 EBRT. Low-dose brachytherapy is completed in just a few days in the hospital. High-dose brachytherapy is done outside the hospital over several treatments (often at least a week apart).
Chemotherapy and Targeted Treatments
Most women with cervical cancer are treated with surgery. However, some women may need to receive chemotherapy before or after surgery. They also may receive chemoradiation treatment, which is a combination of chemotherapy and radiation. In addition to chemotherapy, doctors may prescribe targeted treatments, which focus on specific cell mechanisms thought to be important for the growth and survival of tumor cells. Unlike chemotherapy, targeted treatments are designed to spare healthy tissues and may cause less severe side effects than chemotherapy.
Chemotherapy and targeted treatments for cervical cancer include the following medications:
Bevacizumab (Avastin). In 2014, this targeted treatment became the first drug approved for late-stage cervical cancer since 2006. Bevacizumab helps prevent the growth of new blood vessels that tumors need to grow. Because it more than tripled the rate of response to a cervical cancer drug, a result learned from clinical trials, the U.S. Food and Drug Administration fast-tracked approval of bevacizumab for this type of cervical cancer. Bevacizumab usually is combined with other drugs that target the cancer itself.
Cisplatin. This drug usually is combined with radiation for advanced-stage cervical cancer, alone or with fluorouracil. Cisplatin also may be used to treat cervical cancer that comes back (recurrent) or has spread outside of the pelvis. Cisplatin may be combined with other medications such as fluorouracil plus cetuximab (Erbitux) or docetaxel (Taxotere and others) plus paclitaxel (Taxol and others).
Carboplatin. Carboplatin usually is given intravenously (IV) through a blood vein. It is used in advanced-stage or recurrent cervical cancer.
Topotecan (Hycamtin and others). This medication usually is reserved for treating cervical cancer that no longer responds to other types of treatments.
Gemcitabine (Gemzar and others) and cetuximab. These targeted treatments can slow or stop the growth of cervical cancer cells.
If you experience any of these treatment side effects, talk to your doctor or nurse immediately:
• Fever or chills;
• Heavy bleeding or unusual vaginal discharge;
• Severe pain;
• Redness or discharge from incisions;
• Problems urinating or having a bowel movement;
• Shortness of breath or chest pain.
You should also work with your health care team to manage the following possible life changes due to cancer treatment:
Premature Menopause and Sexual Side Effects
For premenopausal women under age 50 who have a hysterectomy that includes removal of the ovaries, the procedure may cause premature menopause. Estrogen therapy may be prescribed if the woman is young or experiences menopausal symptoms such as hot flashes.
Some women may also experience vaginal dryness after hysterectomy, which can affect their sexual well-being. Many effective prescription and over-the-counter treatments are available to correct vaginal dryness. Most of them are estrogen-based products in cream, gel or other forms. Discuss with your doctor the best option for you.
Before using complementary or alternative treatments such as vitamins or products containing plant-based estrogens, talk to your doctor about the product’s safety and effectiveness.
Avoid using certain products that may irritate the vagina, including douches (especially ones containing vinegar or yogurt), scented lotions, antibacterial or fragrant soaps, bubble baths and bath oils.
Changes in Fertility
Cancer treatments can affect your ability to conceive a child. It’s important to talk to your doctor before treatment to discuss your options for preserving your fertility, even if you aren’t sure you want to have children in the future. The surgical procedure called trachelectomy, discussed on page in the chapter on treatments, can benefit some women with early cervical cancer who wish to become pregnant.
Maintaining