Cervical Cancer Recurrence
If cancer comes back after surgery or treatment it is said to be relapsed or recurrent. Cervical cancer is likely to recur in 30 percent of women with the invasive form of the disease. If it does recur it usually does so within the first 2 years after treatment. Exactly where the cancer comes back will depend on the initial therapy used. For example, after a hysterectomy operation about 25 percent of recurrences occur in the upper part of the vagina or where the cervix used to be. If radiation therapy was the initial primary treatment then the recurrence is usually found in the cervix, the uterus, upper vagina or the pelvic wall.
Common signs of cervical cancer returning are:
1. Sudden and unexplained weight loss.
The outlook for a woman with a recurrence depends on where the cancer develops. The best chance she has of a cure is when the cancer is located 'centrally', that is, it is confined to the pelvic area. The prognosis for women where the cancer has spread to other organs (metastasis) such as the lungs, liver or bones is not as good. A diagnosis is usually performed in the same way as the original cervical cancer diagnosis.
1. What therapies were applied last time.
Recurrence After Surgery
Usually a radical hysterectomy is a very effective cervical cancer treatment – as long as cancer cells have not spread beyond the cervix. Yet sometimes cancerous cells remain behind at the edges of the extracted tissue. These cells can go on to grow and spread into a new problem. This situation is more likely to occur in patients who were originally diagnosed with cervical cancer stages 1B or 2. If cancer is discovered in a biopsy, radiation therapy can be applied directly to the area of concern to kill the remaining cells. However if radiation was given before surgery, it cannot be repeated to the same area again. As an alternative patients may be offered a pelvic exenteration. This is a major surgery which removes cancerous tissues, as well as other pelvic organs such as the bladder, rectum and colon. Urine and feces will rerouted to an opening on the abdomen so that they can still leave the body. This operation has huge psychological effects on the patient so a woman who chooses this surgery needs to be emotionally strong and prepared for a long and difficult recovery. If cancer has spread beyond the pelvis or it cannot be removed by the operation, it will not be performed. About 33 percent of women with recurrent cervical cancer treated with radiation or pelvic exenteration are permanently cured. However nearly 10 percent of patients die during or soon after a pelvic exenteration operation. Complications usually occur due to heart or lung problems. For those who survive, urinary tract infections, kidney problems and bowel disorders are likely to be a lifelong issue. Yet, despite all these complications, this radical operation may the only hope of survival for some women. See also, cervical cancer survival rate.
Recurrence After Radiation Therapy
Some women will find cancer comes back, even if they received radiation directly to the affected zone. It may be that the cancerous cells were strong enough to survive the radiation or that it had spread to area outside of the pelvis which was not treated with the radiation. There are currently no tests which can detect small areas of cancer outside of the pelvis. These areas are clinically termed micrometastases. If radiation has already been given in the original treatment, then it cannot be safely used again. Patients in this incidence will be offered a pelvic exenteration.
When Cancer Has Spread
Traditionally cervical cancer which has spread (metastatic) beyond the pelvis to other parts of the body has been considered incurable. Some are treated with chemo (see Chemotherapy Guide) for the purpose of prolonging life or reducing symptoms associated with progressive cancer. Recent research reports a 'good response' to some chemo drugs including vincristine, doxorubicin, mitomycin-C, bleomycin, cisplatin and methyl CCNU. Yet a good response is not a lasting response. The cancer is rarely cured and although the women may live longer, quality of life is not normally taken into account. Treatment with the drug Platinol has had some good results in shrinking cancer cells by 15 to 25 percent. Some cancer clinical trials are combining Platinol with chemo drugs in the hope of finding a more effective treatment, even a cure. Ultimately all the therapies to date only appear to work for a few months. Chemotherapy is more commonly being used for palliative care, for controlling distressing symptoms that accompany advanced stages of the disease.
Because cervical cancer which has spread beyond the pelvis is difficult to treat and nearly always fatal, much research is being carried out in this area. One recent study of 17 women with advanced or recurrent cervical cancer were given a combination of the drugs Gemzar and Platinol. The drugs were prescribed for 21 days for an average of 5 cycles. 41 percent demonstrated improvement as a result of the combination therapy. Another area of research is in biological therapies used alone or in combination with chemotherapy (see cancer treatments and therapies). The idea behind biological therapy is to trick the patient's own immune system into attacking and destroying cancer cells. These therapies include the use of vaccines, interleukins, interferons and monoclonal antibodies. Furthermore, many more potentially lifesaving drugs are passing through Phase 1 of clinical trials - that is the phase which determines how safe they are before being rolled out to a wider audience for testing. Even better news, a HPV vaccine is on the horizon which may one day eradicate the disease completely. Trials are currently open for women with recurrent or metastatic stages of the disease. See causes of cervical cancer as well as HPV infection for more details.
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