Management of recurrent or metastatic cervical cancer
- Jason D Wright, MD
Jason D Wright, MD
- Sol Goldman Associate Professor of Obstetrics and Gynecology
- Chief, Division of Gynecologic Oncology
- Columbia University College of Physicians and Surgeons
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 pelvic side wall, may be visualized or palpated. Disease within the vagina (or vaginal vault) can be tender to palpation and/or prone to bleeding easily.
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- CLINICAL PRESENTATION
- DIAGNOSTIC EVALUATION
- MANAGEMENT OF LOCAL RECURRENCE
- Candidates for surgical resection
- - Surgical procedure
- Following RT with uterine conservation
- Following hysterectomy
- Nonsurgical options
- - Candidates for radiation therapy
- - Candidates for chemotherapy
- MANAGEMENT OF METASTATIC DISEASE
- Disease isolated to the lymph nodes
- Limited metastatic disease
- Metastatic disease
- - Chemotherapy plus bevacizumab as first-line treatment
- Combination chemotherapy
- Alternate use of carboplatin
- Combination versus single-agent therapy
- - Second-line therapy
- MANAGEMENT OF ACUTELY SYMPTOMATIC PATIENTS
- SUMMARY AND RECOMMENDATIONS