About chemotherapy for cervical cancer

Chemotherapy uses anti cancer or 'cytotoxic' drugs to destroy cancer cells. They work by disrupting the growth of cancer cells. The drugs circulate in the bloodstream around the body. Your doctor may suggest chemotherapy

• As part of your treatment when you are first diagnosed
• For cancer that has come back
• Before surgery as part of a clinical trial

Trials in the past few years have found that giving chemotherapy at the same time as radiotherapy is the best choice of treatment for certain stages of cervical cancer. Your doctor may call this chemoradiation or concurrent chemotherapy and radiotherapy. This is now the most likely treatment if you have anything from a stage 1B2 cancer to a stage 4A cancer. A stage 1B2 cervical cancer is still within the cervix, but is bigger than 4cm across. A stage 4A cancer is one that has spread from the cervix, into the womb and into surrounding tissues, such as the bowel or bladder.

Chemotherapy can shrink advanced cervical cancer. Your doctor may suggest it to help relieve any symptoms that advanced cervical cancer is causing. You may have chemotherapy on it own or alongside radiotherapy or surgery. There is more about this in the section of CancerHelp UK on treating advanced cervical cancer.

Sometimes, doctors try to use chemotherapy before surgery or radiotherapy to shrink a cancer. If it works, this can mean that you need a smaller operation or radiotherapy treatment to a smaller area. Doctors call this type of treatment 'neoadjuvant' therapy. But it remains experimental for cervical cancer. If your doctor suggests this treatment approach, it should only be as part of a clinical trial.

Don't be afraid to ask your doctor about the different treatment options available to you. Answering your questions is part of your doctor's job. It is very important that you feel confident in the treatment your doctor suggests for the stage of cervical cancer you have. There is a list of questions for your doctor that you may find useful at the end of this section of CancerHelp UK.

Most chemotherapy drugs are injections, although some are available as tablets. How often you have the drug depends on which one you are having and on whether you are having a single drug or several.

Generally, a course of chemotherapy takes a few days every 3 or 4 weeks. The drugs are injected into one of your veins. So they can circulate through your blood stream. You have 3 or 4 weeks rest after each round of treatment. Then another few days of chemotherapy injections. This is usually repeated six or more times to make up a complete course.

If you are having chemoradiation, you usually have chemotherapy once a week for 5 or 6 weeks while you are having your course of radiotherapy. Because you are having weekly treatment, rather than 3 weekly, you have a slightly lower dose.

If you are having chemoradiation, you are most likely to have a drug called cisplatin. For advanced cervical cancer, clinical trials are still going on to find which other drugs and combinations of drugs may help. Drugs that have been tested include

• Cisplatin
• Ifosfamide
• Fluorouracil
• Irinotecan
• Paclitaxel (Taxol)
• Docetaxel
• Gemcitabine
• Topotecan

These links take you to another page with information on the specific side effects of each drug. Just click your back button to get back to this page. 

In the UK, the organisations that approve treatments for the NHS have recommended a combination of cisplatin and topotecan as a treatment option for women whose cancer has come back after radiotherapy, or who have stage 4B cervical cancer, but only if they have not been treated with cisplatin before.

Chemotherapy does have side effects. The effects you get will depend on

• Which drugs you have
• How much of each drug you are given
• How you individually react

Not everyone gets every side effect with every drug. Some people react more than others. And different drugs have different side effects. So we can't tell you exactly what will happen to you. Most side effects only last for the few days that you are actually having the drugs. And there is quite a bit that can be done to help. Here is a list of some common side effects

• A drop in the number of blood cells
• Feeling sick
• Diarrhoea
• Hair loss or thinning
• Sore mouth and mouth ulcers
• Feeling tired and run down

There is more about these side effects and how to deal with them in the CancerHelp UK section about chemotherapy.

Ask your doctor or nurse which of these side effects are most common with the chemotherapy drugs you will be having. Tell your doctor or nurse about any side effects you have straight away so that they can help you as much as possible. If you would like more information about anything to do with the side effects of chemotherapy, contact one of the cervical cancer support organisations. They will be happy to help. They often have free factsheets and booklets which they can send to you.

Chemotherapy courses can seem to go on for ever. Particularly if you are getting very tired towards the end of your course. But they do finish. And the side effects will go once your treatment has ended.

Until recently cervical cancer was most likely to be treated with radiotherapy or surgery to remove the cervix and womb (hysterectomy) and lymph nodes. You may have had both treatments. But following clinical trials, doctors now know that giving chemotherapy at the same time as radiotherapy (chemoradiation) gives the best chance of curing cervical cancer that is more than stage 1B2. Giving radiotherapy and chemotherapy at the same time seems to work better at killing cancer cells than having these treatments on their own. The reason for this is not very clear but researchers think it may be because the chemotherapy makes cancer cells more sensitive to radiotherapy, or vice versa.

Many clinical trials have been done comparing different ways of giving this treatment. A 2008 review of these trials reported that chemoradiation helped women with cervical cancer live longer. Chemoradiation also lowered the risk of the cancer coming back or spreading to other parts of the body. Some trials have shown that cisplatin works best alongside radiotherapy for cervical cancer but this review reported that other chemotherapy drugs worked as well as cisplatin.

Combination chemotherapy and radiotherapy is not suitable for you if

• You have very early stage cervical cancer (stage 1A and 1B1), as this can be successfully treated with surgery
• You are not fit enough - for example because your kidneys don’t work as well as they should
• You have very advanced stage cervical cancer (stage 4B) that has spread to other parts of your body such as the lungs or liver

Unfortunately such advanced cervical cancer is unlikely to be cured by the radiotherapy and cisplatin combination. You may have surgery, radiotherapy, chemotherapy or a combination of these, depending on what best suits your particular circumstances.

The side effects of chemoradiation are the same as if you had each treatment separately. But some are likely to be more severe. In particular, there is a risk of developing a very low white blood cell count. This means you are at risk of getting an infection. If you have any signs of infection, such as raised temperature, sore throat or pain when passing urine, you must contact your doctor. You may also get a low platelet count. Platelets help your blood to clot. So if they are low, this may cause symptoms such as nosebleeds, bleeding gums, or a rash of red spots caused by bleeding under the skin. If you have any of these symptoms, let your doctor know as soon as possible. If your blood counts fall very low, you may need to stop chemotherapy for a while until they recover.

Women having this treatment may be more likely to have digestive side effects, such as diarrhoea, during their radiotherapy treatment. Again, do tell your doctor, nurse or radiotherapist. They may not be able to get rid of the problem, but they may be able to give you something to lessen it or help you to cope in other ways. The good news is that cisplatin doesn't generally cause hair loss.

Most side effects are temporary and manageable. There is information about the general side effects of chemotherapy and side effects of radiotherapy in the main chemotherapy and radiotherapy sections of CancerHelp UK.

We don't yet know much scientifically about how some nutritional or herbal supplements may interact with chemotherapy. Some could be harmful. It is very important to let your doctors know if you take any supplements. Or if you are prescribed them by alternative or complementary therapy practitioners.

Talk to your specialist about any other tablets or medicines you take while you are having active treatment. There is information about the safety of herbal, vitamin and diet supplements in the complementary therapies section of CancerHelp UK.

Some studies seem to suggest that fish oil preparations may reduce the effectiveness of chemotherapy drugs. If you are taking or thinking of taking these supplements talk to your doctor to find out whether they could affect your treatment.

For more about chemotherapy look at the chemotherapy section of CancerHelp UK.

It explains the treatment in more detail including

• What it involves
• How chemotherapy is planned and given
• General side effects
• Living with chemotherapy

If you would like more information about anything to do with chemotherapy, contact one of the cervical cancer information organisations. They will be happy to help. They often have free factsheets and booklets which they can send to you. You could also contact our cancer information nurses for help.