Treatments for stage 4 cervical cancer

The following are treatment options for stage 4 cervical cancer. Your healthcare team will suggest treatments based on your needs and work with you to develop a treatment plan.

Chemoradiation is a main treatment for stage 4A cervical cancer. Chemotherapy is given during the same time period as radiation therapy to make the radiation therapy more effective.

Cisplatin or cisplatin plus 5-fluorouracil (Adrucil, 5-FU) is the chemotherapy that is used. If cisplatin is used, it is usually given one time each week during the radiation therapy schedule. If cisplatin plus 5-FU is used, it is usually given every 4 weeks during radiation therapy.

Brachytherapy (a type of internal radiation therapy) is usually given during and after external radiation therapy.

You may be offered radiation therapy for stage 4 cervical cancer. Radiation therapy may be external radiation therapy, brachytherapy or both. For stage 4A cervical cancer, radiation therapy is often given with chemotherapy, but in some cases it may be used alone as the main treatment.

For stage 4B cervical cancer, radiation therapy may be used to relieve pain, stop bleeding or control other symptoms of advanced cervical cancer (called palliative therapy).

Chemotherapy may be offered for stage 4B cervical cancer to relieve pain or control the symptoms of advanced cervical cancer (called palliative chemotherapy).

Chemotherapy drugs used to treat stage 4B cervical cancer are used alone or in combination and include:

• cisplatin
• carboplatin (Paraplatin, Paraplatin AQ)
• paclitaxel (Taxol)
• topotecan (Hycamtin)
• gemcitabine (Gemzar)
• 5-fluorouracil (Adrucil, 5-FU)
• ifosfamide (Ifex)
• docetaxel (Taxotere)
• irinotecan (Camptosar)
• mitomycin (Mutamycin)
• vinorelbine (Navelbine)
• epirubicin (Pharmorubicin)
• doxorubicin (Adriamycin)

The most common chemotherapy drug combinations used to treat cervical cancer are:

• cisplatin and ifosfamide
• cisplatin and paclitaxel
• cisplatin and gemcitabine
• cisplatin and topotecan
• paclitaxel and topotecan

You may be offered targeted therapy for stage 4B cervical cancer. The most common targeted therapy drug used to treat cervical cancer is bevacizumab (Avastin). It is usually given in combination with chemotherapy.

Immunotherapy helps to strengthen or restore the immune system's ability to fight cancer. You may be offered immunotherapy for stage 4 metastatic cervical cancer.

If chemotherapy was used to treat metastatic cervical cancer but it didn't respond or the cancer comes back, then you may be offered cemiplimab (Libtayo).

Pembrolizumab (Keytruda) may also be offered for metastatic cervical cancer in combination with chemotherapy. It is sometimes given with the targeted therapy drug bevacizumab (Avastin).

Find out more about immunotherapy for cervical cancer.

You may want to consider a type of care to make you feel better without treating the cancer itself. This may be because the cancer treatments don’t work anymore, they’re not likely to improve your condition or they may cause side effects that are hard to cope with. There may also be other reasons why you can’t have or don’t want cancer treatment.

Talk to your healthcare team. They can help you choose care and treatment for advanced cancer.

Talk to your doctor about clinical trials open to women with cervical cancer in Canada. Clinical trials look at new ways to prevent, find and treat cancer. Find out more about clinical trials.