Understanding Metastatic and Recurrent Cervical Cancer: Diagnosis, Staging, and Surveillance

Understanding Metastatic and Recurrent Cervical Cancer: Diagnosis, Staging, and Surveillance

What should cervical cancer patients to know about diagnosis, staging, and surveillance? Expert Dr. Shannon MacLaughlan from University of Illinois discusses metastatic cervical cancer versus recurrent cervical cancer, cervical cancer testing, and proactive patient advice to help ensure optimal care.

[ACT]IVATION TIP

“… when you are completing your treatment at the time of diagnosis, I want you to ask your doctor for your treatment summary. A treatment summary is in layman’s terms, meaning language that any of us can understand that describes to you what your diagnosis was, it recaps the treatment that you experienced, it explains what impacts that treatment could have on your health, and it outlines what your surveillance strategy should be.”

 

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Transcript:

Lisa Hatfield:

Dr. MacLaughlan, what exactly is recurrent or metastatic cervical cancer, and are there tests that are used to confirm a recurrence?

Shannon MacLaughlan:

So the word metastatic means that the cancer has spread beyond the organ where it started. So in this circumstance, metastatic cervical cancer means that it has spread away from the cervix. That could mean including other parts of the uterus. It could mean getting into lymph nodes. It could mean invading into the bladder or to the rectum, or it could mean spreading to other parts of the body. So when we say metastatic cervical cancer, that means that the cancer is existing someplace other than just the cervix. Someone can be diagnosed with metastatic cervical cancer at the time of diagnosis.

Now, recurrent cervical cancer means that someone has been treated for cervical cancer, and then the cancer comes back. If and when a cancer comes back, it can come back in different locations. Cancer likes to break its own rules, making it unpredictable. And one of our challenges in treating and curing it, but a recurrent cervical cancer can come back exactly where it was the first time, back in the cervix or back in the pelvis, or it can recur in a lung or in a lymph node or in bones sometimes in other parts of the body.

So there’s a distinction between recurrent cervical cancer and metastatic cervical cancer, though sometimes it’s subtle. So, when someone is diagnosed with cervical cancer for the first time, there are standard tests that should be done to evaluate the extent of the disease. We need to know the size and shape of the tumor in the context of the size and shape of the person that requires a pelvic exam. Pelvic exam includes a speculum, that’s the metal, sometimes plastic instrument that we use inside a vagina to visualize the cervix.

And then the examiner will use a hand inside the patient, inside the patient’s vagina and rectum to evaluate how much space the tumor is taking up in the person’s body and what other organs are involved. At the same time, a biopsy of that tumor is necessary, not just to prove the diagnosis of cervical cancer, but to be able to evaluate the molecular makeup of the tumor. We want to characterize the grade of the tumor. We want to look for particular proteins and whether or not they are expressed.

Some of those proteins, for example, PD-L1 or HER2 is one that we’re starting to look at. We want to be able to look at those under the microscope, because that can inform treatment options for the patient. The other tests that we request of the patient are imaging, so that I think best practice and the most sensitive tools are an MRI of the pelvis, which allows us to correlate images of the tumor and what it is involving. We correlate that with what we have been able to examine with the patient. And then the most sensitive tool for evaluating whether that cancer has gotten into another part of the body is a PET-CT.

Now, PET-CT is a special kind of CT scan. A CT scan can be adequate in super early cancer diagnoses. However, most patients diagnosed with cervical cancer deserve to have a PET-CT as that’s the most sensitive tool, meaning, again, an oversimplification, but it means it’s most accurate. It’s our best chance at not missing something. And we want all of the information possible to lay out a treatment plan that meets the specific patient’s needs. A PET-CT is different from a regular CT scan, because patients get a contrast through their veins. That contrast is made up of sugar, and the sugar has a little radionucleotide connected to it. And that’s helpful to radiologists and to clinicians, because cancer is not very efficient at metabolizing sugar. And the sugar will linger in cancer cells, and the little radionucleotide on the sugar makes that cancer light up on the screen.

Using those tools, the exam, the biopsy, the MRI, the PET-CT, we assign a stage, and we talk to the patient about what treatment is, one, most likely to lead to cure, and two, what’s most appropriate for the patient and their goals. Now, in the case of a recurrence, there are different tools that we use, and it’s highly variable upon what the patient experienced with her diagnosis up front and how not only the tumor responded to the treatment but how the patient responded to the treatment. And so I bring this up because my action tip for this topic is that when you are completing your treatment at the time of diagnosis, I want you to ask your doctor for your treatment summary.

A treatment summary is in layman’s terms, meaning language that any of us can understand that describes to you what your diagnosis was, it recaps the treatment that you experienced, it explains what impacts that treatment could have on your health, and it outlines what your surveillance strategy should be. So I want to be clear that a patient is a survivor the moment they are diagnosed with any kind of cancer. That being said, there is a significant change in the patient experience when you complete treatment.

With your oncologist, the emphasis is going to be on surveillance, and that surveillance is going to mean, in the case of cervical cancer, it’s going to mean that ideally you are being seen by a gynecologic oncologist every few months for the first couple of years. Those visits should include a pelvic exam. The reason I emphasize the importance of a gynecologic oncologist here is that your body is never the same after cancer treatment.

And in your ongoing surveillance, you want your provider to be someone who is experienced with taking care of patients who have experienced what you have been through so that they can help you understand what your new normal is, what isn’t normal for you, etcetera. There are other tests that we sometimes do. Sometimes we do cytology or scrapings at the top of the vagina, and sometimes we do CT scans or PET-CTs, but it’s all very dependent upon what the person experienced at the time of diagnosis.


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