Stage 3
In stage 3 cervical cancer, the cancer has spread beyond the cervix and into the surrounding areas of the pelvis. It may have spread down into the lower part of the vagina and the muscles and ligaments that line the pelvis walls. The cancer may block the tubes that drain the kidneys (ureters) depending on how far it has spread. Stage 3 can be divided into stage 3A and 3B. Stage 3A is when the cancer has spread to the lower third of the vagina but not the pelvic wall. Stage 3B is when the cancer has grown through to the pelvic wall or is blocking one or both of the tubes that drain the kidneys [28].
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Stage 4
Stage 4 cervical is advanced cancer in that has metastasized to other organs outside the cervix and uterus. Like the previous stages, it can be divided into stage 4A and stage 4B. Stage 4A is when the cancer has spread to nearby organs such as the bladder or rectum. If the cancer has metastasized to organs further away in the body, such as the lungs, it is at stage 4B.
Treatment for advanced cervical cancer
Advanced cervical cancer means that the cancer has spread into the tissues surrounding the cervix or further; this is stage 2B or above. It is possible to cure advanced cervical cancer, even if it is recurrent; however, this will depend on how widespread the cancer is and where it has spread to. It is not possible to cure cervical cancer at stage 4B, when the cancer has spread to another organ away from the cervix, such as the lungs. At that point, the aim of treatment is mitigate and control the symptoms [33].
Treatment depends on whether you have received previous treatment, as normal body tissue can only receive radiotherapy a certain number of times. In instances like these, chemotherapy or surgery may be administered without radiotherapy. Although, cervical cancer is most likely to treated with radiotherapy or surgery to remove the cervix, uterus and/or lymph nodes (hysterectomy), some clinical trials demonstrate that chemoradiation (or combined chemotherapy and radiation therapy) actually optimized the chances of curing cervical cancer [34].
The reason behind this is not entirely clear but researchers surmise it may be because the chemotherapy ehances cancer cells more sensitivity to radiotherapy [35].
Treatment for stage 2B or 3
Stage 2B, 3A and 3B cancers are usually treated with chemoradiation or combined chemotherapy and radiation therapy. Chemotherapy is administered once a week over the course of five or six weeks during the same time as external beam radiation therapy. Cisplatin (Platinol AQ) is the chemotherapy drug most commonly used to treat these stages of cervical cancer, as it makes the external beam radiation therapy more effective. Brachytherapy (radioactive seeds or sources are placed in or near the tumor itself) is usually administered before and after external beam radiation therapy [36].
Radiation therapy
Radiation therapy uses high energy waves to treat cervical cancer; it can be administered by an external or internal method [37]:
- External radiotherapy directs beams at the body through a machine similar to an X-ray machine. This treatment is administered over the course of fix or six weeks, one a day from Monday to Friday.
- Brachytherapy, or internal radiotherapy, places a radioactive source into your vagina and up into the uterus. This stays in place for either hours or days giving an extra boost of treatment to the cancer itself and the surrounding area.
- Certain clinical trials have shown that the chemotherapy drug, cisplatin, functions the best alongside radiotherapy, but the others have reported that other chemotherapy drugs work just as well as cisplatin [38].
- Chemoradiation is a viable option for different stages of cervical cancer and there are different ways of administering the treatment, depending on the amount of chemotherapy you receive and the drug your clinician chooses [39].
Treatment for stage 4A
Stage 4A cervical cancer is when it has spread to nearby organs such as your bladder or rectum. If initially diagnosed at this stage, treatment options may include external and internal radiotherapy, along with chemotherapy or radical surgery. Radical surgery means the removal of the uterus, vagina and any part of the bladder, bowel or rectum depending on which area is affected by the cancer [40].
Radical hysterectomy
A radical hysterectomy means the removal of the uterus, the cervix, the top of the vagina, the lymph nodes surrounding the uterus and the tissues holding the uterus in place. If you are post-menopause, the removal of your ovaries may also be a possibility to prevent the occurrence of ovarian cancer in the future. However, it is important to note that you are at no higher risk of ovarian cancer than other women in the general population [41].
Stage 4B
Cervical cancer that has spread to distant locations in the body such as the bones, lungs or liver is much more challenging to treat [43]. Radiation therapy, along with other methods, may be used as palliative therapy to reduce pain or bleeding [44]. Chemotherapy can be used as a targeted therapy, which uses drugs or other substances to identify and attack specific types of cancer cells and reduce harm to normal cells. It can also be used as a palliative therapy to relieve symptoms induced by the cancer and improve the quality of life of the patient [45].
There is no one chemotherapy approach which can improve the length of survival in patients with metastatic cervical cancer. Using Platinol® can produce shrinkage in 15-25 per cent of patients with metastatic cervical cancer. Many clinical trials having combined Platinol® with other chemotherapy drugs in the hopes of improving survival outcomes, yet this can produce more side effects and the length of survival of patients has not improved using Platinol® alone [46].
Treatment for recurrent cervical cancer
Cancer can come back and spread locally within the pelvis or outside of it. The lymph nodes, which run up in a chain on both sides of the groin are a common site for the cervical cancer to spread to [47].
The course of treatment following the recurrence or relapse of cervical cancer depends on the overall condition of the patient, previous treatments the patient has received and where the recurrence is situated. When cervical cancer reoccurs within the pelvis, it may be able to be treated with additional surgery or radiation therapy if no radiation was used previously. Recurrence of cervical cancer outside of the pelvis is more challenging to treat, but include many of the same treatment methods for more advanced stages of cervical cancer [49].
References
[28] Diagram Showing Stage 3A Cervical Cancer. Digital image. Cervical Cancer Stages. Cancer Research UK, 2 June 2014. Web. 25 Sept. 2015.
[29] Diagram Showing Stage 3B Cervical Cancer. Digital image. Cervical Cancer Stages. Cancer Research UK, 2 June 2014. Web. 25 Sept. 2015.
[30] Cervical Cancer Staging 4A. Digital image. Cervical Cancer Stages. Cancer Research UK, 2 June 2014. Web. 25 Sept. 2015.
[31] Cervical Cancer Staging 4B. Digital image. Cervical Cancer Stages. Cancer Research UK, 2 June 2014. Web. 25 Sept. 2015.
[32] “What Advanced Cancer Is.” Treating Advanced Cervical Cancer. Cancer Research UK, 17 June 2014. Web. 29 Sept. 2015.
[33] ibid.
[34] ibid.
[35] “Treatments for Stage III Cervical Cancer.” Treatments for Stage III Cervical Cancer. Canadian Cancer Society, n.d. Web. 29 Sept. 2015.
[36] “Combined Chemotherapy and Radiotherapy Treatment.” Chemoradiation for Cervical Cancer. Cancer Research UK, 2 June 2014. Web. 29 Sept. 2015.
[37] “Chemoradiation for Cervical Cancer.” Chemoradiation for Cervical Cancer. Cancer Research UK, 2 June 2014. Web. 29 Sept. 2015.
[38] “Chemoradiation.” Treating Advanced Cervical Cancer. Cancer Research UK, 17 June 2014. Web. 29 Sept. 2015.
[39] ibid.
[40] “If It’s Spread to Nearby Organs.” Treating Advanced Cervical Cancer. Cancer Research UK, 17 June 2015. Web. 29 Sept. 2015.
[41] “Surgery to Remove the Womb (radical Hysterectomy).” Surgery for Cervical Cancer. Cancer Research UK, 2 June 2014. Web. 29 Sept. 2015.
[42] Radical hysterectomy. Digital image. Surgery for Cervical Cancer. Cancer Research UK, 2 June 2014. Web. 1 Oct. 2015.
[43] “Treatment of Metastatic Stage IVB Cervical Cancer.” Stage IV Cervical Cancer. Texas Oncology, 2015. Web. 01 Oct. 2015.
[44] ibid.
[45] “Stage IVB Cervical Cancer.” Cervical Cancer Treatment (PDQ®). National Cancer Institute, 12 June 2015. Web. 01 Oct. 2015.
[46] “Treatment of Metastatic Stage IVB Cervical Cancer.” Stage IV Cervical Cancer. Texas Oncology, 2015. Web. 01 Oct. 2015.
[47] “If Cancer Has Come Back.” Treating Advanced Cervical Cancer. Cancer Research UK, 17 June 2014. Web. 01 Oct. 2015.
[48] Lymph Nodes. Digital image. Treating Advanced Cervical Cancer. Cancer Research UK, 17 June 2014. Web. 01 Oct. 2015.
[49] “Treatment of Metastatic Stage IVB Cervical Cancer.” Stage IV Cervical Cancer. Texas Oncology, 2015. Web. 01 Oct. 2015.