Thursday, April 14, 2011

Breaking the rules

I'm learning that it's not the first round of cervical cancer that kills you. And indeed, my mother was given chemo and radiation and was cancer-free for about four years. Then it came back and she died.

I'm breaking the rules by doing this, but it's my curiosity. I make a living off it, and I know how to look things up. I can't seem to stop myself.

Recurrence is a bitch

Although there have been important advances in the management of women with cervical cancer, the optimal treatment for patients with locally recurrent and metastatic disease is still problematic, and there are relatively few randomized trials to guide treatment decisions. This paper reviews the approach to management of patients who relapse after primary treatment for cervical cancer. Patients who are still potentially curable with radical treatment are identified, and the various treatment strategies are discussed. However, most women are treated with palliative intent...

A 10%-20% recurrence rate has been reported following primary surgery or radiotherapy in women with stage IB-IIA cervical tumors with no evidence of lymph node involvement...

The majority of recurrences occur within 2 years of diagnosis, and the prognosis is poor, with most patients dying as a result of uncontrolled disease. In a retrospective review of over 500 patients treated at the University of Kentucky, 31% of patients developed tumor recurrence, 58% of these recurred within 1 year and 76% within 2 years.

In this series, only 6% of patients with recurrent tumor survived 3 years. While it is possible to identify subgroups of patients with recurrent cervical cancer who have a substantially better prognosis than this and in whom the objective of treatment is cure, 50%-60% of patients have disease situated beyond the pelvis, which, with few exceptions, is incurable, and treatment is given with palliative intent, as is the case for most patients with pelvic side wall involvement by recurrent cervical cancer..

Most patients who relapse locally after primary radiotherapy are not candidates for further radiotherapy, and pelvic exenterative surgery is the only potentially curative approach for these patients. The 5-year survival rate for patients who undergo total pelvic exenteration ranges from 30%-60%...

Son of a bitch!

And doesn't total pelvic exenteration sound fun!

Invented in 1948, it's still the only treatment option for women "with centrally recurrent cervical, vaginal, or vulvar cancers". And hey, since 1948, they've improved the surgery to the point where "operative mortality rates" are a paltry 3-5%, and "major perioperative complication rate" is only 30-44 per cent.

And how long can you live with all your lower organs removed and the openings sewed shut?

"The overall 5-year survival rate in patients who successfully undergo the procedure is 20-50%."

I think the real question for me is how long would I want to live like that. Certainly not five years.



Anonymous said...

I don't know, Hilary.

I had a "total abdominal hysterectomy- bilateral salpingo-oophorectomy, and pelvic node dissection". This is standard treatment for endometrial cancer, stage 1 (my diagnosis). My surgery/recovery was not exactly fun, but a damn sight better than "total pelvic exteneration" (shudder).

Now, I know cervical cancer is different from endometrial cancer, but I wonder why a total hysterectomy is not an option for you? Could it be just because the Dr.'s are trying to do the least invasive procedure now, to try and save certain bits? The plus side of a total hysterectomy is that there is now no chance of uterine or ovarian cancer, because those "bits" are gone for good. Please investigate all your options.

Wishing you well,

BillyHW said...


Seraphic said...

Okay, that stuff is just gross.

Anonymous said...


In a few hours I make my biannual visit to the surgeon for the PSA update, and um, exam.

I awoke suddenly at 2:54, eyes wide open, staring into the dark, wondering "what if?..." The question wasn't even on the radar when I went to bed.

How apropos for a Friday of Lent; mementoing my mori whether I want to or not. Yay.