General Treatment Rules
Worldwide, carcinoma of the uterine cervix is the second most common malignancy among women and is a major cause of morbidity and mortality.1 Cancer of the uterine cervix ranks third among female genital system malignancies in the United States, and approximately 11,070 new cases and 3870 deaths have been estimated for the year 2008.2 In the United States, despite an increase in the incidence of carcinoma in situ, invasive cervical cancer rates have decreased steadily over the last decades because of early detection and treatment of preinvasive disease.
Women with cervical cancer usually present with early stage disease. Data from the Surveillance, Epidemiology, and End Results (SEER) registry indicate that only 8% of women with cervical cancer were diagnosed with metastatic disease at the time of presentation between 1988 and 2003.3 For stage 0 to IB1 cancers and for some stage IIA cancers, the treatment may include surgery, radiation therapy, or both, depending on patient and physician preference (Table 1). Bulky stage I (stage IB2) and locally advanced (stages II-IVA) cervical cancers are treated with concurrent chemoradiation in the United States. Palliation with platinum-based chemotherapy remains the standard of care for inoperable patients who have advanced disease.4 Selected patients with isolated central recurrence can be treated with curative intent by pelvic exenteration.
|0||Full-thickness involvement of the epithelium without invasion into the stroma (carcinoma in situ)||Surgical|
|IA1||Invasive carcinoma limited to the cervix; diagnosed only by microscopy; no visible lesions; stromal invasion <3 mm in depth and ≤7 mm in horizontal spread||Surgical (or radiotherapeutic)|
|IA2||Invasive carcinoma limited to the cervix; diagnosed only by microscopy; no visible lesions; stromal invasion between 3 mm and 5 mm with horizontal spread ≤7 mm||Surgical (or radiotherapeutic)|
|IB1||Visible lesion ≤4 cm in greatest dimension, or microscopic lesion with >5 mm of depth, or horizontal spread >7 mm||Surgical or radiotherapeutic|
|IB2||Visible lesion >4 cm||Multidisciplinary treatment|
|IIA||Invades beyond the cervix without parametrial invasion but involves the upper two-thirds of the vagina||Surgical or radiotherapeutic|
|IIB||Invades beyond the cervix with parametrial invasion||Multidisciplinary treatment|
|IIIA||Involves lower one-third of the vagina only||Multidisciplinary treatment|
|IIIB||Extends to the pelvic wall and/or causes hydronephrosis or nonfunctioning kidney||Multidisciplinary treatment|
|IVA||The tumor has invaded the mucosa of the bladder or rectum and has grown beyond the true pelvis||Multidisciplinary treatment|
|IVB||Distant spread of disease||Medical treatment|
For this report, we reviewed published and developing chemotherapy approaches in the multidisciplinary and medical management of cervical cancer with a focus on biologic modalities of therapy (Fig. 1). Guidelines for workup and treatment suggestions for cervical cancer can be viewed online (available at: http://www.nccn.org/professionals/physician_gls/PDF/cervical.pdf accessed on May 1, 2009).