K. C. Giede, MD, FRCP, Clinical Fellow in Gynecologic Oncology, Princess Margaret Hospital, University Health Network, University of Toronto, Toronto, ON; Associate Professor of Gynecology and Obstetrics, University of Saskatchewan, Saskatoon, SK.
A. M. Oza, MD, FRCP, Co-Director, Drug Development Program; Co-Chair, NCIC Clinical Trials Group, Princess Margaret Hospital, University Health Network, University of Toronto, Toronto, ON.

The purpose of this article is to review the incidence, prognosis, and management of metastatic cervical cancer in older patients. A literature review was conducted using the key words cervical cancer, elderly, and metastatic disease. There were no studies found specific to metastatic cervical cancer in older patients. The incidence of cervical cancer over the age of 65 remained significant with a greater proportion of older patients presenting with metastatic disease. We found good phase III data on the use of chemotherapy for metastatic cervical cancer. We reviewed data supporting the safe use of chemotherapy and radiotherapy in older patients.
We conclude that older patients are more likely to present with metastatic cervical cancer then their younger counterparts. Standard therapies should not be withheld on the basis of age, though management should focus on palliation.

Key words: cervical cancer, older patients, metastatic.

Nimesh P. Nagarsheth, MD, Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Science, Mount Sinai Medical Center, New York, NY, USA.

Jamal Rahaman, MD, Division of Gynecologic Oncology, Department of Obstetrics,
Gynecology and Reproductive Science, Mount Sinai Medical Center, New York, NY, USA.

The diagnosis and management of cervical cancer in the older patient presents important challenges to the geriatrician and oncologist. Cervical cancer almost never occurs in older patients who have followed screening guidelines and have had a history of normal Pap smears prior to age 70. Early stage disease is best managed by radical surgery. While radical pelvic surgery has been proven safe in selected older patients, the current management of early cervical cancer depends upon the resources available to the geographical location. For locally advanced cervical cancer and early stage patients who are not surgical candidates, radiation therapy with concurrent platinum-based chemotherapy is the standard of care. Radiation therapy and chemotherapy can be safely administered to older patients once allowances are made for age-related physiologic changes. Advanced age should not be used as justification to alter the standard of care for the management of cervical cancer.

Key words: cervical cancer, older adults, chemotherapy, radiation therapy, radical pelvic surgery.