Stage IV Cervical Cancer

Overview
Cervical cancer diagnosed as stage IV disease is commonly detected from an abnormal pelvic
examination or symptoms produced by the patients cancer. Following a staging evaluation of
cervical cancer, a stage IV cancer is said to exist if the cancer has extended beyond the cervix
into adjacent organs, such as the rectum or bladder (stage IVA), or the cancer has spread to
distant locations in the body which may include the bones, lungs or liver (stage IVB). Cervical
cancer diagnosed in this stage is often difficult to treat, and a small minority of patients are cured
of disease.
A variety of factors ultimately influence a patients decision to receive treatment of cancer. The
purpose of receiving cancer treatment may be to improve symptoms through local control of the
cancer, increase a patients chance of cure, or prolong a patients survival. The potential benefits
of receiving cancer treatment must be carefully balanced with the potential risks of receiving
cancer treatment.
The following is a general overview of the treatment of stage IV cervical cancer. Circumstances
unique to your situation and prognostic factors of your cancer may ultimately influence how
these general treatment principles are applied to your situation. The information on this Web site
is intended to help educate you about your treatment options and to facilitate a mutual or shared
decision-making process with your treating cancer physician.
Most new treatments are developed in clinical trials. Clinical trials are studies that evaluate the
effectiveness of new drugs or treatment strategies. The development of more effective cancer
treatments requires that new and innovative therapies be evaluated with cancer patients.
Participation in a clinical trial may offer access to better treatments and advance the existing
knowledge about treatment of this cancer. Clinical trials are available for most stages of cancer.
Patients who are interested in participating in a clinical trial should discuss the risks and benefits
of clinical trials with their physician. To ensure that you are receiving the optimal treatment of
your cancer, it is important to stay informed by following the cancer news in order to learn about
new treatments and the results of clinical trials.
Patients diagnosed with stage IV cervical cancer can be broadly divided into two groups. Patients
with disease that is locally confined, but involves adjacent organs in the pelvis, such as the
rectum and bladder, have localized stage IVA cervical cancer. Other patients have disease that
has spread to distant organs, most commonly the bones, lungs or liver, and have metastatic stage
IVB cervical cancer. Management of patients with metastatic stage IVB disease is aimed at
control of symptoms and pain. After undergoing treatment for cervical cancer, your doctor will
continue to follow you to check to see that the cancer has not returned or is not progressing.
Treatment of Localized Stage IVA Cervical Cancer
Stage IVA cervical cancer is currently best managed by a combination of radiation therapy and
chemotherapy. Radiation therapy is treatment with high energy x-rays that have the ability to kill
cancer cells. Radiation therapy can be administered by a machine that aims x-rays at the body
(external beam radiation) or by placing small capsules of radioactive material directly near the
cervix (internal or implant radiation). Most patients will receive both kinds of radiation therapy
during their course of treatment. External beam radiation therapy for cervical cancer is
administered on an outpatient basis for approximately 4 to 6 weeks.
During or immediately following the external beam portion of radiation therapy, patients may
also undergo an implant radiation procedure. Placing the radiation within the cervix allows a
high dose of radiation to be delivered to the cancer while reducing the radiation to the
surrounding normal tissues and organs. During a procedure in the operating room, a small device
is placed into the cervix and vagina and later is loaded with radioactive material. The
radioactive material is left in place while the patient stays in the hospital for 1-3 days. This
process may be performed once or twice during the course of treatment.
Prior to the 1990s, the standard treatment of locally advanced cervical cancer had utilized
external beam and internal radiation therapy and no significant progress in the treatment of
cervical cancer occurred for many years. More recently, however, the addition of chemotherapy
(anti-cancer drugs) has improved long-term outcomes in patients with this disease.
Chemotherapy, such as Platinol, 5-fluorouracil and other drugs, has the ability to kill cancer
cells and make radiation therapy more effective at killing cancer cells. The strategy of
administering chemotherapy concurrently with radiation treatment is appealing because
chemotherapy and radiation therapy may act together to increase the killing of cancer cells.
Chemotherapy may also destroy cells independently of radiation therapy. Several clinical studies
performed in patients with locally advanced cervical cancer utilizing concurrent chemotherapy
and radiation therapy have suggested that this strategy may improve remission rates and prolong
survival. In order to definitively determine whether radiation therapy administered with
concurrent chemotherapy is superior to radiation therapy alone, several clinical studies were
designed to directly compare the two treatments in patients with locally advanced cervical
cancer.
One recent pivotal clinical trial conducted by various oncology groups in the United States has
shown that radiation therapy combined with chemotherapy for locally advanced cervical cancer
is superior to treatment with radiation therapy alone. In this study, 403 patients were treated with
radiation therapy alone or radiation therapy plus concomitant 5-fluorouracil and Platinol
chemotherapy. Patients with stage III or IVA cervical cancer experienced a 5-year survival rate
of 63% compared to 57% for patients treated with radiation therapy alone. The chance of cancer
recurrence was 42% for patients treated with chemotherapy and radiation therapy compared to
62% for those treated with radiation therapy alone. Concurrent chemotherapy and radiation
therapy were well tolerated except for minor gastrointestinal and hematologic side effects, which
were reversible.
In summary, the combination Platinol chemotherapy administered concurrently with radiation
produces superior overall survival and a decreased risk of cancer recurrence compared to
treatment with radiation therapy alone. Continued research is ongoing to determine whether
additional chemotherapy drugs or doses of radiation may improve the outcome of patients with
locally advanced cervical cancer. At least four other clinical studies have confirmed that
treatment of locally advanced cervical cancer with concurrent Platinol-based chemotherapy
and radiation therapy is superior to radiation therapy alone.
Even with combination chemotherapy and radiation treatment, approximately 20-40% of patients
with stage IV cervical cancer experience recurrence of their cancer. In some patients, cancer cells
may have survived near the cancer despite the radiation therapy. Other patients with stage IV
disease already have small amounts of cancer that have spread outside the cervix and were not
treated by the chemotherapy. These cancer cells cannot be detected with any of the currently
available tests. Undetectable areas of cancer outside the cervix gland are referred to as
micrometastases. The presence of these microscopic areas of cancer or surviving cancer cells can
cause the relapses that follow treatment.
Treatment of Metastatic Stage IVB Cervical Cancer
Cervical cancer that has spread to distant organs and bones is difficult to treat. Historically,
patients with metastatic cervical cancer have been considered incurable and rarely survive more
than a year or two. 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 still succumb to cancer and better
treatment strategies are clearly needed.
Strategies to Improve Treatment
The progress that has been made in the treatment of cervical cancer has resulted from
development of better treatments in patients with more advanced stages of cancer and
participation in clinical trials. While some progress has been made in the treatment of metastatic
cervical cancer, the majority of patients still succumb to cancer and better treatment strategies
are clearly needed. Future progress in the treatment of cervical cancer will result from continued
participation in appropriate clinical trials. Currently, there are several areas of active exploration
aimed at improving the treatment of cervical cancer.
Supportive Care: Supportive care refers to treatments designed to prevent and control the side
effects of cancer and its treatment. Side effects not only cause patients discomfort, but also may
prevent the optimal delivery of therapy at its planned dose and schedule. In order to achieve
optimal outcomes from treatment and improve quality of life, it is imperative that side effects
resulting from cancer and its treatment are appropriately managed. For more information, go to
Supportive Care.
New Chemotherapy Regimens: Several newer chemotherapeutic drugs have demonstrated
ability to kill cervical cancer cells in patients with advanced cancer. One area of active
investigation is the development and exploration of single or multi-agent chemotherapy regimens
as a treatment approach for patients with widespread cervical cancer. In particular, drugs such as
paclitaxel, ifosfamide, Taxotere, Navelbine and Camptosar appear to have promising
activity against cervical cancer cells and are being tested alone or in combination with radiation
and other anticancer agents in clinical trials.
Newer Radiation Techniques: External beam radiation therapy can be delivered more precisely
to the cervix by using a special CT scan and targeting computer. This capability is known as
three-dimensional conformal radiation therapy, or 3D-CRT. The use of 3D-CRT appears to
reduce the chance of injury to nearby body structures, such as the bladder or rectum.
Biological Therapy: Biologic therapies are naturally occurring or synthesized substances that
direct, facilitate or enhance the bodys normal immune defenses. The goal of biologic therapy is
to have the patients own immune defenses attack and destroy the cancer cells. Biologic
therapies include interferons, interleukins, monoclonal antibodies and vaccines. In an attempt to
improve survival rates, these and other agents are being tested alone or in combination with
chemotherapy in clinical trials.
Phase I Trials: New chemotherapy drugs continue to be developed and evaluated in patients
with recurrent cancers in phase I clinical trials. The purpose of phase I trials is to evaluate new
drugs in order to determine the safety and tolerability of a drug and the best way of administering
the drug to patients.
Cervical cancer has a shocking record of number of deaths it has to its credit. Every year millions
of women fall prey to this life-threatening disease and also 1/3rd of them, die before even 5 years
from the time of the diagnosis of cervical cancer.
Cervical cancer support is a concept run by many volunteering organizations who intend to
extend a helping hand to show moral and financial support to the people suffering this disease.
There are several support groups who help the patients in many ways.
The support activities may also include psychological therapy and arranging get together with
other cervical cancer patients to meet them and share information as well as extend mutual
support. Also, the support activities are important for the family members as it is difficult for
them to adjust with their loved one's cancer.
There are different aspects to support the patients suffering from the disease and also their family
members. The support activities may include volunteering activities, raising funds for supporting
the research activities for cervical cancer.
Cervical Cancer Supporting Services:
There are various supporting activities carried out by the support groups for the cancer. Some of
these services will be for the patients as well as the family members to help them cope with the
disease.
These support group organizations welcome people suffering from the cancer as well as those,
who were able to cope with it or the ones who are experiencing cervical cancer recurrence.
Several open forum discussions may be conducted at the organizations to impart individual
experiences as well as discuss the prognosis of the condition, what and how much to expect.
Some of the support services may be as follows:
Informative Sessions for the Partners of Women Diagnosed with Cervical Cancer
It is usually certain that partners of the women suffering from cervical cancer are
supposed to undergo extensive stress while trying to seek answers to various questions.
Every individual has his/her own capability of coping with a difficulty. The informative
sessions will help the partners to seek information about the disease, and what are the
outlooks of a treatment. Sessions may also give them a forum to express how they feel
and empower them to extend support to their partners during this difficult phase.
Living With Cancer
This type of support services, aim at providing supportive hand to the women suffering
from cervical cancer. Although, a patient may be suffering from cancer, but need to know
various different things related to cancer such as practical advice as to how to go ahead
with a treatment or diagnostic examinations and what to expect out of it.
Women may need emotional and psychological counseling to manage the state of mind
that struggles to cope with the condition. Many support organizations conduct
informative and advice sessions on themes such as living with cancer. The sessions may
be helpful and open for the friends and families of the patients.
Diet and Cancer
This is amongst the basic curiosity a patient has after being diagnosed of cancer.
However, suffering from cancer does not mean that a person has to give up all the food
items he/she loves. Support services also include counseling sessions from dieticians to
inform the patient and their families about the diet during the treatment and in general.
It is important that a patient has a balanced diet and keep the body fit so that the treatment
responds well and positively to it. A healthy diet helps the patients to stay healthy and
have adequate energy to bear the adverse effects of the treatment.
Spiritual Support
A lot of things work well with a positive thought, and especially for people who have
strong spiritual belief and faith, there are spiritual support activities conducted by the
support organizations. This is one of the fundamental requirements for such people to
keep their hopes and optimism high.
A cervical cancer diagnosis may be responsible to shake the faith and belief in such
people and then it becomes difficult for people to carry on their lives with cancer. To help
cope with this difficulty boosting the belief and spiritual faith is vital.
There are staff chaplains in some of the support groups. However, if the patient needs, a
local clergy may be called upon. The spiritual activities may include group prayers,
counseling by chaplain or pastor, communion services, and baptisms.
Financial Support
There are certain support organizations that work for fund raising activities to help the
patients be financially capable to meet their treatment needs. Low-income group, people
not covered under Medicare and Medicaid are the target audience of such activities. The
income may be yielded through the sale of cervix cancer awareness products such as
cancer bracelets, t-shirts, other accessories and the proceedings are sent to the needy, to
meet his/her financial needs to treat the cancer.
The proceedings may also be contributed to cancer research to offer cervical cancer
breakthrough treatments and medicines.
Cervical cancer support is an activity to help the people suffering from the disease and their
friends and families to cope with the condition. There are various cancer support groups that
work to provide different services to the patients such as counseling about diet, treatments,
prognosis, spiritual services and financial help.
There are two main categories of support groups: local support groups and online support
groups. Usually hospitals, church, religious institutions work in conjunction with the support
groups to impart respective specialized services.
Patients and families may also seek psychological support and answers to many medical
questions through internet and get information about different forums. Such services are
beneficial for people suffering from severe pain or adverse effects due to the treatment and
hence, cannot go out to attend the services or sessions.