Patient name : patient DL

Age: 56y/o
Sex :F
Diagnosis : Cervical CA stage 111 -B
Address : bgy tipas Taguig City

Client health history
- The patient is a G1 P0 client that has not been able to bear a child in the past years, she has a
husband that works as a mason in the construction business and she is a simple housewife
- The client has experienced spotting in april 2011 and was rushed to the hospital for further
investigation and was found out to have a stage 111 b Cervical cancer and was scheduled for a
cervical tissue biopsy and the test confirms the condition , upon assessment they noticed a very
foul smelling odour coming out of the infected cervix

Cervical cancer is malignant neoplasm of the cervix uteri or cervical area. It may present with vaginal
bleeding, but symptoms may be absent until the cancer is in its advanced stages.
[1]
Treatment consists of
surgery (including local excision) in early stages and chemotherapy and radiotherapy in advanced stages of
the disease.
Pap smear screening can identify potentially precancerous changes. Treatment of high grade changes can
prevent the development of cancer. In developed countries, the widespread use of cervical screening
programs has reduced the incidence of invasive cervical cancer by 50% or more.
[citation needed]

Human papillomavirus (HPV) infection is a necessary factor in the development of almost all cases of
cervical cancer.
[1][2]
HPV vaccines effective against the two strains of HPV that currently cause
approximately 70% of cervical cancer have been licensed in the U.S, Canada, Australia and the EU.
[3][4]
Since
the vaccines only cover some of the cancer causing ("high-risk") types of HPV, women should seek regular
Pap smear screening, even after vaccination.
[5]



Cervix in relation to upper part of vagina and posterior portion of uterus.


Cervical cancer seen on a T2 weighted saggital MR image of the pelvis.
The cervix is the narrow portion of the uterus where it joins with the top of the vagina. Most cervical
cancers are squamous cell carcinomas, arising in the squamous (flattened) epithelial cells that line the
cervix. Adenocarcinoma, arising in glandular epithelial cells is the second most common type. Very rarely,
cancer can arise in other types of cells in the cervix.

Signs and symptoms
The early stages of cervical cancer may be completely asymptomatic.
[1][6]
Vaginal bleeding, contact bleeding
or (rarely) a vaginal mass may indicate the presence of malignancy. Also, moderate pain during sexual
intercourse and vaginal discharge are symptoms of cervical cancer. In advanced disease, metastases may be
present in the abdomen, lungs or elsewhere.
Symptoms of advanced cervical cancer may include: loss of appetite, weight loss, fatigue, pelvic pain, back
pain, leg pain, single swollen leg, heavy bleeding from the vagina, leaking of urine or faeces from the
vagina,
[7]
and bone fractures.
Causes
Human papillomavirus (HPV) infection with high-risk types has been shown to be a necessary factor in the
development of cervical cancer.
[8]
HPV DNA may be detected in virtually all cases of cervical cancer.
[1][8][2]

Not all of the causes of cervical cancer are known. Several other contributing factors have been
implicated.
[9]

Human papillomavirus infection
In the United States each year there are more than 6.2 million new HPV infections in both men and
women, according to the CDC, of which 10 percent will go on to develop persistent dysplasia or cervical
cancer. That is why HPV is known as the "common cold" of the sexually transmitted infection world. It is
very common and affects roughly 80 percent of all sexually active people, whether they have symptoms or
not. The most important risk factor in the development of cervical cancer is infection with a high-risk strain
of human papillomavirus. The virus cancer link works by triggering alterations in the cells of the cervix,
which can lead to the development of cervical intraepithelial neoplasia, which can lead to cancer.
Women who have many sexual partners (or who have sex with men who had many other partners) have a
greater risk.
[10][11]

More than 150 types of HPV are acknowledged to exist (some sources indicate more than 200
subtypes).
[12][13]
Of these, 15 are classified as high-risk types (16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68, 73,
and 82), 3 as probable high-risk (26, 53, and 66), and 12 as low-risk (6, 11, 40, 42, 43, 44, 54, 61, 70, 72, 81, and
CP6108).
[14]
Types 16 and 18 are generally acknowledged to cause about 70% of cervical cancer cases.
Together with type 31, they are the prime risk factors for cervical cancer.
[15]

Genital warts are caused by various strains of HPV which are usually not related to cervical cancer.
However, it is possible to have multiple strains at the same time, including those that can cause cervical
cancer along with those that cause warts. The medically accepted paradigm, officially endorsed by the
American Cancer Society and other organizations, is that a patient must have been infected with HPV to
develop cervical cancer, and is hence viewed as a sexually transmitted disease (although many dispute that,
technically, it is the causative agent, not the cancer, that is a sexually transmitted disease), but most women
infected with high risk HPV will not develop cervical cancer.
[16]
Use of condoms reduces, but does not
always prevent transmission. Likewise, HPV can be transmitted by skin-to-skin-contact with infected areas.
In males, there is no commercially available test for HPV, although HPV is thought to grow preferentially in
the epithelium of the glans penis, and cleaning of this area may be preventative.
[citation needed]

Cofactors
The American Cancer Society provides the following list of risk factors for cervical cancer: human
papillomavirus (HPV) infection, smoking, HIV infection, chlamydia infection, stress and stress-related
disorders, dietary factors, hormonal contraception, multiple pregnancies, exposure to the hormonal drug
diethylstilbestrol, and family history of cervical cancer.
[10]
Early age at first intercourse and first pregnancy
are also considered risk factors, magnified by early use of oral contraceptives.
[17]
There is a possible genetic
risk associated with HLA-B7.
[citation needed]

There has not been any definitive evidence to support the claim that circumcision of the male partner
reduces the risk of cervical cancer, although some researchers say there is compelling epidemiological
evidence that men who have been circumcised are less likely to be infected with HPV.
[18]
However, in men
with low-risk sexual behaviour and monogamous female partners, circumcision makes no difference to the
risk of cervical cancer.
[19]

Diagnosis
Biopsy procedures
While the pap smear is an effective screening test, confirmation of the diagnosis of cervical cancer or pre-
cancer requires a biopsy of the cervix. This is often done through colposcopy, a magnified visual inspection
of the cervix aided by using a dilute acetic acid (e.g. vinegar) solution to highlight abnormal cells on the
surface of the cervix.
[1]

Colposcopic impression, the estimate of disease severity based on the visual inspection, forms part of the
diagnosis.
Further diagnostic and treatment procedures are loop electrical excision procedure (LEEP) and conization,
in which the inner lining of the cervix is removed to be examined pathologically. These are carried out if the
biopsy confirms severe cervical intraepithelial neoplasia.


This large squamous carcinoma (bottom of picture) has obliterated the cervix and invaded the lower
uterine segment. The uterus also has a round leiomyoma up higher.


Micrograph of a (cervical) adenosquamous carcinoma, a type of cervical cancer. H&E stain.
Precancerous lesions
Cervical intraepithelial neoplasia, the potential precursor to cervical cancer, is often diagnosed on
examination of cervical biopsies by a pathologist. For premalignant dysplastic changes, the CIN (cervical
intraepithelial neoplasia) grading is used.
The naming and histologic classification of cervical carcinoma percursor lesions has changed many times
over the 20th century. The World Health Organization classification
[20][21]
system was descriptive of the
lesions, naming them mild, moderate or severe dysplasia or carcinoma in situ (CIS). The term, Cervical
Intraepithelial Neoplasia (CIN) was developed to place emphasis on the spectrum of abnormality in these
lesions, and to help standardise treatment.
[21]
It classifies mild dysplasia as CIN1, moderate dysplasia as
CIN2, and severe dysplasia and CIS as CIN3. More recently, CIN2 and CIN3 have been combined into
CIN2/3. These results are what a pathologist might report from a biopsy.
These should not be confused with the Bethesda System terms for Pap smear (cytology) results. Among the
Bethesda results: Low-grade Squamous Intraepithelial Lesion (LSIL) and High-grade Squamous
Intraepithelial Lesion (HSIL). An LSIL Pap may correspond to CIN1, and HSIL may correspond to CIN2 and
CIN3,
[21]
however they are results of different tests, and the Pap smear results need not match the histologic
findings.
Cancer subtypes
Histologic subtypes of invasive cervical carcinoma include the following:
[22][23]
Though squamous cell
carcinoma is the cervical cancer with the most incidence, the incidence of adenocarcinoma of the cervix has
been increasing in recent decades.
[1]

squamous cell carcinoma (about 80-85%
[citation needed]
)
adenocarcinoma (about 15% of cervical cancers in the UK
[20]
)
adenosquamous carcinoma
small cell carcinoma
neuroendocrine carcinoma
Non-carcinoma malignancies which can rarely occur in the cervix include
melanoma
lymphoma
Note that the FIGO stage does not incorporate lymph node involvement in contrast to the TNM staging for
most other cancers.
For cases treated surgically, information obtained from the pathologist can be used in assigning a separate
pathologic stage but is not to replace the original clinical stage.
Staging
Cervical cancer is staged by the International Federation of Gynecology and Obstetrics (FIGO) staging
system, which is based on clinical examination, rather than surgical findings. It allows only the following
diagnostic tests to be used in determining the stage: palpation, inspection, colposcopy, endocervical
curettage, hysteroscopy, cystoscopy, proctoscopy, intravenous urography, and X-ray examination of the
lungs and skeleton, and cervical conization.
The TNM staging system for cervical cancer is analogous to the FIGO stage.
Stage 0 - full-thickness involvement of the epithelium without invasion into the stroma (carcinoma
in situ)
Stage I - limited to the cervix
o IA - diagnosed only by microscopy; no visible lesions
IA1 - stromal invasion less than 3 mm in depth and 7 mm or less in horizontal
spread
IA2 - stromal invasion between 3 and 5 mm with horizontal spread of 7 mm or less
o IB - visible lesion or a microscopic lesion with more than 5 mm of depth or horizontal
spread of more than 7 mm
IB1 - visible lesion 4 cm or less in greatest dimension
IB2 - visible lesion more than 4 cm
Stage II - invades beyond cervix
o IIA - without parametrial invasion, but involve upper 2/3 of vagina
o IIB - with parametrial invasion
Stage III - extends to pelvic wall or lower third of the vagina
o IIIA - involves lower third of vagina
o IIIB - extends to pelvic wall and/or causes hydronephrosis or non-functioning kidney
Stage IV - extends outside the vagina
o IVA - invades mucosa of bladder or rectum and/or extends beyond true pelvis
o IVB - distant metastasis

Stage 1-A1 young women - conization wis clear margin. Parous women - hysterectomy.

Stage 1-A2 laproscopic lymphadenectomy + vaginal trechelectomy + post operative radiotherapy.
Stage 1B & 2A 1. Wertheim's hysterectomy . 2- schauta vaginal hysterectomy + laparoscopic
lymphadenectomy 3: primary radiotherapy 4: combined surgery & radiotherapy.

Stage 2B , 3 , 4 - chemotherapy
Prevention
Vaccination
Gardasil, is a vaccine against HPV types 6, 11, 16 & 18 which is up to 98% effective.
[24]

Cervarix has been shown to be 92% effective in preventing HPV strains 16 and 18 and is effective for more
than four years.
[25]

Together, HPV types 16 and 18 currently cause about 70% of cervical cancer cases. HPV types 6 and 11 cause
about 90% of genital wart cases. HPV vaccines have also been shown to prevent precursors to some other
cancers associated with HPV.
[26][27]

HPV vaccines are targeted at girls and women of age 9 to 26 because the vaccine only works if given before
infection occurs; therefore, public health workers are targeting girls before they begin having sex. The
vaccines have been shown to be effective for at least 4
[5]
to 6
[28]
years, and it is believed they will be effective
for longer,
[29]
however the duration of effectiveness and whether a booster will be needed is unknown.
The use of the vaccine in men to prevent genital warts, anal cancer, and interrupt transmission to women or
other men is initially considered only a secondary market.
The high cost of this vaccine has been a cause for concern. Several countries have or are considering
programs to fund HPV vaccination.
Condoms
Condoms offer some protection against cervical cancer.
[30]
Evidence on whether condoms protect against
HPV infection is mixed, but they may protect against genital warts and the precursors to cervical cancer.
[30]

They also provide protection against other STDs, such as HIV and Chlamydia, which are associated with
greater risks of developing cervical cancer.
Condoms may also be useful in treating potentially precancerous changes in the cervix. Exposure to semen
appears to increase the risk of precancerous changes (CIN 3), and use of condoms helps to cause these
changes to regress and helps clear HPV.
[31]
One study suggests that prostaglandin in semen may fuel the
growth of cervical and uterine tumours and that affected women may benefit from the use of condoms.
[32][33]

Nutrition
Fruits and vegetables
Higher levels of vegetable consumption were associated with a 54% decrease risk of HPV persistence.
[36]

Vitamin A
There is weak evidence to suggest a significant deficiency of retinol can increase chances of cervical
dysplasia, independently of HPV infection. A small (n~=500) case-control study of a narrow ethnic group
(native Americans in New Mexico) assessed serum micro-nutrients as risk factors for cervical dysplasia.
Subjects in the lowest serum retinol quartile were at increased risk of CIN I compared with women in the
highest quartile.
[37]

However, the study population had low overall serum retinol, suggesting deficiency. A study of serum
retinol in a well-nourished population reveals that the bottom 20% had serum retinol close to that of the
highest levels in this New Mexico sub-population.
[38]

Vitamin C
Risk of type-specific, persistent HPV infection was lower among women reporting intake values of vitamin
C in the upper quartile compared with those reporting intake in the lowest quartile.
[39]

Vitamin E
HPV clearance time was significantly shorter among women with the highest compared with the lowest
serum levels of tocopherols, but significant trends in these associations were limited to infections lasting
</=120 days. Clearance of persistent HPV infection (lasting >120 days) was not significantly associated with
circulating levels of tocopherols. Results from this investigation support an association of micronutrients
with the rapid clearance of incident oncogenic HPV infection of the uterine cervix.
[40]

A statistically significantly lower level of alpha-tocopherol was observed in the blood serum of HPV-positive
patients with cervical intraepithelial neoplasia. The risk of dysplasia was four times higher for an alpha-
tocopherol level < 7.95 mumol/l.
[41]

Folic acid
Higher folate status was inversely associated with becoming HPV test-positive. Women with higher folate
status were significantly less likely to be repeatedly HPV test-positive and more likely to become test-
negative. Studies have shown that lower levels of antioxidants coexisting with low levels of folic acid
increases the risk of CIN development. Improving folate status in subjects at risk of getting infected or
already infected with high-risk HPV may have a beneficial impact in the prevention of cervical cancer.
[42][43]

However, another study showed no relationship between folate status and cervical dysplasia.
[37]

Carotenoids
The likelihood of clearing an oncogenic HPV infection is significantly higher with increasing levels of
lycopenes.
[44]
A 56% reduction in HPV persistence risk was observed in women with the highest plasma
[lycopene] concentrations compared with women with the lowest plasma lycopene concentrations. These
data suggests that vegetable consumption and circulating lycopene may be protective against HPV
persistence.
[36][39][45]

Screening
The widespread introduction of the Papanicolaou test, or Pap smear for cervical cancer screening has been
credited with dramatically reducing the incidence and mortality of cervical cancer in developed countries.
[6]

Pap smear screening every 35 years with appropriate follow-up can reduce cervical cancer incidence by up
to 80%.
[46]
Abnormal Pap smear results may suggest the presence of cervical intraepithelial neoplasia
(potentially premalignant changes in the cervix) before a cancer has developed, allowing examination and
possible preventive treatment. If premalignant disease or cervical cancer is detected early, it can be
monitored or treated relatively noninvasively, with little impairment of fertility.
Cervical cancer screening is typically recommended starting three years or more after first sex, or starting at
age 21 to 25.
[47][48][citation needed]
Recommendations for how often a Pap smear should be done vary from once a
year to once every five years, in the absence of abnormal results.
[46]
Guidelines vary on how long to continue
screening, but well screened women who have not had abnormal smears can stop screening about age 60 to
70.
[47][48][49]

To take a Pap smear, the vagina is held open with a speculum, the loose surface cells on the cervix are
scraped using a specially shaped spatula and a brush, and the cells are spread on a microscope slide. At a
laboratory the slide is stained, examined for abnormal cells and findings are reported.
Until recently the Pap smear has remained the principal technology for preventing cervical cancer.
However, following a rapid review of the published literature, originally commissioned by NICE,
[50]
liquid
based cytology has been incorporated within the UK national screening programme. Although it was
probably intended to improve on the accuracy of the Pap test, its main advantage has been to reduce the
number of inadequate smears from around 9% to around 1%.
[51]
This reduces the need to recall women for a
further smear.
Automated technologies have been developed with the aim of improving on the interpretation of smears,
normally carried out by cytotechnologists. Unfortunately these on the whole have proven less useful;
although the more recent reviews suggest that generally they may be no worse than human
interpretation.
[52]

The HPV test is a newer technique for cervical cancer triage which detects the presence of human
papillomavirus infection in the cervix. It is more sensitive than the pap smear (less likely to produce false
negative results), but less specific (more likely to produce false positive results) and its role in routine
screening is still evolving. Since more than 99% of invasive cervical cancers worldwide contain HPV, some
researchers recommend that HPV testing be done together with routine cervical screening.
[15]
But, given the
prevalence of HPV (around 80% infection history among the sexually active population) others suggest that
routine HPV testing would cause undue alarm to carriers, more unnecessary follow-up testing and
treatment. HPV testing along with cytology significantly increases the cost of screening.
Various experimental techniques, such as visual inspection using acetic acid, sometimes with special lights
(speculoscopy), or taking pictures for expert evaluation (cervicography) have been evaluated as adjuncts to
or replacements for Pap smear screening, especially in countries where Pap smear screening is prohibatively
expensive. There are efforts to develop low cost HPV tests which might be used for primary screening of
older women in less developed countries.
Treatment
Microinvasive cancer (stage IA) is usually treated by hysterectomy (removal of the whole uterus including
part of the vagina). For stage IA2, the lymph nodes are removed as well. An alternative for patients who
desire to remain fertile is a local surgical procedure such as a loop electrical excision procedure (LEEP) or
cone biopsy.
[53]

If a cone biopsy does not produce clear margins,
[54]
one more possible treatment option for patients who
want to preserve their fertility is a trachelectomy.
[55]
This attempts to surgically remove the cancer while
preserving the ovaries and uterus, providing for a more conservative operation than a hysterectomy. It is a
viable option for those in stage I cervical cancer which has not spread; however, it is not yet considered a
standard of care,
[56]
as few doctors are skilled in this procedure. Even the most experienced surgeon cannot
promise that a trachelectomy can be performed until after surgical microscopic examination, as the extent
of the spread of cancer is unknown. If the surgeon is not able to microscopically confirm clear margins of
cervical tissue once the patient is under general anesthesia in the operating room, a hysterectomy may still
be needed. This can only be done during the same operation if the patient has given prior consent. Due to
the possible risk of cancer spread to the lymph nodes in stage 1b cancers and some stage 1a cancers, the
surgeon may also need to remove some lymph nodes from around the uterus for pathologic evaluation.
A radical trachelectomy can be performed abdominally
[57]
or vaginally
[58]
and there are conflicting opinions
as to which is better.
[59]
A radical abdominal trachelectomy with lymphadenectomy usually only requires a
two to three day hospital stay, and most women recover very quickly (approximately six weeks).
Complications are uncommon, although women who are able to conceive after surgery are susceptible to
preterm labor and possible late miscarriage.
[60]
It is generally recommended to wait at least one year before
attempting to become pregnant after surgery.
[61]
Recurrence in the residual cervix is very rare if the cancer
has been cleared with the trachelectomy.
[56]
Yet, it is recommended for patients to practice vigilant
prevention and follow up care including pap screenings/colposcopy, with biopsies of the remaining lower
uterine segment as needed (every 34 months for at least 5 years) to monitor for any recurrence in addition
to minimizing any new exposures to HPV through safe sex practices until one is actively trying to conceive.
Early stages (IB1 and IIA less than 4 cm) can be treated with radical hysterectomy with removal of the
lymph nodes or radiation therapy. Radiation therapy is given as external beam radiotherapy to the pelvis
and brachytherapy (internal radiation). Patients treated with surgery who have high risk features found on
pathologic examination are given radiation therapy with or without chemotherapy in order to reduce the
risk of relapse.
Larger early stage tumors (IB2 and IIA more than 4 cm) may be treated with radiation therapy and
cisplatin-based chemotherapy, hysterectomy (which then usually requires adjuvant radiation therapy), or
cisplatin chemotherapy followed by hysterectomy.
Advanced stage tumors (IIB-IVA) are treated with radiation therapy and cisplatin-based chemotherapy.
On June 15, 2006, the US Food and Drug Administration approved the use of a combination of two
chemotherapy drugs, hycamtin and cisplatin for women with late-stage (IVB) cervical cancer treatment.
[62]

Combination treatment has significant risk of neutropenia, anemia, and thrombocytopenia side effects.
Hycamtin is manufactured by GlaxoSmithKline.
Prognosis
Prognosis depends on the stage of the cancer. With treatment, the 5-year relative survival rate for the
earliest stage of invasive cervical cancer is 92%, and the overall (all stages combined) 5-year survival rate is
about 72%. These statistics may be improved when applied to women newly diagnosed, bearing in mind
that these outcomes may be partly based on the state of treatment five years ago when the women studied
were first diagnosed.
[63]

With treatment, 80 to 90% of women with stage I cancer and 50 to 65% of those with stage II cancer are
alive 5 years after diagnosis. Only 25 to 35% of women with stage III cancer and 15% or fewer of those with
stage IV cancer are alive after 5 years.
[64]

According to the International Federation of Gynecology and Obstetrics, survival improves when
radiotherapy is combined with cisplatin-based chemotherapy.
[65]

As the cancer metastasizes to other parts of the body, prognosis drops dramatically because treatment of
local lesions is generally more effective than whole body treatments such as chemotherapy.
Interval evaluation of the patient after therapy is imperative. Recurrent cervical cancer detected at its
earliest stages might be successfully treated with surgery, radiation, chemotherapy, or a combination of the
three. Thirty-five percent of patients with invasive cervical cancer have persistent or recurrent disease after
treatment.
[66]

Treatment Options by Stage
Stage 0 (Carcinoma in Situ)
Stage IA Cervical Cancer
Stage IB Cervical Cancer
Stage IIA Cervical Cancer
Stage IIB Cervical Cancer
Stage III Cervical Cancer
Stage IVA Cervical Cancer
Stage IVB Cervical Cancer
A link to a list of current clinical trials is included for each treatment section. For some types or stages of
cancer, there may not be any trials listed. Check with your doctor for clinical trials that are not listed here
but may be right for you.
Stage 0 (Carcinoma in Situ)
Treatment of stage 0 may include the following:
Loop electrosurgical excision procedure (LEEP).
Laser surgery.
Conization.
Cryosurgery.
Total hysterectomy for women who cannot or no longer want to have children.
Internal radiation therapy for women who cannot have surgery.
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with
stage 0 cervical cancer. For more specific results, refine the search by using other search features, such as
the location of the trial, the type of treatment, or the name of the drug. General information about clinical
trials is available from the NCI Web site.
Stage IA Cervical Cancer
Treatment of stage IA cervical cancer may include the following:
Total hysterectomy with or without bilateral salpingo-oophorectomy.
Conization.
Modified radical hysterectomy and removal of lymph nodes.
Internal radiation therapy.
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with
stage IA cervical cancer. For more specific results, refine the search by using other search features, such as
the location of the trial, the type of treatment, or the name of the drug. General information about clinical
trials is available from the NCI Web site.
Stage IB Cervical Cancer
Treatment of stage IB cervical cancer may include the following:
A combination of internal radiation therapy and external radiation therapy.
Radical hysterectomy and removal of lymph nodes.
Radical hysterectomy and removal of lymph nodes followed by radiation therapy plus
chemotherapy.
Radiation therapy plus chemotherapy.
Stage IIA Cervical Cancer
Treatment of stage IIA cervical cancer may include the following:
A combination of internal radiation therapy and external radiation therapy plus chemotherapy.
Radical hysterectomy and removal of lymph nodes.
Radical hysterectomy and removal of lymph nodes followed by radiation therapy plus
chemotherapy.
Stage IIB Cervical Cancer
Treatment of stage IIB cervical cancer may include internal and external radiation therapy combined with
chemotherapy.
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with
stage IIB cervical cancer. For more specific results, refine the search by using other search features, such as
the location of the trial, the type of treatment, or the name of the drug. General information about clinical
trials is available from the NCI Web site.
Stage III Cervical Cancer
Treatment of stage III cervical cancer may include internal and external radiation therapy combined with
chemotherapy.
.
Stage IVA Cervical Cancer
Treatment of stage IVA cervical cancer may include internal and external radiation therapy combined with
chemotherapy.
Stage IVB Cervical Cancer
Treatment of stage IVB cervical cancer may include the following:
Radiation therapy as palliative therapy to relieve symptoms caused by the cancer and improve
quality of life.
Chemotherapy.
Clinical trials of new anticancer drugs or drug combinations.