Recurrent Cervical Cancer

Overview

When cervical cancer has been detected or has returned following initial treatment with surgery, radiation therapy and/or chemotherapy, it is said to be recurrent or relapsed. The course of treatment for relapsed cervical cancer depends on what treatment a patient has previously received and where the recurrence is located. Some patients who have recurrence of cervical cancer within the pelvis can be treated with additional surgery or with radiation therapy, if no radiation therapy was given previously. Recurrence of cervical cancer outside the pelvis is difficult to treat.

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The following is a general overview of the diagnosis and treatment of recurrent cervical cancer. Recent advances in treatment have resulted in new treatment options that reduce symptoms and improve survival. Each person with stage III cervical cancer is different, and the specific characteristics of your condition will determine how it is managed. The information on this Web site is intended to help educate you about treatment options and to facilitate a shared decision-making process with your treating physician.

Treatment depends on many factors, including what treatment the patient had before, the location of the recurrence and the overall condition of the patient. If the patient had surgery to remove the cervix and the cancer comes back only in a small area near the operation, radiation therapy may be administered. If the patient already received radiation therapy to the pelvis, radiation therapy cannot be administered again to the same part of the body. Some patients with recurrent cervical cancer in the pelvis can undergo an extensive surgical procedure that removes the cancer and many pelvic organs. Other patients have recurrent cervical cancer outside the pelvis and may receive chemotherapy or radiation therapy to alleviate symptoms.

Recurrent Cervical Cancer After Surgery

A radical hysterectomy is a very effective therapy if the cancer has not spread beyond the cervix. At times, a small area of cancer has spread beyond the cervix and cancer cells may be present at the edge of the surgical specimen. Usually, this can be determined only after the surgery when the specimen is examined under the microscope. Other times, the region of the operation may be contaminated with microscopic cancer cells. The presence of microscopic areas of cancer cells can cause the cancer to return some time after the surgery. This situation occurs more frequently in patients with large stage IB or stage II cervical cancer.

Patients with a small amount of cancer recurrence in the area of previous surgery can be treated in an attempt to rid the cancer again. If the patient has not received radiation therapy to the pelvis, external beam radiation therapy to the area of the recurrence can kill cancer cells after the surgery. Patients who have received prior radiation therapy may be able to undergo a pelvic exenteration, which is an extensive surgical procedure that removes the cancer and many pelvic organs. A pelvic exenteration is only performed if cancer cannot be detected elsewhere in the body and all of the cancer can be removed by the surgery. Approximately one-third of patients with recurrent cancer will survive free of cancer after treatment with radiation therapy or pelvic exenteration.

Other patients already have small amounts of cancer that have spread outside the pelvis and were not removed by surgery. These cancer cells cannot be detected with any of the currently available tests. Undetectable areas of cancer outside the pelvis are referred to as micrometastases. The presence of microscopic areas of cancer cells can cause the cancer to return outside the pelvis some time after the surgery. Please see the section below for more information.

Recurrent Cervical Cancer After Radiation Therapy

Depending on the features of the cervical cancer, some patients will experience a recurrence of the cervical cancer after radiation therapy. In these patients, cancer cells may have survived despite the radiation therapy. Other patients already have small amounts of cancer that have spread outside the pelvis and were not treated by the radiation. These cancer cells cannot be detected with any of the currently available tests. Undetectable areas of cancer outside the pelvis are referred to as micrometastases. The presence of these microscopic areas of cancer or surviving cancer cells can cause the relapses that follow treatment with radiation therapy.

Once a patient has received radiation therapy to the pelvis, more radiation therapy cannot safely be administered to the same area. Patients who have received prior radiation therapy may be able to undergo a pelvic exenteration, which is an extensive surgical procedure that removes the cancer and many pelvic organs. A pelvic exenteration is only performed if cancer cannot be detected elsewhere in the body and all of the cancer can be removed by the surgery. Approximately one-third of patients with recurrent cancer will survive free of cancer after treatment with radiation therapy or pelvic exenteration.

Recurrent Cervical Cancer Outside the Pelvis

Cervical cancer that has spread to distant organs and bones is difficult to treat. Historically, patients with metastatic cervical cancer have been considered incurable. Some patients are offered treatment with chemotherapy for the purpose of prolonging their duration of survival and alleviating symptoms from progressive cancer. Other patients are managed with efforts to reduce pain or bleeding, including local radiation therapy to affected parts of the body.

There is no good single chemotherapy approach that can improve the length of survival in patients with metastatic cervical cancer. Treatment with Platinol® can produce shrinkage in 15-25% of patients with metastatic cervical cancer. Many clinical trials have combined Platinol® with other chemotherapy drugs in hopes of improving cancer shrinkage and survival. Although these combination regimens can have more side effects, length of survival has not been improved over Platinol® alone. Unfortunately, these chemotherapies typically work for only a few months before the cervical cancer begins to grow again. Most patients ultimately succumb to cancer and better treatment strategies are clearly needed.

Strategies to Improve Treatment

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