Experts Review Current Management of Advanced Cervical Cancer
Today’s treatment choices for invasive cervical cancer remain similar to those available in the previous decade, and this cancer causes considerable physical and psychological morbidity. To describe the epidemiology, treatment, and issues in survivorship facing patients with advanced cervical cancer, Merry Markham, MD, Division of Hematology and Oncology, University of Florida College of Medicine, Gainesville, FL, and colleagues recently cowrote a review of these topics (JCO Oncol Pract. 2022; Published online March 14. doi:10.1200/OP.21.00795).
According to Dr Markham and coauthors, wide-scale public screening for cervical cancer in the United States in the 1960s cut the incidence of cervical cancer in half by 2007. However, the rate of decrease in incidence slowed in the 2000s and plateaued from 2012 to 2017.
Nearly 15,000 new cases of cervical cancer are estimated to have occurred in the United States in 2021. Slightly more than half include regional or distant metastases at diagnosis.
Symptoms of locally advanced disease include irregular or postcoital vaginal bleeding and vaginal discharge. Symptoms of advanced or metastatic disease include pelvic pain, bone pain, back pain from hydronephrosis, and urinary tract or bowel symptoms.
Regarding staging, evaluation of invasive cervical cancer includes assessment of tumor size, parametrial spread, lymph node disease, and distant metastasis. A comparative trial revealed that magnetic resonance imaging is superior to clinical examination or computed tomography for measuring tumor size and determining whether the uterine body is affected. The 2018 International Federation of Gynecology and Obstetrics staging system incorporated precise measurements of tumor size and specific information about lymph node disease.
Single-agent cisplatin-based chemotherapy with concurrent radiation therapy is the mainstay of treatment for locally advanced disease. Combination chemotherapy plus bevacizumab typically are used to treat patients with metastatic, progressive, or recurrent disease. In addition, incorporating immunotherapy into the treatment regimen of women whose cancer expresses programmed death ligand-1 is supported by data from recent clinical trials.
Patients with locally advanced or metastatic cervical cancer are at high risk of recurrence and should be followed up every 3 months for the first 2 years after treatment cessation, then every 6 months for 3 years and annually thereafter.
Physical morbidity from the treatment of locally advanced cervical cancer treatment mainly results from pelvic irradiation and includes bladder, bowel, and sexual dysfunction. Treatment of these sequelae focuses on identifying and treating reversible or treatable causes of symptoms and palliating symptoms with irreversible causes.
“From a psychologic standpoint, patients with cervical cancer face the stigma of having a preventable cancer caused by a sexually transmitted infection and the ramifications of sexual dysfunction…. Aside from the psychological implications related to sexual well-being, patients are also at risk for mood disturbances such as dysphoria and anxiety,” wrote Dr Markham and colleges. “Clinicians must invite honest dialogue to be able to address specific survivorship issues.”
“In conclusion, although significant strides have been made in prevention of cervical cancer, progress has stalled recently in the United States…. additional work needs to be performed to improve therapeutics and supportive care for patients with cervical cancer.”
