaches its lowest point about 10-14 days after chemotherapy. Your white blood cells will then increase steadily and will usually return to normal before your next cycle of chemotherapy is due.
You should contact your doctor or the hospital straight away if:
your temperature goes above 38˚C (100.4˚F)
you suddenly feel unwell, even with a normal temperature.
You will have a blood test before having more chemotherapy to make sure that your white blood cells have recovered.Occasionally it may be necessary to delay your treatment if your blood count is still low.
Watch our slideshow for advice about how to avoid infection when you have reduced immunity.
If the level of red blood cells in your blood is low, you may feel tired and breathless. This is called anaemia. Anaemia can be treated by having a blood transfusion.
Bruising and bleeding
The chemotherapy can reduce the production of platelets, which help the blood to clot. Having low numbers of platelets increases your chance of bleeding, and this can affect people in different ways. Let your doctor know if you have any unexplained bruising or bleeding, such as nosebleeds, bleeding gums, blood in your urine or stools, blood spots or rashes on the skin. You may need to have a platelet transfusion.
Nausea and vomitting
Some chemotherapy drugs can make you feel sick (nauseated) or be sick (vomit). Your cancer specialist can prescribe effective anti-sickness (anti-emetic) drugs to prevent or greatly reduce this. If the sickness is not controlled, or continues, let your doctor know. They can prescribe other anti-sickness drugs that may be more effective.
Chemotherapy affects people in different ways. Some people find they’re able to lead a fairly normal life during their treatment, but many find they become very tired and have to take things much more slowly. Try to pace yourself by balancing periods of rest with some gentle exercise, such as short walks.
Effects on the kidneys
Some of the chemotherapy drugs used to treat cancer of the cervix may affect the kidneys. Usually this doesn’t cause any symptoms, but sometimes the effect can be severe and the kidneys can be permanently damaged unless the treatment is stopped.
For this reason your kidney function will be checked by a blood test before each treatment. You may be asked to drink plenty of fluids, and to measure how much liquid you drink and the amount of urine you pass.
Chemotherapy drugs can sometimes make your mouth sore and cause small mouth ulcers. Some people find that sucking on ice may be soothing. Drinking plenty of fluids, and cleaning your teeth regularly and gently with a soft toothbrush, can help to reduce the risk of this happening.
Tell your nurse or doctor if you have any of these problems, as they can prescribe mouthwashes and medicine to prevent or clear mouth infections.
Loss of appetite
Some people lose their appetite while they’re having chemotherapy. This can be mild and may only last a few days. If it doesn’t improve you can ask to see a dietitian or specialist nurse at your hospital. They can give you advice on improving your appetite and keeping to a healthy weight.
Numbness or tingling in hands or feet
This is due to the effect of some chemotherapy drugs on your nerves and is known as peripheral neuropathy. Tell your doctor if you notice this symptom, as it may be controlled by slightly lowering the dose of the chemotherapy drug.
The problem usually improves slowly over a few months after treatment is over, but for some people it can persist. Talk to your doctor if this happens.
Some chemotherapy drugs can cause temporary hair loss. Your doctor or nurse will be able to tell you if you’re likely to experience this. There are many ways of covering up hair loss, including wigs, hats and scarves. If you are an inpatient when you have your treatment, or if you’re on income support, you can get a free wig from the NHS.
If you do lose your hair, it should start to grow back within 3-6 months of finishing treatment.
Although they may be difficult to cope with at times, most of these side effects will disappear once your treatment is over.
Chemotherapy can affect your ability to become pregnant after treatment. It’s important to discuss any concerns you have about this with your hospital team before your treatment starts.
It’s not advisable to become pregnant while having chemotherapy, as the drugs may harm the developing baby. For this reason, your doctor will advise you to use a reliable method of contraception (usually a ‘barrier method’, such as condoms) throughout your treatment and for a few months afterwards. You can discuss this with your doctor or nurse.
Condoms should be used if you have sex within the first 48 hours after chemotherapy. This is to protect your partner from any of the drug that may be present in the vaginal fluid