The first 60 days: Locally advanced cervical cancer
Locally advanced cervical cancer has grown beyond the cervix or into the pelvic lymph nodes but not to distant organs. It is treated with cisplatin chemotherapy given alongside external radiotherapy and brachytherapy, and two recent trials have improved on that: adding pembrolizumab, and giving six weeks of chemotherapy before the radiotherapy starts. Below, week by week, is what OnCo's record of Locally advanced cervical cancer says about the first two months: the order is typical, the timing is yours to ask about. Sections appear only where the record has something to say. Orientation, not medical advice.
What happens now
Staging tests establish exactly what and where the cancer is. Everything else follows from the answers.
Pelvic MRI and whole-body PET-CT; surgical para-aortic staging in selected cases.
Ask which of these were tested and what the results were; see the report reader for what each value means.
These specialties appear in the standard of care for this cancer. In most centres they meet weekly as a tumour board to agree each plan; you can ask when yours was discussed and what was decided.
- RadiologistNamed in the standard of care for: Staging.
- SurgeonNamed in the standard of care for: Staging, Central pelvic recurrence after radiotherapy.
- Medical oncologistNamed in the standard of care for: Standard chemoradiation, High-risk disease (node-positive IB2 to IIB, III to IVA), Induction option, Not recommended and 1 more.
- Clinical oncologist (radiotherapy)Named in the standard of care for: Standard chemoradiation, High-risk disease (node-positive IB2 to IIB, III to IVA), Induction option, Not recommended and 1 more.
A second opinion from a centre that treats many similar cases is normal, not rude; the standard of care tells you what to compare it against.
Each row is a setting from the standard of care, in the order it usually arises. Not all will apply to you; your stage and biomarkers decide which do. The guideline grade, where recorded, says how strong the evidence is.
Pembrolizumab with chemoradiation and for up to two years afterwards (KEYNOTE-A18).
Weekly cisplatin with pelvic external-beam radiotherapy followed by image-guided brachytherapy, completed within eight weeks.
Six weekly cycles of carboplatin-paclitaxel before chemoradiation (INTERLACE), particularly where immunotherapy is not available.
Adjuvant carboplatin-paclitaxel after chemoradiation gave no benefit in OUTBACK.
Pelvic exenteration in selected patients; re-irradiation with brachytherapy or protons in specialist centres.
Generated from this cancer's standard of care, biomarkers and open problems. Take the group that matches where you are. To tick, add your own and print, open the one-page appointment sheet.
Newly diagnosed
- What is my exact diagnosis, stage, and grade, and which tests established them?Everything else follows from an accurate stage and subtype.
- Which biomarkers have been tested on my tumour (for example FIGO 2018 stage including nodal status on PET-CT, Tumour volume on MRI, Para-aortic node involvement, Haemoglobin before and during radiotherapy, HPV type and p16), and what were the results?These results decide eligibility for targeted therapy, immunotherapy, and trials.
- Which subtype is my cancer, and does that change the recommended treatment?Recognised subtypes for this cancer include FIGO 2018 stage IB3 and IIA2, Stage IIB, Stage IIIA to IIIB.
- Is germline (inherited) genetic testing recommended for me or my family?Inherited variants can change treatment and matter for relatives.
Standard chemoradiation
- For my situation (standard chemoradiation), which of the standard options do you recommend and why?Guideline options include: Weekly cisplatin with pelvic external-beam radiotherapy followed by image-guided brachytherapy, completed within eight weeks.
- Am I a candidate for Cisplatin, and what side effects should I expect?Knowing the expected toxicities helps you plan work, family, and supportive care.
High-risk disease (node-positive IB2 to IIB, III to IVA)
- For my situation (high-risk disease (node-positive ib2 to iib, iii to iva)), which of the standard options do you recommend and why?Guideline options include: Pembrolizumab with chemoradiation and for up to two years afterwards (KEYNOTE-A18).
- Am I a candidate for Pembrolizumab, Cisplatin, and what side effects should I expect?Knowing the expected toxicities helps you plan work, family, and supportive care.
- How do the results of KEYNOTE-A18 / ENGOT-cx11 / GOG-3047 apply to someone like me?Trial populations differ from individual patients; ask how closely you match.
Induction option
- For my situation (induction option), which of the standard options do you recommend and why?Guideline options include: Six weekly cycles of carboplatin-paclitaxel before chemoradiation (INTERLACE), particularly where immunotherapy is not available.
- Am I a candidate for Carboplatin, Paclitaxel / nab-paclitaxel, and what side effects should I expect?Knowing the expected toxicities helps you plan work, family, and supportive care.
- How do the results of INTERLACE apply to someone like me?Trial populations differ from individual patients; ask how closely you match.
Not recommended
- For my situation (not recommended), which of the standard options do you recommend and why?Guideline options include: Adjuvant carboplatin-paclitaxel after chemoradiation gave no benefit in OUTBACK.
- Am I a candidate for Carboplatin, Paclitaxel / nab-paclitaxel, and what side effects should I expect?Knowing the expected toxicities helps you plan work, family, and supportive care.
- How do the results of OUTBACK / ANZGOG 0902 / GOG-0274 apply to someone like me?Trial populations differ from individual patients; ask how closely you match.
Staging
- For my situation (staging), which of the standard options do you recommend and why?Guideline options include: Pelvic MRI and whole-body PET-CT; surgical para-aortic staging in selected cases.
Central pelvic recurrence after radiotherapy
- For my situation (central pelvic recurrence after radiotherapy), which of the standard options do you recommend and why?Guideline options include: Pelvic exenteration in selected patients; re-irradiation with brachytherapy or protons in specialist centres.
Any stage
- Are there clinical trials I could join, for example of HPV circulating tumour DNA to guide cervical cancer therapy, Pembrolizumab, Proton therapy, MRD / molecular residual disease testing?Trials are how the next standard of care is set; asking early keeps options open.
- Would a second opinion at a high-volume centre change anything, and can you help arrange it?Rare or high-stakes decisions benefit from a centre that treats many similar patients.
- What supportive care (symptom control, nutrition, exercise, mental health, financial help) is available from the start?Supportive care improves quality of life and helps patients complete treatment.
- I read that “Whether induction chemotherapy and pembrolizumab should be combined”. How does that affect my plan?Open problems are where trials and second opinions matter most.
- I read that “Access to brachytherapy and PET-CT where most patients live”. How does that affect my plan?Open problems are where trials and second opinions matter most.
Much of what helps in the first weeks is free if you know to ask: testing, helplines, rides and lodging, second opinions, trial travel.
- Locally advanced cervical cancer: the full pageLocally advanced cervical cancer has grown beyond the cervix or into the pelvic lymph nodes but not to distant organs. It is treated with cisplatin chemotherapy given alongside external radiotherapy and brachytherapy, and two recent trials have improved on that: adding pembrolizumab, and giving six weeks of chemotherapy before the radiotherapy starts.
- One-page appointment sheetYour questions, the words you may hear, what to bring, and space for the answers. Print it.
- Treatment sequencingWhich treatment tends to follow which, line by line.
- NavigatorStandard of care for your stage, what you have tried, and trials near you.
- Laparoscopy (keyhole surgery): Operating or looking inside the abdomen through a few small holes with a camera, instead of one large incision.
- Radiotherapy: Using high-energy X-rays or particles to damage the DNA of cancer cells in a precisely aimed volume of the body.
- Chemoradiation (chemoradiotherapy, CRT): Radiotherapy given at the same time as chemotherapy, which sensitises the cancer to radiation.
Every term links to the glossary.