Endometrial Cancer: Chemotherapy

What is chemotherapy?

Chemotherapy uses anticancer medicines to kill cancer cells. The medicines are made to attack and kill cancer cells that grow quickly. Some normal cells also grow quickly. Because of this, chemotherapy can also harm those cells. This can cause side effects.

When might chemotherapy be used to treat endometrial cancer?

Chemotherapy is not often used for endometrial cancer. But your doctor may feel it’s needed based on if and where your cancer has spread (stage). Chemotherapy may be a treatment option for people with more advanced stages of endometrial cancer. This is when the cancer has spread outside the uterus to other parts of your body.

It's very important to talk with a gynecologic oncologist. This is a specialist with training in the diagnosis, treatment, and watching of female cancers. Your doctor may suggest chemotherapy to treat you in one of these cases:

• To add to your treatment with radiation to help make the radiation work better

• After you’ve had surgery, to help make sure that all the cancer cells have been killed

• If cancer comes back in other parts of your body after it's been treated

How is chemotherapy given for endometrial cancer?

Chemotherapy is most often given into your blood through an IV (intravenous) line that's put into a vein. It may also be taken by mouth as a pill, or as an injection. The treatment is most often done as an outpatient visit to a hospital infusion center. You go home the same day. Or it may be done at your healthcare provider’s office, a chemotherapy clinic, or at home. In some cases, you may stay in the hospital during treatment.

If you need to have an IV for each cycle of chemotherapy, it can be helpful to have a vein (venous) access device or an indwelling catheter. A catheter is a thin, flexible tube. The catheter would stay in place between cycles. This is done so that you don't have a new IV started each time you get treatment. One end of the tube is placed into a vein near your heart. The other end is placed just under the skin or comes out through the skin. The medicine can then be connected to it when you have treatment. Your healthcare team will talk with you about the risks and benefits of a venous access device or indwelling catheter.

You get chemotherapy in cycles over a period of time. That means you may take the medicine for a set amount of time and then you have a rest period. Each period of treatment and rest is 1 cycle. You may have several cycles. Having treatment in cycles helps by:

• Killing more cancer cells. The medicine can kill more cancer cells over time, because the cells aren't all dividing at the same time. Cycles allow the medicine to fight more cells.

• Giving your body a rest. Treatment is hard on other cells of the body that divide quickly. This includes cells in the lining of the mouth and stomach. This causes side effects, such as sores and nausea. Between cycles, your body can get a rest from the chemotherapy.

• Giving your mind a rest. Having chemotherapy can be stressful. Taking breaks between cycles can let you get an emotional break between treatments.

What types of medicines are used to treat endometrial cancer?

In most cases, two or more medicines are used together. This is called combination therapy. The medicines most often used to treat endometrial cancer are:

• Doxorubicin hydrochloride or liposomal doxorubicin

• Cisplatin

• Paclitaxel

• Carboplatin

The combinations most often used are:

• Paclitaxel and carboplatin

• Doxorubicin and cisplatin

Which medicines you get and how often you get them depend on many factors. You may also have chemo along with radiation therapy.

If you have advanced endometrial cancer, this means the cancer has spread far from your uterus. In this case, your doctor may suggest you join a clinical trial. New medicines or new combinations of older medicines may help you. Talk with your healthcare team about these options.

What are common side effects of chemotherapy?

Side effects are common with chemotherapy. But it's important to know that they can often be prevented or controlled. The side effects usually go away when the treatment ends. Side effects depend on the type and amount of medicines you’re taking. They vary from person to person.

Some common side effects include:

• Nausea and vomiting

• Mouth sores

• Constipation or diarrhea

• Hair loss

• Hearing loss

• Infections from low white blood cell counts

• Easy bruising or bleeding from low blood platelets

• Tiredness from low red blood cell counts

• Loss of appetite

• Dizziness

• Skin problems, such as dryness, rash, blistering, or darkening skin

• Tingling, numbness, or swelling in hands or feet

• Kidney damage

Most of these side effects will get better between treatment cycles and go away over time after treatment ends. You may also be able to help manage some of these side effects. Tell your healthcare providers about any side effects you have. They can help you cope with the side effects and try to keep them from getting worse.

Working with your healthcare provider

It's important to know which medicines you're taking. Write your medicines down, and ask your healthcare team how they work and what side effects they might have.

You will have blood tests done regularly while you're getting chemotherapy. This is to make sure you aren't having harmful reactions. Make sure you ask which problems mean you should call your healthcare provider or nurse right away. For example, chemotherapy can make you more likely to get infections. Make sure you know what number to call with questions. Is there a different number for evenings and weekends?

Your healthcare provider or nurse may advise you to call them if you have any of these symptoms:

• Fever

• Sore throat

• Shaking chills

• Redness, swelling, and warmth at the site of an injury, injection, or IV catheter

• New cough or shortness of breath

• Nasal congestion

• Burning during urination

It may be helpful to keep a diary of your side effects. Write down physical and emotional changes. A written list will make it easier for you to remember your questions when you go to your appointments. It will also make it easier for you to work with your healthcare team to make a plan to manage any side effects you have.