Cisplatin and radiotherapy in cervical cancer (outpatient chemotherapy)

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Cisplatin and radiotherapy in cervical cancer

This information is a supplement to the verbal instructions from your physician. You will receive radiotherapy together with chemotherapy to increase the effects of the radiotherapy. First you will meet with your medical oncologist, radiation oncologist, nurse practitioner, and radiotherapist. They can tell you more about the treatment, the expected side effects, and what to watch out for.

The treatment: what to expect

The radiation treatment cycle will take five to seven weeks. During these weeks, you will receive radiation treatment on 23 days, excluding Saturdays, Sundays and holidays. Every week you will meet with your medical oncologist or nurse practitioner at the clinic. You will also see your radiation oncologist every week.

Your treatment week begins on Monday or Tuesday morning at around 8 o'clock. You will receive an IV through which we administer fluids. After that, you will receive your dose of chemotherapy through the IV, followed by more fluids. Radiation treatment takes place in the afternoon, usually after the second dose of fluids, and sometimes during. After the radiotherapy and the following rinse, you can go home (this will be around 5 p.m.). On all other weekdays you will receive your radiation as an outpatient. After six doses of chemotherapy, you will receive your last dose on the day prior to internal radiation (brachy).

In the first part of this folder, you can read more about the treatment cycle, the plan for your treatments. The second part contains information about the potential side effects and our recommendations, and in the third part we list contact information in case you have any questions.

The treatment cycle

Treatment plans are always personalized and custom-made. The plan below is common for patients who will have surgery. Some people may only need 5 doses of chemotherapy after surgery. Your medical oncologist will discuss the plan with you.

Internal and external radiation
This flyer does not contain information specifically about the radiotherapy. Your radiation oncologist and radiotherapist can tell you more about this treatment. They will also give you a flyer with more information about the treatment.

Your radiation oncologist will tell you how many times you will need to be irradiated, and whether you will need internal radiation treatment afterwards. They will provide information about the specific side effects of the radiation.

Administration of the chemotherapy

• You will get your chemotherapy treatment at the outpatient clinic (dagbehandeling).
• We will regularly monitor your blood values. Depending on the results, your treatment will be continued or postponed.
• We will insert an IV needle so we can give you the IV fluids and chemotherapy. We will remove the needle after the treatment.

Specific measures

• On the days when you get your dose of cisplatin, and especially on the days after, please make sure you drink plenty of fluids (2 liters a day) to prevent damage to the kidneys.
• If you are unable to drink enough fluids, or if you struggle with vomiting and/or diarrhea and are losing a lot of fluids, please notify your physician. We may need to give you extra fluids trough an IV.
• You cannot take any painkillers from the NSAID group during your treatment. The NSAID group includes ibuprofen, diclofenac, and naproxen. Paracetamol is fine. Always consult your physician about your medication use.
• While using Cisplatin, we recommend that you do not use fish oil supplements or other supplements containing omega 3 for 24 hours before and after your treatment. These products can make the chemotherapy less effective.
• A full nutritional advice can be found on Voedingenkankerinfo.nl(website is in Dutch).

Anti-nausea medication policy during the chemotherapy treatment

Side effects

You will receive more information and recommendations about the most common side effects. These are potential side effects. Which means that they may occur, but may not be an issue for you. Some people experience many side effects while other people do not. Most side effects are temporary. The extent of the side effects says nothing about the result of the treatment. The recommendations are guidelines and not solutions.

• Nausea and vomiting
• Change of taste
• Unpleasant taste during administration
• Effect on the bone marrow
• Irritation and/or inflammation of the oral mucosa and/or esophagus
• Effect on the kidneys
• Hair loss
• Fatigue/low energy
• Skin reactions
• Effect on intimacy
• Menstrual disorders
• Diarrhea*
• Tingling and numbness of fingertips and toes*
• Ringing in the ears and/or hearing loss*
• Constipation
• Allergic reaction after previous cisplatin treatment*

* very rare

Information and advice regarding the side effects

Vomiting and nausea

• Vomiting and nausea are caused by irritation of the oral mucosa.
• The cisplatin can cause late onset nausea (starting 3 days after the treatment).
• Use anti-nausea medication.
• Try to figure out what you can and cannot eat, this is different for everyone.
• Eat small, light meals during the day. An empty stomach can also make you feel nauseous.
• Eat at times when you feel less nauseous, even during the night if you’re awake.
• Don’t force yourself to eat, make up for the damage later.
• Some smells can increase the feelings of nausea.
• Get plenty of fresh air.
• Try to drink 2 liters per day.
• If necessary, ask a dietician for advice.

Nutritional advice from patients

• Let the stomach slowly get used to solid foods.
• Don’t go to bed on an empty stomach, and eat immediately after getting up.
• Warm foods can be difficult. Use alternatives such as salads.
• Drink carbonated drinks like cola of ginger ale.
• Drink coffee or tea with milk.

Change of taste

• Change of taste can lead to decreased appetite.
• There isn’t much you can do, try many different products.
• When you taste less, it is important to make your food look appetizing.

Unpleasant taste during administration

• A metallic taste may develop during administration.
• Sucking on a peppermint candy or lemon drop may help.

Effect on the bone marrow

• Having fewer white blood cells (leukocytes) causes a higher chance of infections.
• Having fewer platelets (thrombocytes) causes a higher risk of bruising, nosebleeds, and bleeding gums.
• Having fewer red blood cells (erythrocytes) can cause anemia.
• The inhibition of the production of blood cells by the bone marrow is temporary.
• In the event of spontaneous bruising or nosebleeds that are difficult to control, please inform your physician.
• If you have a fever of more than 38.5 degrees Celsius, please inform your physician.
• Taking extra vitamins or iron tablets generally has no effect on the recovery of the bone marrow.

Irritation and/or inflammation of the oral mucosa and/or esophagus

• This can cause a very dry mouth or an excessive production of saliva.
• You may suffer from thick and tough mucus in your mouth.
• This can cause wounds in your mouth.
• Good oral hygiene is important in preventing and treating irritation and/or inflammation of the oral mucosa.
• Brush your teeth regularly with a soft toothbrush.
• Rinse your mouth 4 to 6 times a day with salt water (one teaspoon per 250 ml of water).
• Grease your lips regularly, so that chapping is less likely to occur.
• Use lemon drops or chewing gum if you have a dry mouth.
• When you visit the dentist, please let them know that you are being treated with cytostatics.
• Consult your physician if you have a cold sore on your lip. Try and prevent it from spreading.
• Notify your physician if you have a sore mouth with white coating.
• A popsicle can provide relief for a dry or sore mouth.

Influence on the kidneys

• See specific measures.
• Please drink enough fluids.
• Try to drink 2 liters a day.
• Inform you physician if you are unable to drink enough fluids.
• Do not take painkillers from the NSAID group, such as ibuprofen, diclofenac and naproxen.

Hair loss

• Your hair may become thinner.
• Be gentle with you hair.
• Don’t wash your hair with water that is too hot.
• Use a mild shampoo and conditioner.
• Dry your hair carefully.
• We recommend against getting a perm of dyeing your hair.

Fatigue/low energy

• You may notice that you have less energy, tire easily, and have strong emotions during your treatment.
• Adjust your everyday life, take enough time to rest.

Skin reactions

• Such as redness, itchiness, dryness, flakiness, inflammation.
• Wash the irradiated skin carefully, only with water, and pat to dry.
• Avoid abrasive clothing, direct sunlight, and extreme cold.
• Do not shave the irradiated skin and don’t put bandages on the irradiated skin.
• The radiotherapist will tell you how to treat skin reactions.
• Always let us know if these side effects occurs.

Effect on intimacy

• You may experience a lack desire for sexual intercourse as a result of the diagnosis and the side effects.
• Because of the irritation of the mucosa of the vagina, sexual intercourse may cause a burning sensation, or be painful.
• Please use effective contraception over the course of your chemotherapy treatment.

Menstrual disorders

• This can vary from skipping a month to total absence of menstruation.
• This may be accompanied with menopausal symptoms.
• After the treatment, menstruation should go back to normal.

Diarrhea*

• Caused by irritation of the mucosa of the bowel.
• Try to drink 2 liters per day.
• A special diet isn’t necessary.

Tingling and numbness of fingertips and toes*

• Please inform your physician during your next hospital visit.

Ringing in the ears and/or hearing loss*

• Hearing loss starts with the high notes.
• Please inform your physician during your next hospital visit.

Constipation

• Please ask your physician if you have enough bowel movements.
• Please inform your physician if you have not had a bowel movement in two days.
• Ask you physician for laxatives.
• Try to drink 2 liters a day.
• Try to exercise every day, such as taking a walk.

Allergic reaction after previous cisplatin treatment*

• Occurs during the administration or directly after the treatment.
• Symptoms may include itchiness, skin rash, shortness of breath, low blood pressure, hot flashes, or a fever.
• If this occurs, we will discuss with your physician how to continue your treatment.

When to inform your physician
You should contact your physician or the physician on call in case of:

• persistent nausea and/or vomiting despite the use of medication against this.
• spontaneous bruising.
• Regular nosebleeds that are difficult to control.
• A fever higher than 38.5 degrees Celsius.
• Diarrhea that persists over a long time.

Practical information

Contact

Phone number: 020 512 9111.

The phone operators will connect you with the right department.

For urgent matters outside office hours, please ask for the weekend- evening- or night attending. For non-urgent matters, we kindly ask you to wait for the next business day.

Patient Information Center

Would you like more information because you or your loved one is dealing with cancer? Our staff is happy to help. You can call or stop by without an appointment. More information: www.avl.nl/cpi

Center for Quality of Life

Do you need professional support during and after your treatment? You can get an appointment at our center trough your practitioner. More information: www.avl.nl/ckvl

Information on the internet

www.avl.nl

www.avl.nl/mijnavl
www.avl.nl/spreekuren

www.avl.nl/parkeren

www.avl.nl/gasthuis

Visiting address

Antoni van Leeuwenhoek

Plesmanlaan 121

1066 CX Amsterdam

Post address

Antoni van Leeuwenhoek

Postbus 90203

1006 BE Amsterdam

Juni 2025