While generally patients with a localized recurrence may be candidates for chemotherapy and/or radiation therapy if they have not received maximal radiation to the site of recurrence, patients with an isolated central pelvic recurrent disease following previous radiation therapy should be evaluated for consideration of a pelvic exenteration.
Because pelvic exenterations often require the removal of entire organs, multidisciplinary team-based care is needed to allow for the possible reconstruction of one or more of the affecting structures including bladder, bowel, vagina, pelvic floor support, and nearby vasculature. Patients should undergo imaging to rule-out distant disease (PET-CT or PET-MRI) and also undergo a pelvic MRI to characterize soft tissue/tumor in the pelvis to better describe possible affected structures. While an exenterative procedure is potentially curative, morbidity is high. Therefore, patients should be reviewed for feasibility of the procedure by a multidisciplinary team and should be in good general health and have adequate nutritional status in order to undergo this extensive procedure.
Radical hysterectomy may also be an option in carefully selected patients with small central pelvic lesions involving the uterus/cervix only. In this situation, a patient should undergo additional imaging to rule out distant disease (PET-CT or PET-MRI) and undergo a pelvic MRI to characterize soft tissue/tumor in the pelvis and if invasion involving other nearby organs is present. If further locoregional invasion is identified, the patient should be evaluated for a pelvic exenteration.
Learn more about the treatment of recurrent cervical cancer.
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Cite this: Sarah Ackroyd. Fast Five Quiz: Recurrent/Metastatic Cervical Cancer - Medscape - May 31, 2023.