Worldwide cervical cancer is third most common cancer of all cancers in women, with
85% cases occurring in developing countries, where cervical cancer is second most frequent cause of
cancer deaths in women. Global burden of cervical cancer reported for 2008 was, 529,800 cases and
275,100 deaths. It is estimated that yearly 134,420 Indian women will be diagnosed and estimated
72,825 will die with cervical cancer, because most (85%) cases present in advanced stages. In
advanced cases mission of management is, shrinkage of cancer and slow its growth and spread, with
minimum effects of therapy on other parts of the body.
Present review is to know the possibilities of management strategies for quality survival in cases who
report with advanced cervical cancer.
Status: Cervical cancer that has spread locally or beyond pelvis, surgery, chemotherapy and
radiotherapy can be used singly or with each other in individualized way. Treatment will depend on
size, spread, number of secondaries, symptoms, cancer is causing and patient’s condition.
Traditionally patients included as advanced stages are, stage IIB to IVA (locally advanced disease)
and IV B, disease with metastasis at distant places. However, many, who deal with these cancers
include IB2 and IIA2 disease in advanced category because these stages need multimodality therapy
and outcome is poorer than early stage cases (IA through IIA1). Radiologic imaging studies are
recommended for stage IB2 or greater disease for stage of cancer. MRI is useful to rule out disease
high in endocervix. Histopathological confirmation is essential in all cases. Histopathology and many
other things affect quality survival.
Usually, advanced cervical cancer is treated with combined chemotherapy, radiotherapy
(chemoradiation). In stage IVA, exenteration may be performed, by removing uterus, cervix, fallopian
tubes ovaries with vagina, surrounding tissue as well as any part of bladder, bowel or rectum that is
affected by cancer and create diversion of bladder, bowel or both depending upon whether anterior or
posterior or complete exenteration is done. It may be not possible to do much for stage IVB cervical
cancer but individualized therapy helps. Lack of needed social support, system for transport create
problems including cost of therapy.
In patients with refractory cancer, a comprehensive coordinated approach is needed including hospice
as per need, pain specialists, emotional, spiritual support, individualized per need.
Mission is survival with quality. When cure is not possible, it is essential that attempts are made to
allay symptoms which affect everyday life.