Monitoring for Recurrence in Cervical Cancer Patients

Uterine cervical cancer is a type of cancer that occurs in the cells of the cervix, the lower part of the uterus that connects to the vagina. It is primarily caused by persistent infection with high-risk types of human papillomavirus (HPV).

For cervical cancer survivors, close monitoring is crucial because even after successful treatment, there is a risk of recurrence. Regular follow-up care, including pelvic exams, imaging tests, and HPV testing, allows early detection of any signs of cancer returning. Early intervention in the case of recurrence significantly improves the chances of successful treatment and long-term survival.

How Often Should Cervical Cancer Survivors Attend Follow-up Visits?

In most cases, cervical cancer patients should schedule follow-up visits every three to six months for the first two years after treatment, then annually after that, depending on their individual risk factors and their doctor's recommendations. These regular check-ups help monitor for recurrence and manage any lingering side effects of treatment.

Differentiating between treatment side effects and signs of cancer recurrence can be challenging, as both may cause symptoms like fatigue, pelvic pain, or changes in bowel or bladder habits.

However, treatment side effects often improve over time, while symptoms of recurrence may persist or worsen. New, unexplained symptoms such as unusual bleeding, persistent pain, or swollen lymph nodes should be reported to a cervical cancer doctor immediately, as they could indicate recurrence.

Common Tests to Monitor for Cervical Cancer Recurrence

During follow-up visits, various tests are performed to monitor for any signs of recurrence. These tests help detect abnormalities early, allowing for prompt intervention. Common tests include:

• Pelvic Exam: This involves a visual and physical examination of the pelvic area to check for abnormalities in the cervix, vagina, and surrounding tissues. It helps assess whether new growths or irregularities have developed since the last visit.
• Pap Smear: This test collects cells from the cervix to detect precancerous or cancerous changes. It is a key screening tool to identify any early signs of recurrence.
• HPV Test: This screening checks for high-risk strains of the human papillomavirus (HPV) that may lead to cancer recurrence. Persistent HPV infections can be a warning sign for returning cancer.
• Imaging Tests: Scans like CT, MRI, or PET can identify tumours or abnormal growths that may be undetectable during a physical exam. These tests are especially helpful in assessing areas beyond the cervix.
• Blood Tests: Certain biomarkers, like squamous cell carcinoma (SCC) antigen, can be monitored through blood tests to detect recurrence. Elevated levels may indicate the return of cancer or tumour growth.
• Colposcopy: This procedure allows for a closer examination of the cervix using a special magnifying device, allowing doctors to spot abnormal areas more precisely. A biopsy can be performed for further evaluation if suspicious tissues are found.

Why Does Cervical Cancer Recur After Initial Treatment?

Cervical cancer can return due to several factors. These include incomplete removal of cancer cells during surgery, resistance to radiation or chemotherapy, or the presence of microscopic cancer cells that were undetected and remained dormant.

Cancer cells may go undetected if they are too small to be seen on imaging scans or during initial treatment, allowing them to survive and grow later.

Possible Areas Where Cervical Cancer Can Recur

Cervical cancer can potentially return in several areas of the body, including:

• Pelvis: This area is the most common site for recurrence, often near the original tumour location.
• Lymph Nodes: Cancer cells can spread to lymph nodes in the pelvic area or elsewhere in the body.
• Lungs: Metastasis to the lungs may occur, leading to new tumours.
• Liver and Bones: In more advanced cases, cervical cancer may spread to distant organs like the liver or bones.

Signs and Treatment Options for Cervical Cancer Recurrence

Signs of cervical cancer recurrence may include persistent pelvic pain, abnormal vaginal bleeding or discharge, and changes in bowel or bladder habits. Other symptoms can involve unexplained weight loss, fatigue, swollen lymph nodes, or pain in areas where the cancer has spread, such as the back, legs, or chest.

Treatment options for cervical cancer recurrence depend on the location and extent of the recurrence. They may include:

• Surgery: If the recurrence is localised, surgery, such as pelvic exenteration, may be an option to remove the cancerous tissue.
• Radiation Therapy: High-energy radiation can target and kill recurrent cancer cells, particularly if radiation is not used extensively during initial treatment.
• Chemotherapy: Drugs that destroy cancer cells may be administered, often in combination with other treatments, especially if the cancer has spread beyond the pelvis.
• Targeted Therapy: Specific drugs target cancer cell mechanisms and may be used alongside other treatments to inhibit tumour growth.
• Immunotherapy: This treatment stimulates the body’s immune system to attack cancer cells and is considered in cases of advanced or resistant cervical cancer.

Regular monitoring and early detection are essential for cervical cancer survivors to catch any signs of recurrence and improve treatment outcomes. Additionally, awareness of potential symptoms and treatment options can help manage recurrence effectively.

For those seeking cervical cancer treatment in Singapore, Dr Quek offers follow-up services, including advanced treatments and personalised care. Call us today at +65 6479 9555 for more information on cervical cancer monitoring and treatment options.