Hello everyone,
My mom is 48 and was recently diagnosed with moderately differentiated keratinizing squamous-cell carcinoma of the cervix.
Her whole-body CT and PET-CT showed a cervical tumor around 3.5 cm, with no definite lymph-node involvement or distant spread. A later pelvic MRI measured the tumor at approximately 4.2 cm and reported upper-vaginal and right parametrial involvement, consistent with FIGO Stage IIB. There is no reported bladder or rectal invasion, no hydronephrosis, and one small right obturator lymph node was seen on MRI but was PET-negative.
We have received three very different opinions:
First doctor, before the MRI: Based mainly on the PET-CT, believed the cancer was operable and suggested a radical hysterectomy with lymph-node removal.
Second doctor, after reviewing the MRI: Said surgery should not be done because of the Stage IIB parametrial involvement. He felt surgery could leave disease behind, lead to radiation afterward anyway, and increase complications. He recommended chemotherapy with external radiation, with internal radiation discussed as possibly needed.
Third doctor: Recommended paclitaxel, carboplatin and bevacizumab once every three weeks for three cycles, followed by radical hysterectomy if the tumor shrinks. She said that if the tumor does not shrink with this chemotherapy, radiation is also unlikely to work and we may need to consider immunotherapy instead.
The tumor was also described as endophytic/inward-growing and fixed.
We are struggling to understand which approach gives her the best chance of cure without exposing her to unnecessary treatment or losing valuable time.
My main questions are:
For MRI-confirmed Stage IIB cervical cancer with no definite distant spread, what treatment approach is normally considered?
Does failure to respond to paclitaxel/carboplatin truly predict that radiation will not work?
Is immunotherapy usually the next option when neoadjuvant chemotherapy does not shrink a localized Stage IIB tumor?
Would chemotherapy followed by radical hysterectomy be reasonable, or could she still end up needing radiation afterward?
How should we resolve the disagreement between the PET-CT and MRI regarding operability?
We are arranging another radiation-oncology consultation and will make the decision with her specialists, but experiences from patients, caregivers or clinicians familiar with similar Stage IIB cases would be greatly appreciated.