Cervical cancer - Chemotherapy

Description

An in-depth report on the causes, diagnosis, treatment, and prevention of cervical cancer.

Alternative Names

Dysplasia; Human papillomas virus; Pap smear

Chemotherapy:

Chemotherapy uses cell-killing drugs called cytotoxic drugs to destroy widespread cancer cells that have spread from the primary tumor and can no longer be treated with surgery or radiation alone. Chemotherapy is usually used along with radiation (a combination called “chemoradiation”) for treatment of stages IB1 - IVB cervical cancer. Chemotherapy can help increase the effectiveness of radiation therapy. In the most advanced cancer stage, IVB, chemotherapy is used palliatively to help relieve symptoms.

Platinum-Based Drugs. Platinum-based drugs are the main chemotherapy treatment for cervical cancer. Cisplatin is the primary drug used. Carboplatin is an alternative platinum drug, that is used for treating more advanced cervical cancer.

Other drugs. Other drugs may be given alone or in combination with a platinum-based drug. They include paclitaxel, topotecan, gemcitabine, 5-FU, vinorelbine, and others.

Administration. Chemotherapy is typically given intravenously at a medical center or doctor's office. The drugs are given in cycles with a period of rest following a period of treatment, to allow recovery from the side effects.

Side Effects. Chemotherapy affects all fast-growing cells, including healthy ones. So, side effects are inevitable. Side effects occur with all chemotherapeutic drugs. They are more severe with higher doses and increase over the course of treatment. Side effects also tend to be more severe when chemotherapy is given along with radiation.

Common side effects may include:

Nausea and vomiting. Drugs can help relieve these side effects.
Diarrhea
Temporary hair loss
Loss of appetite and weight
Fatigue

Complications. Serious short- and long-term complications can also occur and may vary, depending on the specific drugs used. They include:

Severe drop in white blood cell count (neutropenia). The reduction in white blood cells suppresses the immune system and makes patients more susceptible to infections.
Reduction of blood platelets (thrombocytopenia), which can lead to bruising.
Anemia. Chemotherapy can cause reduction in red blood cells, which leads to anemia. Chemotherapy-induced anemia is usually treated with erythropoiesis-stimulating drugs, which include epoietin alfa (Epogen, Procrit) and darberpetin alfa (Aranesp). Recent studies have shown that these drugs may contribute to rapid tumor growth in patients with cervical cancer. Doctors need to follow strict dosing guidelines when administering these drugs. Patients should discuss the risks and benefits of erythropoiesis-stimulating drugs with their oncologists. [For more information, see In-Depth Report #57: Anemia ]
Premature menopause
Liver and kidney damage
Problems with concentration, motor function, and memory

Resources

www.cancer.gov -- National Cancer Institute
www.cancer.org -- American Cancer Society
www.acog.org -- American College of Obstetricians and Gynecologists
www.ashastd.org -- American Social Health Association
www.nccc-online.org -- National Cervical Cancer Coalition
www.cervicalcancercampaign.org -- Cervical Cancer Public Education Campaign
www.thegcf.org -- Gynecologic Cancer Foundation
www.wcn.org -- Women's Cancer Network
www.cancer.net -- Cancer.Net

References

Committee on Infectious Diseases. Prevention of human papillomavirus infection: provisional recommendations for immunization of girls and women with quadrivalent human papillomavirus vaccine. Pediatrics. 2007 Sep;120(3):666-8.

Dunne EF, Unger ER, Sternberg M, McQuillan G, Swan DC, Patel SS, et al. Prevalence of HPV infection among females in the United States. JAMA. 2007 Feb 28;297(8):813-9.

FUTURE II Study Group. Quadrivalent vaccine against human papillomavirus to prevent high-grade cervical lesions. N Engl J Med. 2007 May 10;356(19):1915-27.

Garland SM, Hernandez-Avila M, Wheeler CM, Perez G, Harper DM, Leodolter S, et al. Quadrivalent vaccine against human papillomavirus to prevent anogenital diseases. N Engl J Med. 2007 May 10;356(19):1928-43.

Hildesheim A, Herrero R, Wacholder S, Rodriguez AC, Solomon D, Bratti MC, et al. Effect of human papillomavirus 16/18 L1 viruslike particle vaccine among young women with preexisting infection: a randomized trial. JAMA. 2007 Aug 15;298(7):743-53.

Huang CM. Human papillomavirus and vaccination. Mayo Clin Proc. 2008;83(6):701-6.

Hunter MI, Monk BJ and Tewari KS. Cervical neoplasia in pregnancy. Part 1: screening and management of preinvasive disease. Am J Obstet Gynecol. 2008;199(1):3-9.

Hunter MI, Tewari K and Monk BJ. Cervical neoplasia in pregnancy. Part 2: current treatment of invasive disease. Am J Obstet Gynecol. 2008;199(1):10-8.

Long HJ 3rd, Laack NN and Gostout BS. Prevention, diagnosis, and treatment of cervical cancer. Mayo Clin Proc. 2007;82(12):1566-74.

Markowitz LE, Dunne EF, Saraiya M, Lawson HW, Chesson H, Unger ER; Centers for Disease Control and Prevention (CDC); Advisory Committee on Immunization Practices (ACIP). Quadrivalent human papillomavirus vaccine: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 2007 Mar 23;56(RR-2):1-24.

Mayrand MH, Duarte-Franco E, Rodrigues I, Walter SD, Hanley J, Ferenczy A, et al. Human papillomavirus DNA versus Papanicolaou screening tests for cervical cancer. N Engl J Med. 2007;357(16): 1579-88.

Naucler P, Ryd W, Tornberg S, Strand A, Wadell G, Elfgren K, et al. Human papillomavirus and Papanicolaou tests to screen for cervical cancer. N Engl J Med. 2007;357(16):1589-97.

Ronco G, Cuzick J, Pierotti P, Cariaggi MP, Dalla Palma P, Naldoni C, et al. Accuracy of liquid based versus conventional cytology: overall results of new technologies for cervical cancer screening: randomised controlled trial. BMJ. 2007 Jul 7;335(7609):28. Epub 2007 May 21.

Saslow D, Castle PE, Cox JT, Davey DD, Einstein MH, Ferris DG, et al. American Cancer Society Guideline for human papillomavirus (HPV) vaccine use to prevent cervical cancer and its precursors. CA Cancer J Clin. 2007 Jan-Feb;57(1):7-28.

Wright TC Jr., Massad LS, Dunton CJ, Spitzer M, Wilkinson EJ and Solomon D. 2006 consensus guidelines for the management of women with abnormal cervical cancer screening tests. Am J Obstet Gynecol. 2007;197(4): 346-55.

Wright TC Jr., Massad LS, Dunton CJ, Spitzer M, Wilkinson EJ and Solomon D. 2006 consensus guidelines for the management of women with cervical intraepithelial neoplasia or adenocarcinoma in situ. Am J Obstet Gynecol. 2007;197(4): 340-5.

Reviewed last on: 10/6/2008
Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

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