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Advanced cancer

Recurrent and advanced cervical cancer

Recurrent cervical cancer is cancer that has recurred (come back) after it has been treated.

Recurrence is when the cancer comes back in the same part of the body. Secondary cancer is when the cancer spreads to another part of the body.

Cervical cancer may come back in the cervix, the pelvis, or elsewhere.

Advanced cervical cancer is cancer which has spread beyond the pelvis and local lymph nodes.

Treatment options

Treatment of recurrent cervical cancer may include the following:

  • Depending on whether you had radiotherapy in your initial treatment, you may be offered radiotherapy, chemotherapy or both.
  • If you were originally treated with radiotherapy and the recurrent cancer is in the cervix or central area of the pelvis, then surgery may be possible. This is called a pelvic exenteration. Details of this procedure can be found below.
  • If the recurrent cervical cancer is outside the pelvis, or if cervical cancer is advanced at the time of initial diagnosis, treatment is highly individualised and may involve radiotherapy and/or chemotherapy.
  • You should also ask what clinical trials are being undertaken because you may be eligible to participate in studies of new anticancer drugs or drug combinations.

If you have a kidney obstruction (blockage), your health care team will recommend a procedure to relieve the obstruction before cancer treatment. This could be a nephrostomy, which is a small plastic tube placed through the skin and into the kidney to drain urine, or a stent, which is an internal tube placed in the kidney, through the ureter and into the bladder. Ask your treatment team for more information about these procedures.

Pelvic exenteration

Pelvic exenteration is a rarely performed procedure. This may be offered if the cancer has spread beyond the uterus to the surrounding organs (either the bladder or rectum), or has returned in the pelvic area after radiation treatment.

After tests to confirm there is no other area of cancer in the body, the surgeon removes the affected organs, such as the lower colon, rectum, bladder, cervix, vagina, ovaries, and nearby lymph nodes. Openings called stoma are made to bring the small or large intestine out onto the abdomen. This allows urine and faeces to flow from inside the body to a collection bag. Common stoma include:

  • ileostomy (formed from the lower half of the small bowel, called the ileum, which joins up with the colon)
  • colostomy (formed from the colon)
  • ileal conduit (formed by isolating a small piece of ileum and implanting the tubes from the kidney (ureters) into it).

For more information about adapting to life with a stoma, you would be introduced to a stomal therapist prior to the procedure who will form part of the recovery team. If this service is not mentioned ask your treatment team or contact your local stoma association.

Plastic surgery to reconstruct the vagina may also be offered at a suitable time after pelvic exenteration.

Benefits and disadvantages of cancer treatment

Some women with a recurrence of cervical cancer are detected early and have very good outcomes with treatment. However, you may be told there is only a small chance that your cancer can be cured, or that cure is not the aim of treatment, although treatment may be the best way to control symptoms. In this case, you may not be sure if you want to continue to have treatment.

Some people with more advanced cancer will choose treatment, even if it only offers a small or no chance of cure. Some people may choose options that don’t try to treat the cancer, but make them feel as well as possible. You may wish to discuss your options with your treatment team, family and friends, or with a counsellor, psychologist or psychiatrist.

Questions you may want to ask include:

  • What’s the best we can hope for by trying another treatment? What is the goal?
  • Is this treatment plan meant to help side effects, slow the spread of cancer, or both?
  • Is there a chance that a new treatment will be found while we try the old one?
  • What’s the most likely result of trying this treatment?
  • What are the possible side effects and other downsides of the treatment? How likely are they?
  • Are the possible rewards bigger than the possible drawbacks?

It is important to ask your health care team what to expect in the future. It’s also important to be clear with them about how much information you want to receive from them.

If you feel that you would like to stop treatment, but your family or your partner does not want you to, it might help for you and your doctor or a counsellor or psychologist to talk to your family or your partner about their feelings.