Surgical Removal of Lung Metastases Improves Survival in Cervical Cancer
According to a recent article published in the Annals of Thoracic Surgery, the surgical removal of cancer that has spread to the lungs improves survival in a subset of patients with cervical cancer.
The cervix is a glandular organ that is located at the bottom of the uterus. Due to intensive screening efforts which include the Pap smear and/or testing for the human papillomavirus (HPV), cervical cancer in the United States is often detected and treated early, resulting in high cure rates. There are different types of cervical cancer, depending upon the type of cell within the cervix that the cancer originated. Squamous cell, adenosquamous cell and adenocarcinoma are examples of 3 different types of cervical cancer. Treatment for early cervical cancer depends upon how far the cancer has spread, but may include surgery to remove the cancer or surrounding tissue, a hysterectomy which involves the removal of the cervix and uterus, or radiation therapy. Some patients may also receive chemotherapy. Metastatic cervical cancer refers to cancer that has spread to distant sites in the body. Patients may be initially diagnosed with metastatic cervical cancer, or patients may experience a cancer recurrence to distant sites in the body following initial therapy.
One site of the body in which the cancer may spread is to the lungs, referred to as pulmonary metastases. Researchers have been evaluating the surgical removal of pulmonary metastases in various types of cancers, resulting in promising long-term outcomes for some patients. Recently, researchers from Japan conducted a clinical trial to evaluate the removal of pulmonary metastases in patients with cervical cancer. This trial included 29 patients who had been diagnosed with early cervical cancer (stages IB or II) and had undergone a hysterectomy or radiation therapy as initial treatment. Pulmonary metastases in these patients were detected after a disease-free period following initial therapy. All patients underwent the surgical removal of their pulmonary metastases. Overall, the cancer-free survival rate at 5 years after the surgical removal of pulmonary metastases was nearly 33%. Patients who had squamous cell cancer had a 5-year cancer-free survival of 47.4% following the surgical removal of pulmonary metastases, compared to 0% for patients with either adenosquamous cancer and adenocarcinoma. In addition, patients with 2 or fewer pulmonary metastases had a 5-year cancer-free survival of 42.2% following surgery, compared to 0% for those with 3 or more.
The researchers concluded that patients with squamous cell cervical cancer with 2 or fewer pulmonary metastases may achieve sustained long-term cancer-free survival with the surgical removal of their metastases. Patients with metastatic cervical cancer with pulmonary metastases may wish to speak with their physician about the risks and benefits of the surgical removal of their metastases or the participation in a clinical trial evaluating other novel therapeutic options. Sources of information regarding ongoing clinical trials include the National Cancer Institute.
Reference: Yamamoto K, Yoshikawa H, Shiromizu K, et al. Pulmonary metastasectomy for uterine cervical cancer: a multivariate analysis. Annals of Thoracic Surgery. 2004;77:1179-1182.