Cervical Cancer - Treatment for Cervical Cancer

Stage IV and Treatments

In stage IV invasive cancer with tumor spread beyond the pelvis or to the mucosal lining of the bladder or rectum. Five-year survival rates are less than 20%.

Stage IV. In stage IVA the cancer involves the inner lining of the bladder or rectum. Treatment Options: Radiation therapy with concurrent cisplatin-based chemotherapy.

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Stage IVB. In stage IVB, the cancer has metastasized beyond the pelvis. Treatment Options: Platinum-based chemotherapy yields short-lived response in 20% of patients. Clinical trial participation is reasonable.

Recurrent or Persistent Cancer and Treatments

Cervical cancer may recur locally in the lymph nodes near the cervix, or it may metastasize to distant sites, such as the lung or bones, or it may appear both locally and in distant locations.

Treatment Options: Pelvic exenteration if cancer has spread to only local areas. (This involves removal of the cervix, uterus, vagina, and perhaps bladder, lower colon, or rectum. It is an aggressive surgical approach that may lead to cure in a small percentage of patients with recurrent cervical cancer.) Radiotherapy is another option if it is technically possible, generally if patients did not have it previously. If cancer has metastasized, platinum-based chemotherapy is reasonable. Other agents may be useful under certain circumstances.

Treatment of Pregnant Women with Cervical Cancer

Only 1% of cervical cancers occur during pregnancy or shortly afterwards. To diagnose the condition, a cervical biopsy, in which a small amount of tissue is removed for diagnosis, can be performed anytime during the pregnancy. However, a cone biopsy, which removes larger amounts of tissue, is typically delayed until after the first trimester to reduce the risk of abortion. The options may be as follows:

If the abnormality is diagnosed as dysplasia or even carcinoma in situ, treatment is sometimes delayed until a few weeks after the mother gives birth, and vaginal delivery may still be possible. The risks and benefits of this approach, however, should be discussed with the doctor.
If early-stage cancer is diagnosed in the late second or third trimester, a woman may sometimes be able to delay treatment until the baby is delivered. A Cesarean section is the preferred delivery method. The cancer treatment of choice is started shortly afterward.
More locally advanced invasive cancer is nearly always treated, particularly if is diagnosed within the first 20 weeks of the pregnancy.