Although uncommon at initial diagnosis, metastatic disease will develop in 15 to 61 percent women with cervical cancer, usually within the first two years of completing treatment [1,2]. In the majority of cases, metastatic cervical cancer is not curable. However, for some patients who present with recurrent disease in the pelvis (locoregional recurrence) or with limited distant metastatic disease, surgical treatment is potentially curative.
Histologically, squamous cell carcinoma (SCC), adenocarcinoma, and adenosquamous carcinomas account for approximately 70, 25, and 3 to 5 percent of all cervical cancers, respectively (table 1) . Rarer histologies include neuroendocrine or small cell carcinomas.
The management of recurrent or metastatic cervical cancer will be discussed here. Specific issues regarding patterns of relapse after treatment are discussed separately. (See "Invasive cervical cancer: Patterns of recurrence and posttreatment surveillance".)
Recurrent cervical cancer can present as a local recurrence or as metastatic disease.
Locally recurrent cervical cancer usually presents with vaginal symptoms (ie, discharge, bleeding, dyspareunia, or pain). On pelvic exam, a mass or nodularity at the vaginal cuff, which may extend to the side wall, may be visualized or palpated. Disease within the vaginal pelvis (or vaginal vault) can be tender to palpation and/or prone to bleeding easily.