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Treatment for stage 1B cervical cancer

Treatment for stage 1B cervical cancer

Question

Dear OncoLink "Ask The Experts,"

My wife has been diagnosed with cervical cancer stage IB. The pathology calls it adenosquamous carcinoma and poorly differentiated. A radical hysterectomy was performed. Twenty-three lymph nodes were removed and are free of cancer. The tumor depth was 0.6cm. The lower uterus was involved as well as the cervix engulfed. Should she have brachytherapy and chemotherapy? The doctors are giving us a variety of opinions.  


Answer

Christina S. Chu, MD, Assistant Professor of the Division of Gynecologic Oncology at the University of Pennsylvania Health System, responds:

After radical hysterectomy, certain patients may be at higher risk for recurrence. Some of these risk factors include large tumor size (more than 4 cm), cancer spread to pelvic lymph nodes, presence of tumor in the lymphatic and vascular spaces, deep cervical stromal invasion, and surgical margins involved with tumor. For patients with cancer spread to the pelvic lymph nodes, external beam radiation to the pelvis may lead to a modest improvement in prognosis. Patients with negative lymph nodes who have additional risk factors may also benefit from radiation therapy after surgery. Many physicians would recommend external beam radiation, and some might also recommend brachytherapy, depending on the situation. Strong consideration may be given to using chemotherapy in conjunction with radiation, especially for those patients with locally advanced tumors (stage IB, II, III or IV disease), or for those with early disease (stage I to IIA) who also have risk factors for recurrence.