Chemotherapy Can Play A Vital Role In Treating Advanced and Aggressive Endometrial Cancers

Chemotherapy can be a key part of a successful treatment plan, especially when combined with other treatments like surgery and radiation, helping to improve survival and quality of life.

“Chemotherapy is the backbone of treatment after surgery if treatment is needed in that setting,” Dr. Jennifer Mueller, a gynecologic surgeon at Memorial Sloan Kettering Cancer in New York, tells SurivorNet.

What is Chemotherapy?

Chemotherapy is a form of cancer treatment that uses drugs to kill cancer cells or slow their growth.

It works against endometrial cancer by targeting rapidly dividing cancer cells, disrupting their ability to grow and multiply. The goal is to shrink tumors and slow cancer spread.

The drugs used in chemotherapy are usually given orally (in pill form)  or intravenously (injected into a vein), allowing them to reach cancer cells throughout the body.

The specific drugs and treatment strategy depend on a variety of factors including the cancer’s stage, type, and the patient’s overall health. And, while it’s effective in attacking cancer cells, chemotherapy can also affect fast-growing healthy cells, leading to side effects.

Overall, chemotherapy is one of the most tried and true forms of cancer treatment doctors have at their disposal. Yet it is still constantly evolving, with ongoing research aimed at making it even more effective with fewer side effects.

When is Chemo Used in Endometrial Cancer?

Chemotherapy works by targeting rapidly dividing cancer cells. Doctors may use it to treat your disease for a variety of reasons, including the following:

Adjuvant Chemotherapy

This means chemo is given after the first or primary treatment (usually surgery), doctors may schedule chemotherapy to destroy any leftover cancer cells and lower the chance of the cancer coming back. This extra step helps ensure the cancer is fully addressed.

Dr. Mueller explains that making the decision to give a patient chemotherapy after surgery will depend on the pathology report.

“So you’ve had your surgery and the biggest question people have truly from the minute they’re diagnosed with endometrial cancer is am I going to be okay? Can you get the cancer out and then do I need any additional treatment? This is a time after surgery where when we get a report back the pathology we can talk about what stage cancer you have. And then when you meet with your surgeon and you go through the pathology report that gives us a lot of information that helps us to decide if you need additional treatment,”​ she says.

Doctors usually reserve adjuvant chemotherapy for high-risk endometrial cancers, including:

• Serous adenocarcinoma, a fast growing cancer that can appear at any stage
• Clear cell adenocarcinoma, a rare cancer where cells look empty or “clear” under the microscope
• Grade 3 deeply invasive endometrioid carcinoma, a specific type of cancer that has grown deeper into the uterus
• Later stage cancers that have spread to other parts of the body

Neoadjuvant Chemotherapy

This is therapy that is given before your main treatment if your cancer is somewhat advanced but still contained within the uterus. Sometimes, doctors give chemotherapy before the surgery to make the tumor smaller and easier to take out. They may also use it to see how the rest of treatment is working. This approach can make the surgery simpler and more effective.

Palliative Chemotherapy

This care focuses on relieving symptoms and improving quality of life, rather than curing the disease itself. For advanced stages of endometrial cancer, chemotherapy can provide some relief even if a cure is not possible. In earlier stage cancer it may help improve symptoms and quality of life.

Which Chemo Drugs are Used for Endometrial Cancer?

Your doctor will tailor the amount, frequency, and timing of your chemotherapy to the specific stage of your cancer and your ability to handle side effects.

The go-to chemo medicine for endometrial cancer typically includes a platinum-based agent.

“We use a double medication regimen called carboplatin and paclitaxel that’s given in the vein and that is given every three weeks,” notes Dr. Mueller. “You have three weeks of time between the first day of your cycle to the first day of your next cycle, but that’s the period of time where the medicine is working.”

Dr. Mueller explains that a cycle of chemotherapy typically involves a day of receiving your medication through a vein as the care team closely monitors you for safety and hydration. This is followed by a three-week break before the next cycle.

This regimen allows the medicine to work and the body to recover.

She advises patients to plan for a full day of treatment, suggesting they bring someone for support or activities to pass the time. Dr. Mueller emphasizes both the intensive nature of treatment days and the importance of the breaks between cycles for patient recovery and well-being.

Chemotherapy drugs work by damaging the DNA of cancer cells, which stops them from dividing and growing.

Along with a platinum-based drug, doctors often prescribe a taxane, another type of chemotherapy drug. The most commonly used taxane in the U.S. is paclitaxel, also known by its brand name, Taxol.

The combination of a platinum drug and a taxane is so effective it’s become the standard treatment for endometrial cancer.

This regimen is often referred to as “carbo-tax,” with “carbo” standing for carboplatin (or another platinum-based drug) and “tax” representing the taxane drug, like paclitaxel.

While this combo is a common approach, the specific doses and schedule of treatments are customized for each patient based on their unique needs and how well they respond to therapy.

Coping With Side Effects

Because chemo impacts some healthy cells along with the cancerous cells, it often can have side effects. These vary depending on the drugs used and the individual’s response.

Neuropathy

Chemotherapy-induced neuropathy is caused by damage to the peripheral nerves, the nerves that connect the brain and spinal cord to the rest of the body.

Chemo drugs damage the nerve cells’ structure or function, interrupting their ability to send signals properly. The result is symptoms like pain, tingling, or numbness, especially in the hands and feet.

This side effect occurs because some chemotherapy agents can’t distinguish between healthy cells and cancer cells. The likelihood and severity of neuropathy depend on the type of chemotherapy drug used, the dosage, and the treatment duration.

Dr. Mueller says your doctor will likely ask every cycle how your hands and feet are doing and whether or not you have any tingling or numbness.

“That’s because the medicines you’re getting, the carboplatin paclitaxel, particularly the paclitaxel, is associated with neuropathy and it may not be completely reversed after the chemo is completed,” she says. “So if it accumulates over time and becomes more severe your doctor may adjust your dose of paclitaxel or completely stop the paclitaxel.”

She adds: “And that’s because you do want to have the ability to use your hands and feet with sensation. That’s how you get through your day. You button your buttons, you zip your zipper, you tie your shoes or you walk around and feel your feet on the ground. So you can imagine how important it is for us to keep our sensation in our hands and feet. It’s a really important one to keep your doctor notified about.”

Your doctor may suggest several approaches to dealing with neuropathy, including:

• Medications: Doctors prescribe drugs like antidepressants, anticonvulsants, and pain relievers to ease pain and discomfort. For example, duloxetine (Cymbalta) can help manage neuropathic pain by affecting chemicals in the brain that send pain signals, while gabapentin (Neurontin) reduces nerve pain by stabilizing electrical activity in the nerves.
• Dose Adjustment: Adjusting the chemotherapy dose or changing the treatment schedule can minimize nerve damage. This delicate balance aims to maintain the effectiveness of cancer treatment while reducing the risk of neuropathy.
• Physical Therapy: Physical therapists recommend specific exercises to strengthen muscles and reduce pain. These exercises can also improve balance, decreasing the risk of falls due to numbness or weakness.
• Supplements: Healthcare providers may suggest supplements like Vitamin B12, Folic Acid, and Alpha-lipoic Acid to support nerve health. Vitamin B12 and Folic Acid are crucial for nerve repair and maintenance, and Alpha-lipoic Acid, an antioxidant, has been shown to improve nerve function in some patients.
• Lifestyle Changes: Simple adjustments, such as wearing protective gloves and footwear, can prevent injuries due to decreased sensation. These changes help safeguard against burns, cuts, and other injuries that might go unnoticed because they are masked by neuropathy.

Hair Loss

Hair loss is one of the more distressing side effects of chemotherapy — but unfortunately, many chemotherapies do cause hair loss or thinning because they target all rapidly dividing cells, not just cancer cells. Hair follicles, which produce hair, are among the fastest-growing cells in the body.

Not all chemotherapies cause hair loss, but many do. Hair loss typically begins just after the end of the first cycle for chemotherapy for endometrial cancer — and will continue throughout treatment.

“Another common concern people have is whether they’re going to lose their hair with chemotherapy. And I try to be really direct about that because I don’t think that we’re doing anyone any favors to gloss over that part. So with carboplatin paclitaxel, you will lose your hair over time,” Dr, Mueller says.

If hair loss is a concern, talk to your doctor about a couple of new treatments that can help prevent or at least slow it down:

• Scalp cooling caps: These caps lower the temperature of the scalp during chemotherapy sessions, reducing blood flow to hair follicles and limiting the amount of chemotherapy drugs that reach them. In general, they’ve proven to be quite effective for halting hair loss, but individual responses vary. Their use is growing as awareness increases and evidence supporting their effectiveness accumulates.

“That’s basically where you have this extremely cold helmet that you can put on your head during your infusion and what it does is it chills the hair scalp so much that the chemotherapy doesn’t get there,” Dr. Mueller explains. “So you have to wear it the entire time you’re getting your infusion with every single cycle and you still could lose some hair so that your hair is thinned. But for the most part, people have an overall positive experience from hair loss if they’re using the cold cap.”

• The drug Minoxidil: This is a medication best known for preventing men from going bald. Doctors sometimes recommend people going through chemo apply it to the scalp before and during chemotherapy to promote hair retention and speed up regrowth after treatment. Its effectiveness can vary.

“If you don’t use the cold cap, over time usually by cycle two or cycle three, you will start to lose your hair. It won’t be an all or none where you just wake up and all your hair is gone but your hair will start to thin,” Dr. Mueller says.

Mueller says that some people preemptively shave their heads. Others get fitted for a wig, while others opt to wear hats or scarves.

Some families will shave their heads in solidarity with the patient.

“There’s a lot of stories out there of how we can support each other through a side effect like that. And I spend a lot of time on this because our hair is such a part of how people see us and can signal that you’re going through something like chemotherapy and you may feel very private about that and you may not want others to know,”​ she says.

Take comfort in the fact that chemo-related hair loss is temporary.  Most people can expect regrowth around four to six weeks after they complete treatment. Patients often report changes to hair color and texture when it begins growing back.

Feeling Tired

It’s no secret that chemotherapy can be taxing, leading to unusual fatigue or tiredness. While fatigue usually only lasts for seven to 10 days after treatment, for some women the experience can be debilitating.

Patients will need to gauge themselves, learn their limits, and not overdo it.

“Everybody talks about a couple of low days in a cycle and it’s different for everyone, but it’s usually in the first week and I encourage people to lean in,” she says. “If you need a nap, take a nap but try to move every single day, get fresh air, be around people that care about you and support you. And if your appetite starts to drop because you have nausea or fatigue, even small bites of food throughout the day can be very helpful for keeping nutrition and above all hydration is very important.”

As for medications that specifically help fatigue from chemotherapy, doctors primarily focus on managing the underlying causes:

• Anemia: If fatigue is due to anemia (a loss of red blood cells that is a common side effect of chemotherapy), treatments might include iron supplements or erythropoiesis-stimulating agents (ESAs) to stimulate red blood cell production.
• Stimulants: In some cases, doctors may prescribe stimulants such as modafinil, traditionally used for sleep disorders, to help improve alertness and reduce fatigue.
• Steroids: Occasionally, short-term use of steroids can help boost energy levels.

Nausea

While chemotherapy is not as harsh as days gone by, Dr. Mueller says that may patients still experience some degree of nausea and upset stomach. She advises that the best way to manage chemotherapy side effects is to prepare for them.

For nausea, medications like Zofran may be effective treatment

“We have many, many, many medications that we give before, during, and after chemotherapy that should minimize the nausea that patients experience,” Dr. Mueller says.

Questions to Ask Your Doctor

• How does chemotherapy fit into my overall treatment plan?
• What are the potential side effects of the chemotherapy drugs you’re recommending?
• How will we manage the side effects?
• Are there any alternative or complementary treatments I should consider (or avoid) alongside chemotherapy?
• What support services or resources are available to help me cope with the emotional and psychological challenges?

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