Nonsurgical management of cervical cancer: locally advanced, recurrent, and metastatic disease, survivorship, and beyond

Abstract

Despite the declining incidence of cervical cancer as a result of the introduction of screening programs, globally it remains a leading cause of cancer-related death in women. Outcomes for patients who are diagnosed with anything but early-stage disease remain poor. Here we examine emerging strategies to improve the treatment of locally advanced disease. We discuss emerging biologic data, which are informing our investigation of new therapeutic interventions in persistent, recurrent, and metastatic cervical cancer. We recognize the importance of interventions to improve quality of life and to prevent long-term sequelae in women undergoing treatment. Finally, and perhaps most importantly, we recognize the need for global collaboration and advocacy to improve the outcome for all women at risk of and diagnosed with this disease.

FIGURE 1. Infiltrative versus Expansile Cervical Cancer

Infiltrative corpus invasive cervix cancer has higher local failure rates, increased frequency of nodal metastases at presentation, and poor survival compared with exophytic tumor of similar volume.

FIGURE 2. Ultrasound and MRI Images for Delivery of Brachytherapy

The left ultrasound image shows the tandem position and superimposed isodoses in the treatment position. The ultrasound images correlates very well with the corresponding MRI image.

FIGURE 3. Rationale for Targeting Angiogenesis in Cervical Cancer

Abbreviations: TSP-1, thrombospondin-1; VEGF, vascular endothelial growth factor; HIF1α, hypoxia inducible factor 1α.