Cervix Carcinoma Stage IV
Stage 4 cervical cancer represents the most advanced form of this disease, where cancer has spread beyond the cervix to nearby organs or distant parts of the body. While this diagnosis presents serious challenges, modern treatment approaches combining chemotherapy, radiation, immunotherapy, and targeted drugs offer ways to manage symptoms and extend life.
Table of contents
- What is stage 4 cervical cancer?
- Treatment approaches
- Treatment for stage 4A cervical cancer
- Treatment for stage 4B cervical cancer
- Side effects of treatment
- Treatment for recurrent cervical cancer
What is stage 4 cervical cancer?
The stage of a cancer tells you how big it is and whether it has spread. Doctors use the International Federation of Gynecology and Obstetrics (FIGO) staging system for cervical cancer. There are 4 stages, numbered 1 to 4.[1]
Stage 4 means the cancer has spread outside the area between the hip bones (called the pelvis), to the lining of the bladder, to the lining of the back passage (rectum), or to other organs such as the lungs.[1]
Stage 4 cervical cancer is divided into two groups. Stage 4A is when the cancer has spread to nearby organs such as the bladder or back passage. Stage 4B is when the cancer has spread to organs further away, such as the lungs. Your doctor might call stage 4B secondary or metastatic cancer.[1]
About 1% of all cervical cancer patients present with stage 4B disease.[5] The five-year survival rate for stage 4 cervical cancer is approximately 15-17%, compared to 95% in stage 1.[20]
Treatment approaches
The stage of your cancer helps your doctor to decide which treatment you need. Treatment also depends on your type of cancer (the type of cells the cancer started in), where the cancer is, and other health conditions that you have.[1]
Stage 4 cervical cancer might be treated with a combination of different approaches. You might receive chemotherapy before chemoradiotherapy (a treatment combining chemotherapy and radiotherapy), surgery to remove lymph nodes, targeted drug treatment, or immunotherapy.[1] Some people may choose to just have treatment to control symptoms.[1]
Treatment for stage 4A cervical cancer
You usually have treatment with a combination of radiotherapy and chemotherapy (chemoradiotherapy) for stage 4A cervical cancer. With this treatment, you have chemotherapy during your course of radiotherapy.[1]
You have chemotherapy once a week. You have daily external radiotherapy for 5 days every week, for around 5 weeks. You also have internal radiotherapy called brachytherapy.[1] Brachytherapy is a type of internal radiation therapy where a small device is placed into the cervix and vagina and later loaded with radioactive material. The radioactive material is left in place while the patient stays in the hospital for 1-3 days.[5]
Before you have the above treatments, you might have chemotherapy. This is called neoadjuvant chemotherapy.[1] You might also have a boost of radiotherapy if there is a risk of any cancer cells in pelvic lymph nodes.[1]
The chemotherapy most commonly used with radiation therapy is cisplatin, or cisplatin plus 5-fluorouracil (5-FU). If cisplatin is used, it is usually given one time each week during the radiation therapy schedule. If cisplatin plus 5-FU is used, it is usually given every 4 weeks during radiation therapy.[3]
If you haven’t had chemotherapy before, you might have one of the following combinations: cisplatin and paclitaxel, or carboplatin and paclitaxel.[1]
In a few people, a surgery called pelvic exenteration might be offered to treat stage 4A cancer. This is a major operation that may involve removing your womb and cervix.[1]
Treatment for stage 4B cervical cancer
Treatment for cancer that has spread further away in the body aims to shrink the cancer, reduce symptoms, and help you feel more comfortable. It can sometimes help you live some time longer.[1]
Chemotherapy
Chemotherapy may be offered for stage 4B cervical cancer to relieve pain or control the symptoms of advanced cervical cancer (called palliative chemotherapy).[3] Chemotherapy can help to shrink a cancer down to reduce symptoms and help you feel more comfortable.[1]
Chemotherapy drugs used to treat stage 4B cervical cancer include cisplatin, carboplatin, paclitaxel, topotecan, gemcitabine, 5-fluorouracil, ifosfamide, docetaxel, irinotecan, mitomycin, vinorelbine, epirubicin, and doxorubicin. These drugs may be used alone or in combination.[3]
The most common chemotherapy drug combinations used to treat cervical cancer are cisplatin and ifosfamide, cisplatin and paclitaxel, cisplatin and gemcitabine, cisplatin and topotecan, and paclitaxel and topotecan.[3]
Immunotherapy
You might have the immunotherapy drug pembrolizumab plus chemotherapy with or without the targeted cancer drug bevacizumab for metastatic cervical cancer.[1] Immunotherapy helps to strengthen or restore the immune system’s ability to fight cancer.[3]
If chemotherapy was used to treat metastatic cervical cancer but it didn’t respond or the cancer comes back, then you may be offered cemiplimab.[3] Pembrolizumab may also be offered for metastatic cervical cancer in combination with chemotherapy, sometimes given with the targeted therapy drug bevacizumab.[3]
Targeted therapy
You may be offered targeted therapy for stage 4B cervical cancer. The most common targeted therapy drug used to treat cervical cancer is bevacizumab. It is usually given in combination with chemotherapy.[3]
Radiotherapy
Radiotherapy can help to shrink the cancer and improve your quality of life if the cancer has spread and is causing symptoms such as pain.[1] For stage 4B cervical cancer, radiation therapy may be used to relieve pain, stop bleeding, or control other symptoms of advanced cervical cancer (called palliative therapy).[3]
Surgery
Surgery is not often used. But your doctor might suggest an operation if the cancer is causing a blockage in the kidneys or bowel.[1]
Side effects of treatment
Different treatments can cause different side effects. Grade 3 or 4 leukopenia (low white blood cell count) is more common in patients treated with chemoradiotherapy, occurring in about 24% of patients. Grade 3 or 4 neutropenia (low neutrophil count) is more frequent in those treated with chemotherapy alone, occurring in about 28% of patients.[12]
Development of grade 3 proctitis (inflammation of the rectum) can occur as a late side effect in patients who receive radiotherapy.[12]
Treatment for recurrent cervical cancer
Sometimes cervical cancer can come back after treatment. It may come back near to the area where the cancer first started (local recurrence). Or it may come back in another part of the body (secondary or metastatic cancer).[1]
The treatment you have depends on where the cancer is, what treatment you had before, your general health, and your wishes. Your doctor will talk to you about the treatment options and the treatment’s aim.[1]
You might have surgery if chemoradiotherapy was your primary treatment and if the cancer hasn’t spread too far. The operation might mean removing your womb and cervix (hysterectomy) and the nearby lymph nodes.[1]