Kathryn E. Vinson, MS, CCRC

Stage 4 Cervical Cancer – Remember in Dirty Rotten Scoundrels when Steve Martin says that ladies have it easier – after all – we have fewer prostate problems? Well, he was right on the prostate issue, obviously; however, we ladies do have our own specific problems in the form of breast (yes, men do get breast cancer too), ovarian, endometrial, and cervical cancers. What I think is perhaps the scariest part of these “lady cancers” is their propensity to be silent.

The nursing mother that feels a lump, but thinks is just a swollen milk duct.

The woman that has always had heavy or irregular periods, so doesn’t recognize the abnormal bleeding.

One of these terrifying cancers, cervical cancer, is very sneaky. With symptoms not varying tremendously from stage 1 to stage 4, it is easy to see how it can progress virtually unnoticed.

Symptoms of Cervical Cancer

In its early stages, cervical cancer can be difficult for patients to identify, but its symptoms can include:

• Abnormal vaginal bleeding – such as bleeding between periods or after intercourse
• Pain during intercourse
• Vaginal bleeding after menopause

The best way to catch cervical cancer in its earliest stages is to have regular Pap tests done by your physician. Pap tests look for abnormal cells, sometimes referred to as dypslasias. Many physicians will also order an HPV test, which will look for the presence of that virus in the cervical cells. For more information about HPV and cervical cancer, take a look at our article “Vaccinating Against Cancer.”

Types of Cervical Cancer

There are two main types of cervical cancer: squamous cell carcinoma (which accounts for roughly 90% of all cervical cancers) and adenocarcinoma. The main difference in these cancers is where the dysplasia originates – on the outside of the cervix where it meets the vagina, the exocervix (squamous cell carcinoma), or on the inside, canal-like portion of the cervix known as the endocervix (adenocarcinoma). Mixed cell cervical cancer is possible, but far less common that the single cell types.

Cervical Cancer Survival Rates

As with other cancers, the survival rate of cervical cancer is highest when it is caught early, with the stage 4 cervical cancer survival rate being as low as 15%. Five-year survival rates for all cervical cancer stages are seen below:

StageSurvival Rate0 (pre-cancerous lesions)93%1A/1B93%/80%2A/2B63%/58%3A/3B35%/32%4A/4B16%/15%

In stage 4A cervical cancer, the disease has spread to the bladder or rectum, but has not yet infiltrated the lymph nodes or organs in other areas of the body; stage 4B cervical cancer sees the disease in other areas of the body besides the pelvis.

Treatment Options by Stage

Treatment options for cervical cancer vary by stage, as is the case with most cancers. The stages of cervical cancer indicate how deep the cancer has reached in the cervix, pelvic cavity, beyond the pelvic organs, and to the lymph nodes. Keep in mind these are typical treatments, and actual treatments may vary based on a variety of factors.

• Stage 0 – In the earliest stage of all cervical cancers, the cancer is found only on the surface of the cervix, and has not yet invaded any deeper tissues. This allows doctors to simply remove the cancerous cells via cryosurgery, laser surgery, or simple hysterectomy (for more aggressive cancers).
• Stage 1 – These cancers need to be treated more aggressively, as they are moving deeper into the cervical tissue. The main choice in treatment at this stage is whether the woman wants to maintain her fertility. If fertility is not an issue, doctors can proceed with hysterectomy, and possibly external beam radiation. If the woman wants to maintain her fertility, the doctors can opt for a cone biopsy. If no cancerous cells are seen at the edges of the biopsy, it is deemed to have clean margins, and this can be followed by careful monitoring. Another procedure, called trachelectomy can be ordered. This procedure removes the cervix and upper part of the vagina, but preserves fertility.
• Stage 2 – Stage 2A treatment is similar to treatments in late stage 1 and can vary by the wish to maintain fertility. Sadly, any progression beyond stage 2A often requires hysterectomy, chemotherapy, and radiation.
• Recurrent cervical cancer – when cervical cancer comes back, treatment will depend on where the recurrence shows up. When it occurs in the pelvis, surgery may be useful to remove tumors. Chemo and radiation may be ordered; however, their use is to prolong/improve quality of life; sadly they aren’t thought to be curative at this point. For patients with recurrent cervical cancer or stage 4 cervical cancer, clinical trials may be an option. Please see our page on clinical trials for information on how to find trials enrolling in your area.

As always, much love, abundant blessings, and many prayers to all of the cancer warriors and their families.

Sources:
https://www.cancer.org/cancer/cervical-cancer/treating/by-stage.html
https://www.cancercenter.com/cervical-cancer/stages/tab/tnm-system/