The good news is that the majority of patients presenting with early disease (stage 1-2) and many with stage 3 disease are cured by the treatments outlined above.
Where the patient’s disease relapses in the pelvis after radiotherapy, there is a potential for cure by radical surgery such as the Wertheim hysterectomy. However, the complication rates following such surgery carried out after radiotherapy are greater and include fistulae (canals) between the vaginal and rectum on occasion. That is not to say that the risk is not worth the taking as it may be the only chance of cure, but simply that greater thought must go into the decision by both the doctor and the patient.
Conversely, the patient who relapses after surgery in the pelvis could theoretically be ‘salvaged’ by pelvic radiotherapy but once again the chances of complications must be weighed up; for example, the chance of leg swelling is greater in this situation.
For the patient who relapses after radical therapy with metastatic relapse outside the pelvis, then chemotherapy is the only logical therapy that can prolong life, as it is the only therapy that goes all around the body (surgery and radiotherapy are aimed at the pelvis only).
Chemotherapy has not had a good track record in this disease but in recent years remissions have been forthcoming in a good proportion of patients with combination drug regimens usually containing cis-platinum. Furthermore, as mentioned above, the use of cis-platinum together with radiation therapy in the radical therapy of early disease is now standard practice and has improved the cure rates in early stage disease.
In the advanced disease situation, the effects of chemotherapy are temporary but may set the cancer back for many months and so many women will elect to have the course which is reasonably well tolerated if attention to anti-emetic therapy is given. Once the disease has relapsed outside the pelvis, the outlook is ultimately very gloomy.