Chemotherapy uses drugs to kill cancer cells by either inhibiting cell growth or division. It may be used after surgery to treat cancers with an increased risk of returning after treatment, including ovarian, uterine or cervical cancer. The manner in which the chemotherapy is administered varies based on disease site, and in some instances it is combined with radiation therapy. Traditionally, the drugs used are given by vein (intravenously) in a dedicated infusion center under the care of a highly trained nursing staff. The chemotherapy is given in cycles, with treatment periods and rest periods. The side effects associated with treatment vary significantly, and are dependent on the type of chemotherapy drug being given and the duration of therapy. Commonly experienced side effects include: temporary hair loss, fatigue, nausea and suppression of the bone marrow and blood cells
For patients with Stage III ovarian cancer, chemotherapy agents can be administered directly into the abdominal (or peritoneal) cavity – intra-peritoneal chemotherapy – in addition to intravenous administration. Scientific studies show that for appropriately selected patients, intra-peritoneal chemotherapy can substantially improve the chances of long-term survival.
Some types of gynecologic cancer need hormones to grow. These tumors have hormone receptors for the hormones estrogen, progesterone, or both. If lab tests show that the tumor has these receptors, then hormone therapy may be an option. Hormone therapy has been used in certain types of uterine and ovarian cancer. In addition, select women with early stage uterine cancer who wish to preserve their fertility may be candidates for hormonal therapy if they meet specific criteria. The most common drug used for hormone therapy is progesterone tablets. Possible side effects include weight gain, swelling, and breast tenderness.
For a minority of patients, the initial surgical effort at removal of all cancer (cytoreduction) may not be appropriate either because their medical condition does not permit the surgery to be performed safely or because the location of the disease does not readily lend itself to surgical removal. In these instances, treatment starts with chemotherapy (usually three to four treatments or cycles) to allow the patient's medical condition to improve or to reduce the extent of disease. Cytoreductive surgery is then performed three to four months after starting chemotherapy and is usually followed by another three to four months of chemotherapy.
New Treatment Approaches
Recently, researchers have focused on the use of angiogenesis inhibitors in the treatment of certain cancers (ovarian and uterine cancer). These drugs block the growth of new blood vessels and interfere with the proteins and enzymes that ovarian cancer needs to grow. Bevacizumab (Avastin) is the most widely studied angiogenesis inhibitor for ovarian cancer and appears to enhance the effectiveness of standard chemotherapy with carboplatin and paclitaxel. Researchers are also studying the effectiveness of hyperthermic intra-peritoneal chemotherapy. In this treatment approach, the peritoneal cavity is bathed directly with heated chemotherapy drugs immediately after cytoreductive surgery.