Management of recurrent cancer of the uterine cervix

Abstract

In developing countries, cervical cancer is the most common cause of cancer deaths in women, due in large part to lack of screening and patient education. Screening results in earlier diagnosis and intervention, but local recurrences still happen and are difficult to treat. Early-stage (IB and IIA) cervical cancer can be cured on an average rate of 80% with either radical surgery or definitive radiation; on the other hand, 30-50% of patients with stage IIB to IV will ultimately fail. The prognosis of recurrent cervical carcinoma is grim regardless of the mode of primary treatment except those with isolated small vaginal or cervical relapse for which a 5-year survival of 35-50% has been reported. These patients constitute less than 10% of all patients with recurrent cervical cancer. In the remaining patients, 5-year survival rates are between 3.2 and 13%. The treatment of this condition has a high morbidity and risk versus benefit of the treatment offered has to be weighed. Refinement in surgical techniques, addition of intraoperative radiation therapy and regional chemotherapy, has improved the outcomes in these patients. There is a lack of randomized trials in this field and the treatment is chosen according to the extent of disease, patients' general condition and expectation and availability of surgical expertise and treatment facilities.Keywords Cervical cancer Á Recurrence Á Multimodality therapyIn developing countries, cervical cancer is the most common cause of cancer deaths in women, due in large part to lack of screening and patient education [1]. Screening results in earlier diagnosis and intervention, but local recurrences still happen and are difficult to treat. Earlystage (IB and IIA) cervical cancer can be cured on an average rate of 80% with either radical surgery or definitive radiation; on the other hand, 30-50% of patients with stage IIB to IV will ultimately fail. Recurrent cervical carcinoma remains a tough clinical problem. The prognosis of recurrent cervical carcinoma is grim regardless of the mode of primary treatment except those with isolated small vaginal or cervical relapse for which a 5-year survival of 35-50% has been reported. These patients constitute \10% of all patients with recurrent cervical cancer. In the remaining patients 5-year survival rates are between 3.2 and 13%.