Cisplatin and topotecan is used to treat advanced cervical cancer.

It is best to read this information with our general information about chemotherapy and the type of cancer you have.

The drugs used in this treatment are:

• cisplatin
• topotecan.

You will be given cisplatin and topotecan in the chemotherapy day unit or during a short stay in hospital. A chemotherapy nurse will give it to you.

During treatment you usually see a cancer doctor, a chemotherapy nurse or a specialist nurse, and a specialist pharmacist. This is who we mean when we mention doctor, nurse or pharmacist in this information.

Before or on the day of treatment, a nurse or person trained to take blood (phlebotomist) will take a blood sample from you. This is to check that it is okay for you to have chemotherapy.

You will also see a doctor or nurse before you have chemotherapy. They will ask you how you have been feeling. If your blood results are okay, the pharmacist will prepare your chemotherapy. Your nurse will tell you when your treatment is likely to be ready.

Your nurse will give you anti-sickness (anti-emetic) drugs before the chemotherapy. The chemotherapy drugs can be given through:

• a short, thin tube that they put into a vein in your arm or hand (cannula)
• a fine tube that goes under the skin of your chest and into a vein close by (central line)
• a fine tube that is put into a vein in your arm and goes up into a vein in your chest (PICC line).

Your nurse will give you topotecan (a colourless fluid) as a drip (infusion) for 30 minutes. After this, they will give you cisplatin as a drip over a longer period of time. They usually run the drip through a pump, which gives you the treatment over a set time. You will have extra fluids through your drip before and after the cisplatin, to protect your kidneys.

You will have chemotherapy as a course of several sessions (cycles) of treatment over a few months. Each cycle of cisplatin and topotecan takes 21 days (3 weeks). Cisplatin and topotecan can be given in different ways. Your doctor or nurse will be able to give you details of your treatment course.

• On day 1, you have topotecan and cisplatin.
• On day 2, you have just topotecan.
• On day 3, you have topotecan again.
• You then have a rest period with no chemotherapy for 18 days.

At the end of the 21 days, you start your second cycle of treatment. This is exactly the same as the first cycle. Your doctor or nurse will tell you the number of cycles you are likely to have.

We explain the most common side effects of this treatment here. We also include some less common side effects.

You may get some of the side effects we mention, but you are unlikely to get all of them. 

If you are also having treatment with other cancer drugs, you may have some side effects that we haven’t listed here. 

Always tell your doctor, nurse or pharmacist about any side effects you have.

Your doctor can give you drugs to help control some side effects. 

It is important to take them exactly as your nurse or pharmacist explains. This means they will be more likely to work for you. 

Your nurse will give you advice about managing your side effects. 

After your treatment is over, most side effects start to improve.

Serious and life-threatening side effects

Some cancer treatments can cause severe side effects. Rarely, these may be life-threatening. Your cancer doctor or nurse can explain the risk of these side effects to you.

Contact the hospital

Your nurse will give you telephone numbers for the hospital. If you feel unwell or need advice, you can call them at any time of the day or night. 

Save these numbers in your phone or keep them somewhere safe.

More information

We cannot list every side effect for this treatment. There are some rare side effects that are not listed. You can visit the electronic Medicines Compendium (eMC) for more detailed information.

Some people may have side effects while they are being given the chemotherapy or shortly after they have it:

Allergic reaction

Some people have an allergic reaction while having this treatment. Signs of a reaction can include:

• feeling hot or flushed 
• a skin rash
• itching
• shivering
• feeling dizzy
• a headache
• feeling breathless 
• swelling of your face or mouth
• pain in your back, tummy or chest.

Your nurse will check you for signs of a reaction during your treatment. If you feel unwell or have any of these signs, tell them straight away. If you do have a reaction, it can be treated quickly.

Sometimes a reaction can happen a few hours after treatment. If you get any signs or feel unwell after you get home, contact the hospital straight away.

Risk of infection

This treatment can reduce the number of white blood cells in your blood. These cells fight infection. 

If the number of white blood cells is low, you are more likely to get an infection. A low white blood cell count is called neutropenia.

If you have an infection, it is important to treat it as soon as possible. 

Contact the hospital straight away on the 24-hour contact number you have if:

• your temperature goes over 37.5°C (99.5°F)
• you suddenly feel unwell, even with a normal temperature
• you have symptoms of an infection.

Symptoms of an infection include:

• feeling shivery
• a sore throat
• a cough
• diarrhoea
• needing to pass urine often.

It is important to follow any specific advice your cancer treatment team gives you.

The number of white blood cells will usually return to normal before your next treatment. 

You will have a blood test before having more treatment. If your white blood cell count is low, your doctor may delay your treatment for a short time.

Bruising and bleeding

This treatment can reduce the number of platelets in your blood. Platelets are cells that help the blood to clot. 

Tell your doctor if you have any bruising or bleeding that you cannot explain. 

This includes:

• nosebleeds
• bleeding gums
• tiny red or purple spots on the skin that may look like a rash.

Some people may need a drip to give them extra platelets. This is called a platelet transfusion.

Anaemia (low number of red blood cells)

This treatment can reduce the number of red blood cells in your blood. These cells carry oxygen around the body.

If the number of red blood cells is low, you may be tired and breathless. Tell your doctor or nurse if you feel like this.

If you are very anaemic, you may need a drip to give you extra red blood cells. This is called a blood transfusion.

Feeling sick

You may feel sick in the first few days after this treatment. Your doctor will give you anti-sickness drugs to help prevent or control sickness. Take the drugs exactly as your nurse or pharmacist tells you. 

It is easier to prevent sickness than to treat it after it has started.

If you feel sick, take small sips of fluids and eat small amounts often. 

If you continue to feel sick, or if you vomit more than once in 24 hours, contact the hospital as soon as possible. They will give you advice and may change the anti-sickness drug to one that works better for you.

Changes to your taste

You may get a bitter or metal taste in your mouth. Sucking sugar-free sweets may help with this. Some foods may taste different or have no taste. Try different foods to find out what tastes best to you. Taste changes usually get better after treatment finishes. Your nurse can give you more advice.

Loss of appetite

This treatment can affect your appetite. Do not worry if you do not eat much for a day or two. But if your appetite does not come back after a few days, tell your nurse or dietitian. They will give you advice. They may give you food or drink supplements.

Hair loss

Your hair will get thinner or you may lose all the hair from your head. You may also lose your eyelashes, eyebrows or other body hair. Hair loss usually starts after your first or second treatment.

Your nurse can talk to you about ways to cope with hair loss. There are ways to cover up hair loss if you want to. It is important to cover your head to protect your scalp when you are out in the sun.

Hair loss is almost always temporary and your hair will usually grow back after treatment ends.

Feeling tired

Feeling tired is a common side effect. It is often worse towards the end of treatment and for some weeks after it has finished. 

Try to pace yourself and plan your day so you have time to rest. 

Gentle exercise, like short walks, can give you more energy. 

If you feel sleepy, do not drive or operate machinery.

Effects on the kidneys

Cisplatin can affect how your kidneys work. You will have blood tests before and during treatment to check this.

Before and after each treatment, your nurses will give you extra fluids through a drip. This is to protect your kidneys. It is also important to drink at least 2 litres (3½ pints) of fluids each day.

If you pass less urine than usual, tell your nurse.

Numb or tingling hands or feet (peripheral neuropathy)

This treatment affects the nerves, which can cause numb, tingling or painful hands or feet. You may find it hard to fasten buttons or do other fiddly tasks.

Tell your doctor if you have these symptoms. They sometimes need to lower the dose of the drug. 

The symptoms usually improve slowly after treatment finishes, but for some people they may never go away. Talk to your doctor if you are worried about this.

Diarrhoea

If you have diarrhoea, contact the hospital for advice. Try to drink at least 2 litres (3½ pints) of fluids every day. It can help to avoid alcohol, caffeine, milk products, high-fat foods and high-fibre foods.

Constipation

This treatment can cause constipation. Here are some tips that may help:

• drink at least 2 litres (3½ pints) of fluids each day
• eat high-fibre foods, such as fruit, vegetables and wholemeal bread
• do regular gentle exercise, like going for short walks.

If you have constipation, contact the hospital for advice. Your doctor can give you drugs called laxatives to help.

Changes in hearing

Cisplatin can affect your hearing. You may have a hearing test before you start treatment. You may get ringing in your ears (tinnitus) and become unable to hear some high-pitched sounds. Tinnitus usually gets better after treatment ends. Some hearing changes can be permanent. Tell your doctor if you notice any changes in your hearing.

Sore mouth

You may get a sore mouth or mouth ulcers. This can make you more likely to get a mouth infection. 

Use a soft toothbrush to clean your teeth or dentures in the morning, at night and after meals.

If your mouth is sore:

• tell your nurse or doctor – they can give you a mouthwash or medicines to help
• try to drink plenty of fluids
• avoid alcohol, tobacco, and foods that irritate your mouth.

Effects on the lungs

This treatment can cause changes to the lungs. Tell your doctor if you develop: 

• a cough
• wheezing
• a fever (high temperature)
• breathlessness.

You should also tell them if any existing breathing problems get worse. You may have tests to check your lungs.

Blood clot risk

Cancer and some cancer treatments can increase the risk of a blood clot. Symptoms of a blood clot include:

• pain, redness or swelling in a leg or arm
• breathlessness
• chest pain. 

If you have any of these symptoms, contact a doctor straight away. 

A blood clot is serious, but can be treated with drugs that thin the blood. Your doctor or nurse can give you more information.

Other medicines

Some medicines can affect chemotherapy or be harmful when you are having it. This includes medicines you can buy in a shop or chemist. 

Tell your cancer doctor about any drugs you are taking, including over-the-counter drugs, complementary therapies and herbal drugs.

Fertility

Some cancer drugs can affect your ability to get pregnant (your fertility). If you are worried about this, it is important to talk with your doctor before you start treatment.

Contraception

Your doctor will advise you not to get pregnant during this treatment. The drugs may harm the developing baby. It is important to use contraception during your treatment.

Sex

If you have sex in the first few days after chemotherapy, you need to use a condom. This is to protect your partner in case there is any chemotherapy in vaginal fluid.

Changes to your periods

Chemotherapy can sometimes stop the ovaries working. You may not get a period every month and they may eventually stop. In some women this is temporary, but for others it is permanent and they start the menopause.

Breastfeeding

Women are advised not to breastfeed while having this treatment and for some time afterwards. This is because the drugs could be passed to the baby through breast milk.

Medical and dental treatment

If you need medical treatment for any reason other than cancer, always tell the doctors and nurses that you are having cancer treatment. 

Give them the contact details for your cancer doctor so they can ask for advice.

If you think you need dental treatment, talk to your cancer doctor or nurse. Always tell your dentist you are having cancer treatment.