Treatment of Stage IV Cervical Cancer

If you have Stage IVA cervical cancer, you will probably be treated with high-dose internal and external radiation therapy.

• Internal radiation therapy (brachytherapy) - This technique uses a small pellet of radioactive material placed directly in the vagina near the tumor or in the tumor using thin needles. The radioactive material is left in place while you stay in the hospital for 1 to 3 days. This process might be repeated. This treatment is also known as interstitial radiation therapy.
• External beam radiation therapy (EBRT) - Radiation from outside the body is focused on the cancer. Most people are treated with EBRT 5 days a week for 5 to 7 weeks as an outpatient. This schedule helps protect healthy cells and tissues by spreading out the total dose of radiation.

You will probably also be treated with chemotherapy (cisplatin with or without 5-fluorouracil or other chemotherapy drugs) to increase the effectiveness of radiation therapy.

• Platinol^® (cisplatin) - Cisplatin is a platinum compound chemotherapy drug that acts like an alkylating agent. It stops cancer cells from growing, which kills them. Cisplatin is given by an injection into the vein over at least 1 hour. Your dose depends upon the type of cancer you have, your size, and how well your kidneys work.
• Adrucil ^® or Efudex ^® (5-fluorouracil or 5-FU) - 5-FU belongs to the group of chemotherapy drugs known as antimetabolites. 5-FU prevents cells from making DNA and RNA, which stops cells from growing. 5-FU is given as a shot in the vein over 5 to 10 minutes, over 20 to 60 minutes, or continuously over 22 to 24 hours for 1 to 4 days or longer. The treatment can be repeated weekly, every other week, or every 3 weeks. The dose depends on your size.

If you have Stage IVB cervical cancer, you may be treated with radiation therapy to relieve your cancer symptoms.

You might also be treated with chemotherapy, possibly cisplatin or carboplatin along with another drug, such as paclitaxel, gemcitabine, topotecan, ifosfamide, or vinorelbine. A recent study found that the combination of cisplatin and topotecan can be effective.

• Camptosar ^® (irinotecan) - Irinotecan belongs to a group of chemotherapy drugs known as topoisomerase inhibitors. Irinotecan stops cancer cells from growing by preventing the development of elements necessary for cell division. Irinotecan is given by an injection in a vein over 90 minutes weekly for 3 weeks and then one off or once every 3 weeks. The dose depends on your size, your age, whether you have had radiation to your abdomen/pelvis, how well your liver is working, your blood counts, and whether you have had any side effects such as diarrhea.
• Gemzar ^® (gemcitabine) - Gemcitabine belongs to a group of chemotherapy drugs known as antimetabolites. Gemcitabine prevents cells from making DNA and RNA, which stops cancer cells from growing; this kills the cancer cells. Gemcitabine is given as an injection in a vein over 30 minutes. It is usually given once a week for 3 weeks, followed by 1 week off. The dose depends on your size, your blood counts, and the cancer being treated.
• Hycamtin ^® (topotecan) - Topotecan hydrochloride belongs to the group of chemotherapy drugs known as topoisomerase inhibitors. Topotecan hydrochloride stops cancer cells from growing by preventing the development of elements necessary for cell division. Topotecan hydrochloride is given by a shot in the vein over 30 minutes for 3 to 5 days; this is usually repeated every 3 to 4 weeks. The dose and schedule depend on your weight, your blood counts, how well your kidneys are working, and the type of cancer being treated.
• Ifex ^® (ifosfamide) - Ifosfamide belongs to a group of chemotherapy drugs known as alkylating agents. Ifosfamide stops cancer cells from growing and kills them. Ifosfamide is given as an injection in a vein over 1 to 24 hours for a few days. The dose depends on your size, how well your kidneys are working, your blood counts, and the type of cancer being treated.
• Navelbine ^® (vinorelbine) - Vinorelbine tartrate belongs to the group of chemotherapy drugs known as plant (vinca) alkaloids. Vinorelbine tartrate stops cells from dividing, which kills them. Vinorelbine tartrate is given by an injection in the vein over 5 to 10 minutes. The dose depends on your weight, how well your liver is working, your blood counts, and the type of cancer being treated.
• Paraplatin ^® (carboplatin) - Carboplatin is a platinum chemotherapy drug that belongs to a group of drugs known as alkylating agents. It stops cancer cells from growing, which kills them. Carboplatin is given as an injection in the vein over 15 to 60 minutes. The dose depends upon your size, but may be lowered or not given if your blood counts are low. It can also be given as an infusion into a vein over 24 hours or directly into the peritoneal cavity in advanced ovarian cancer.
• Taxol^® or Onxol^® (paclitaxel) - Paclitaxel belongs to a group of chemotherapy drugs known as taxanes. It is also called a mitotic inhibitor because it affects cells during mitosis (cell division). It stops cells from dividing, which kills them. Paclitaxel is given by an injection into a vein, usually over a 3-hour period, every 3 weeks. Sometimes, smaller doses are given once a week over shorter periods. The dose depends on your weight, how well your liver works, the side effects you have, and how often the medicine is given.

This content has been reviewed and approved by Myo Thant, MD.