Treatment Options for Metastatic Cervical Cancer

Q: Treatment Options for Metastatic Cervical Cancer

Hello, Feng： <br>1. <br>First of all, imaging studies have their limitations; positron emission tomography (PET) may not detect very small metastatic cancer cells, and the same applies to computed tomography (CT). <br>Therefore, clinical assessment is usually still necessary. <br

Please provide information on the treatment for metastatic cervical cancer?

Dear Doctor: My mother was diagnosed with stage IIB cervical cancer in September 2017 and underwent chemotherapy (cisplatin) and radiation therapy (both internal and external).
In March 2020, after discovering brain metastasis, she underwent surgery to remove the brain tumor.
In 2021, she experienced shortness of breath while walking, and upon examination, pleural effusion was found, confirming cancer cell metastasis.
I would like to ask the doctor: 1.
Over the past few years, my mother has been regularly returning for check-ups, and her radiation oncologist has been conducting PET scans for monitoring.
I have heard that PET scans are less sensitive for brain tumors, but why were they unable to detect lung metastasis earlier? Would a CT scan be necessary for earlier detection? 2.
My mother is 65 years old this year; is stage IV cancer no longer curable? Is chemotherapy worth pursuing? The attending physician mentioned that if she is unwilling to undergo chemotherapy, palliative care is recommended, but is there really no chance at all? 3.
Besides chemotherapy, I have seen discussions in online groups about "Keytruda," a drug approved by the FDA for cervical cancer.
I wonder if this medication is also available in Taiwan?

Feng, 30~39 year old female. Ask Date: 2022/12/14

Dr. Lin Xinwang reply Obstetrics and Gynecology

Hello, Feng:
1.
First of all, imaging studies have their limitations; positron emission tomography (PET) may not detect very small metastatic cancer cells, and the same applies to computed tomography (CT).
Therefore, clinical assessment is usually still necessary.
Based on your description, the presence of brain metastases indicates that the disease has already disseminated throughout the body, although other organs may not show obvious lesions at the time of examination.
Hence, regular follow-up examinations are also necessary to monitor whether the disease continues to worsen.
2.
In stage IV cancer, if the patient's condition is manageable, treatment can delay disease progression; however, it cannot cure the disease.
Therefore, the treatment goals focus on prolonging life and alleviating discomfort caused by the disease.
For example, chemotherapy may delay tumor progression, thereby reducing pleural effusion, which can help alleviate the patient's shortness of breath caused by the fluid accumulation and improve their quality of life.
3.
Jisuda (Atezolizumab) is an immunotherapy drug that can be used for cervical cancer.
It is already available in Taiwan, and it is advisable to consult the patient's attending physician or seek the opinion of a hematologist-oncologist.

Reply Date: 2022/12/14

More Info

Understanding treatment options for metastatic cervical cancer is crucial, especially for patients like your mother who have undergone various treatments and are facing significant challenges. Let's address your questions one by one.

1. Detection of Metastasis: You mentioned that your mother has undergone regular follow-ups with PET scans. While PET scans are useful for detecting metabolic activity in tumors, they can sometimes miss smaller lesions or those that are less metabolically active, particularly in the brain or lungs. CT scans are often more sensitive for certain types of lesions, especially in the lungs. Therefore, it is advisable to incorporate CT imaging into the follow-up regimen, particularly for lung metastasis, as it can provide clearer anatomical details and help in early detection of new lesions.

2. Stage IV Cervical Cancer and Treatment Options: At stage IV, the prognosis can be challenging, and the focus often shifts from curative intent to palliative care. However, this does not mean that treatment options are exhausted. Chemotherapy can still be beneficial in managing symptoms and potentially slowing disease progression. The decision to pursue chemotherapy should be made in consultation with her oncologist, weighing the potential benefits against the side effects. If chemotherapy is not desired, palliative care options, including pain management and supportive therapies, can significantly improve quality of life. It is essential to have open discussions with her healthcare team about her goals and preferences.

3. Use of New Medications: Regarding "Gisuda" (also known as pembrolizumab), it is an immunotherapy drug that has shown promise in treating certain types of cervical cancer, particularly in cases with high PD-L1 expression or specific genetic markers. As of now, it is essential to check with local oncologists or cancer centers in Taiwan to see if this medication is available and applicable for your mother’s specific case. The availability of newer treatments can vary by region, and clinical trials may also be an option worth exploring.

In addition to these points, it is crucial to consider the overall well-being of your mother. Engaging in supportive care, including nutritional support, psychological counseling, and possibly integrating complementary therapies, can enhance her quality of life.
Moreover, the role of clinical trials should not be overlooked. Many patients with advanced cancer may qualify for trials that offer access to cutting-edge therapies that are not yet widely available. Discussing this option with her oncologist could provide additional avenues for treatment.

In conclusion, while metastatic cervical cancer presents significant challenges, there are still treatment options available. Regular imaging, considering chemotherapy or palliative care, exploring new medications, and possibly engaging in clinical trials are all critical components of managing her condition. It is essential to maintain open communication with her healthcare team to navigate these options effectively.

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