Small and Large Cell Cervical Cancer: Comprehensive Health Information

Small and Large Cell Cervical Cancer: A Comprehensive Guide

General Information

Small cell cervical cancer (SCCC) and large cell cervical cancer (LCCC) are rare, aggressive subtypes of cervical cancer. These conditions belong to a broader category of tumours known as neuroendocrine cancers, which originate in the neuroendocrine system—a network of hormone-producing cells that share characteristics with both endocrine (hormone) cells and nerve cells.

Key Facts:

Prevalence: While they are the most common type of neuroendocrine tumour found in the cervix, they account for less than 1% of all cervical cancers.
Cause: Unlike other types of cervical cancer, SCCC and LCCC have no established link to the Human Papillomavirus (HPV). Due to their extreme rarity, the underlying cause of these tumours is not yet fully understood.

Symptoms

Many individuals with SCCC/LCCC may not experience any initial warning signs. However, some symptoms that may occur include:

• Vaginal bleeding
• Vaginal discharge
• Bleeding after sexual intercourse

General Cervical Cancer Symptoms

In its very early stages, cervical cancer often presents without any symptoms, which is why regular cervical screening (Pap tests) is so important for sexually active women. When symptoms do appear, they can include:

• Vaginal discharge that is tinged with blood.
• Vaginal bleeding and/or pain during sexual intercourse.
• Abnormal vaginal bleeding, which may involve excessively heavy periods, bleeding between menstrual periods, or any bleeding after menopause.

• Increased frequency of urination.
• Pelvic pain.

It is vital to remember that these symptoms are not exclusively signs of cervical cancer and can indicate other health issues. Any persistent symptoms should be discussed with a doctor.

Diagnosis

An early and accurate diagnosis is crucial to determine if the cancer has spread (metastasis) and to help doctors formulate the most effective treatment plan.

Diagnosis of Small and Large Cell Cervical Cancer (SCCC/LCCC)

Most cases are diagnosed either after a patient reports symptoms or when a gynaecologist observes an abnormality on the cervix during a physical examination and proceeds with a biopsy.

Pap Test (Smear)

While SCCC/LCCC tumours can sometimes be detected via a Pap smear, it is not an ideal diagnostic method. Many women with the disease may have normal Pap smear results before the tumour is found because these rare cancers are not known to have a pre-malignant (pre-cancerous) stage.

Cervical Cancer Diagnostic Tests

If symptoms or Pap test results suggest the presence of pre-cancerous cells or cervical cancer, your doctor will conduct a physical examination and ask about your health history and lifestyle. One or more of the following tests may be used to confirm a diagnosis, check for spread, or monitor treatment effectiveness:

Colposcopy

An instrument called a colposcope (a specialised microscope) is used to examine any abnormal tissue on the cervix, vagina, or vulva more closely.

Biopsy

A small tissue sample is removed from the cervix for microscopic examination. Types include:

Punch Biopsy: Removal of tissue using forceps.
Endocervical Curettage (ECC): Scraping a tissue sample from the cervical canal using a small brush or curette.
LEEP (Loop Electrosurgical Excision Procedure): Using a thin wire loop heated by radio waves to remove cells.
Cone Biopsy: Removal of a cone-shaped sample of tissue, often requiring general or local anaesthesia, which allows a pathologist to check for abnormal cells beneath the surface.

Other Diagnostic Procedures

Cystoscopy or Proctoscopy: If there is suspicion the cancer has spread, these procedures use lighted tubes to view the inside of the bladder (cystoscopy) or the anus, rectum, and lower colon (proctoscopy).
Imaging Tests: These scans help determine the extent of the disease and may include CT scans, MRI scans, PET scans, Chest X-rays, and Ultrasounds.
Lymph Node Dissection: Removal of lymph nodes to determine if the cancer has spread to the lymphatic system.

Cervical Cancer Stages

The stage of a cancer describes the size of the primary tumour and how far it has spread in the body. The stages for cervical cancer are set by FIGO (the International Federation of Gynaecology and Obstetrics), ranging from Stage I to Stage IV, with higher numbers indicating more advanced disease that is generally more challenging to treat.

Treatment

Your doctor will recommend the best treatment options based on several factors, including the stage of the cancer, its size, whether it has spread, your age, overall health, and, if applicable, your desire to have children in the future. Treatment plans are always customised to the patient's specific needs.

Treatment for Small and Large Cell Cervical Cancer (SCCC/LCCC)

Due to the aggressive nature of SCCC/LCCC, treatment typically involves a combination of surgery, chemotherapy, and/or radiation.

Small Tumours (4 cm or less, limited to the cervix)

Treatment usually involves a radical hysterectomy and lymph node dissection, followed by combined chemotherapy and radiation. Cisplatinum and etoposide are the most common chemotherapy drugs used. A second course of chemotherapy may be given.

Larger Tumours or Metastatic Disease

SSCHRC utilises combined chemotherapy and radiation, often with additional chemotherapy. This regimen is based on data from studies of neuroendocrine lung tumours, as specific research on neuroendocrine cervical tumours is limited.

General Cervical Cancer Treatment

Surgery

For Small Pre-cancerous Lesions or Early-Stage Cancer:

Cryosurgery (Cryotherapy): Freezes and destroys pre-cancerous tissue.
LEEP: Uses an electrical current to remove pre-cancerous lesions.
Cone Biopsy: Removes all cancerous tissue; may be used when the cancer is small and fertility preservation is desired.
Hysterectomy: Removes the uterus and cervix. May be performed through the vagina or an abdominal incision. Minimally invasive laparoscopic or robotic surgery may be an option.
Bilateral Salpingo-Oophorectomy: Removal of the fallopian tubes and ovaries, often done concurrently with a hysterectomy, especially if the woman is near menopause, to lower the risk of cancer recurrence in those organs.

For Larger Cervical Cancer Lesions (Limited to the Cervix):

Trachelectomy: Surgical removal of the cervix and surrounding tissue, but not the uterus. This fertility-sparing procedure is sometimes an option for young women with tumours typically up to 2 cm.
Radical Hysterectomy: Removes the cervix, uterus, part of the vagina, the tissues next to the cervix (parametria), and nearby lymph nodes.
Sentinel Lymph Node Biopsy: Removal of the key lymph nodes where the cancer is most likely to spread initially, performed as part of the surgical resection.

Other Surgical Types:

Pelvic Exenteration: A complex surgery, typically for recurrent cancer, that removes the organs removed in a radical hysterectomy plus the bladder, vagina, rectum, and part of the colon.
Laparoscopic Retroperitoneal Lymph Node Dissection: An advanced procedure to help plan surgery and determine the extent of cancer spread.

Radiation Therapy

Radiation therapy uses focused beams of high energy to kill cancer cells, precisely targeting the tumour while minimising damage to healthy tissue. It is often used for cancers that have spread beyond the cervix or for very large lesions (greater than 4 cm). It may be used instead of surgery or after surgery to reduce the risk of recurrence.

Intensity Modulated Radiation Therapy (IMRT): Directs multiple beams of varying intensity onto the tumour to deliver the highest possible dose.
Brachytherapy: Delivers radiation internally using small radioactive materials placed as close to the tumour as possible, allowing for very high doses directly at the tumour site. High-dose brachytherapy is often performed on an outpatient basis.

Chemotherapy

Chemotherapy drugs work to kill cancer cells, control their growth, or relieve symptoms. Treatment may involve a single drug or a combination, depending on the type and growth rate of the cancer. SSCHRC provides advanced chemotherapy options and supportive care to manage side effects such as nausea and constipation.

Clinical Trials

As a leading research centre, SSCHRC offers patients access to clinical trials (research studies) of new treatments for cervical cancer. The goal is to continuously improve treatment outcomes, including tumour response and quality of life. SSCHRC's Innovative Surgery Working Group is pioneering minimally-invasive and fertility-sparing surgical strategies through groundbreaking international trials.

Furthermore, SSCHRC is working to establish a worldwide tumour registry for small and large cell cervical cancers to collect sufficient data on treatments and outcomes to eventually discover the cause of the disease and develop more effective treatments.