Various factors ultimately influence a patient’s decision to accept cancer treatment. The goals of receiving cancer treatment may be to improve symptoms through local control of the cancer, increase the patient’s chance of recovery, or prolong the patient’s survival. The potential benefits of receiving cancer treatment must be carefully balanced against the potential risks of receiving cancer treatment.
The following is an overview of the treatment of stage IV cervical cancer. It can ultimately influence how these general treatment principles are applied to situations with stage 4 cancer.
Most of the new treatments being developed are in clinical trials. Clinical trial studies that evaluate the effectiveness of a new drug or treatment strategy. The development of more effective cancer treatments requires that new and innovative therapies be evaluated with cancer patients. Participation in clinical trials may offer access to better treatments and advance existing knowledge about these cancer treatments. Clinical trials are available for most stages of cancer. Patients interested in participating in clinical trials should discuss the risks and benefits of clinical trials with their doctors. To ensure that sufferers can undergo treatment properly.
Patients diagnosed with stage IV cervical cancer can be divided into two groups. Patients with disease that is locally limited, but involves adjacent organs in the pelvis, such as the rectum and bladder, are local conditions of stage IVA cervical cancer.
Other patients have disease that has spread to distant organs, most commonly the bones, lungs or liver, and has metastatic stage IVB cervical cancer. The management of patients with metastatic stage IVB disease is aimed at controlling cervical cancer symptoms and pain. After undergoing treatment for cervical cancer, the doctor will continue to follow you to check to see that the cancer has not returned or is not progressing.
Treatment of Stage IVA Localized Cervical Cancer
Stage IVA cervical cancer is currently best managed by a combination of radiation therapy and chemotherapy. Radiation therapy is a high-energy x-ray treatment that has the ability to kill cancer cells. Radiation therapy can be given by a machine that aims at x-rays on the body (external beam radiation) or by placing a small capsule of radioactive material directly near the cervix (internal radiation or implants). Most patients will receive both types of radiation therapy during their treatment. External beam radiation therapy for cervical cancer is given on an outpatient basis for about 4 to 6 weeks.
During or immediately after external beam radiation therapy, patients may also undergo radiation implant procedures. Placing radiation in the cervix allows high doses of radiation to be delivered to the cancer while reducing radiation to surrounding normal tissues and organs. During the procedure in the operating room, a small device is placed into the cervix as well as in the vagina and is then carried out with radioactive material. The radioactive material is left in place while the patient remains in the hospital for 1-3 days. This process can be done once or twice during treatment.
The strategy of giving chemotherapy along with radiation treatment will be helpful because chemotherapy and radiation therapy can act together to increase cancer cell killing. Chemotherapy can also damage cells independent of radiation therapy. Several clinical studies conducted on patients with locally advanced cervical cancer utilizing chemotherapy and radiation therapy together have suggested that this strategy could increase remission rates and prolong survival. To definitively determine whether radiation therapy given with concurrent chemotherapy is superior to radiation therapy alone, several clinical studies were designed to directly compare the two treatments in patients with advanced cervical cancer.
One important clinical trial conducted by various oncology groups in the United States has shown that radiation therapy combined with chemotherapy for advanced cervical cancer is superior to treatment with radiation therapy alone. Even patients with stage III or IVA cervical cancer experienced a 5-year survival rate of 63% compared with 57% for patients treated with radiation therapy alone. The chance of cancer recurrence was 42% for patients treated with chemotherapy and radiation therapy compared with 62% for those treated with radiation therapy alone. Concomitant chemotherapy and radiation therapy are well tolerated except for minor gastrointestinal and hematologic side effects, which are reversible.
Further research is ongoing to determine whether additional chemotherapy drugs or radiation doses can locally improve patient outcomes with advanced cervical cancer. At least four clinical studies have confirmed that treatment of advanced cervical cancer with concurrent chemotherapy and Platinol-based radiation therapy is superior to radiation therapy alone.
Treatment of Cervical Stage IVB Metastatic Cancer
Cervical cancer that has spread to distant organs and bones is difficult to treat. Historically, patients with cervical cancer metastases have been deemed incurable and rarely survive more than a year or two. Some patients are offered treatment with chemotherapy for the purpose of extending their duration of survival and reducing symptoms of 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 single good chemotherapy approach that can increase the length of survival in patients with cervical cancer metastases. Unfortunately, this chemotherapy usually works for only a few months before cervical cancer starts growing again. Most patients still succumb to cancer and better treatment strategies are clearly needed.
Strategies to Improve Care
The advances that have been achieved in the treatment of cervical cancer have resulted from the 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 advances in cervical cancer treatment will result from continued participation in appropriate clinical trials. Currently, there are several areas of active exploration aimed at improving cervical cancer treatment.
Supportive care refers to treatments designed to prevent and control the side effects of cancer and its treatment. Side effects can not only cause patient discomfort, but may also prevent optimal delivery of therapy at the planned dose and schedule. In order to achieve optimal results from treatment and improve quality of life, it is very important that the side effects of cancer and its treatments are properly managed. For more information, visit Supportive Care.
External beam radiation therapy can be delivered more precisely to the cervix by using a special CT scan and targeting a computer. This capability is known as three-dimens
ional 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 that occurs naturally or is synthesized by substances that direct, facilitate or enhance normal immune defenses. The goal of biological therapy is to have itself attack the patient’s immune defenses and destroy cancer cells. Biological therapy includes interferon, interleukin, monoclonal antibodies and vaccines. In an effort to improve survival rates, these and other agents are being tested alone or in combination with chemotherapy in clinical trials.
Stage I Examination
New chemotherapy drugs are continuously being developed and evaluated in patients with recurrent cancer in phase I clinical trials. The aim of the phase I trial is to evaluate new drugs to determine the safety and tolerability of the drug and the best way to administer the drug to patients.