Cervical Cancer

Source:

SEER’s Training Web Sitehttp://training.seer.cancer.gov.index.html

Background

Cervical cancer occurs when normal cells in the cervix change into cancer cells. Normally takes several years to happen, but

can also happen in a very short period of time. Each year, about 11,000 women in the

United States learn that they have cancer of the cervix.

About 3,670 women will die from cervical cancer in the US during 2007.

Risk Factors

Relationship to sexual intercourse Many partners during lifetime Frequent intercourse Early onset of sexual activity First pregnancy in teenage years Multiparity (several children) by mid 20s

Risk Factors

Venereal diseases Genital herpes (Herpes Simplex Virus type 2--HSV-

2) Human papilloma virus (HPV)

Race-incidence higher in blacks/Hispanics Low socioeconomic status Poor genital hygiene Cigarette smoking Peak incidence over 40 years

Signs & Symptoms

Post-coital or unexplained vaginal spotting or bleeding

Persistent vaginal discharge Pelvic pain

Statistics

Once a leading cause of cancer death for American women.

Rate declined by 74% between 1955-1992.

Main reason – increased use of Pap test.Death rate continues to decline nearly 4%

a year.Source: American Cancer Society

Survival Rates

Adenocarcinomas of the cervix have a worse prognosis than squamous cell cancers. 

Five-Year Survival RatesSquamous Cell Carcinoma Adenocarcinoma

Stage 0 100% 100% Stage I 60 - 85% 65 - 75% Stage II 40 - 60% 30 - 40% Stage III up to 40% 20 - 30% Stage IV < 15% < 10%

(from the National Cancer Institute's Physician Data Query system, July 2002)

5-year survival rates by stage:

Below are listed the chances a woman will live 5 years after treatmentfor the various stages of cervical cancer. These are overall survival figures, so they also include women who die of other causes. Thenumbers are approximate and come from women treated more than 10 years ago. (source – ACS)

IA

IBI

IB2

IIA/B

IIIA/B

IV

Above 95%

Around 90%

Around 80%-85%

Around 75%-78%

Around 47%-50%

Around 20%-30%

Pap Test Result Abbreviation Also Known As Tests and Treatments May Include

Atypical squamous cells–undetermined significance

ASC–US   HPV testing

Repeat Pap test

Colposcopy and biopsy

Estrogen cream

Atypical squamous cells–cannot exclude HSIL

ASC–H   Colposcopy and biopsy

Atypical glandular cells AGC   Colposcopy and biopsy and/or endocervical curettage

Endocervical adenocarcinoma in situ

AIS   Colposcopy and biopsy and/or endocervical curettage

Low-grade squamous intraepithelial lesion

LSIL Mild dysplasia Colposcopy and biopsy

Cervical intraepithelial neoplasia–1 (CIN–1)

High-grade squamous intraepithelial lesion

HSIL Moderate dysplasia Colposcopy and biopsy and/or endocervical curettage

Severe dysplasia CIN-2 Cin-3 Carcinoma insitu (CIS)

Further treatment with LEEP, cryotherapy, laser therapy, conization, or hysterectomy

Cervix Anatomy

Cervix Anatomy

Pre-cancerous conditions

Squamous intraepithelial lesion (SIL) - abnormal growth of squamous cells on the surface of the cervix.

‘Lesion' = area of abnormal tissue.‘Intraepithelial' = abnormal cells present

only in the surface layer of the cervix. Cell changes are low grade or high grade,

depending on involvement and how abnormal the cells are.

Pre-cancerous conditions:Low-grade SIL

Early changes in the size, shape, and number of cells that form the surface of the cervix.

May be called mild dysplasia or cervical intraepithelial neoplasia 1 (CIN 1).

Most often occurs in women between the ages of 25 and 35 but can appear in other age groups as well.

Pre-cancerous conditions:High-grade SIL

Large number of precancerous cellsOnly involves cells on the surface of the

cervix Will not become cancerous and invade

deeper layers of cervix for months/yearsAlso may be called moderate or severe

dysplasia, CIN 2 or 3, or carcinoma in situ Develop most often between the ages of

30 and 40 but can occur at other ages

Synonyms for In Situ Carcinoma

Bowen's disease, Stage 0, CIN grade III, confined to epithelium, intraepidermal, intraepithelial, involvement up to but not including the basement

membrane, noninfiltrating, noninvasive, no stromal involvement, papillary noninfiltrating

Cervical Cancer

If abnormal cells spread deeper into the cervix or to other tissues or organs, the disease is then called cervical cancer, or invasive cervical cancer.

Occurs most often in women over the age of 40.

Slightly over 20% are diagnosed when over 65. (ACS)

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Tissue types (histology)

Squamous cell carcinoma - arises mostly in lower third of cervix; 90%  of all cervical cancers; also called epidermoid carcinoma

Subcategorized as keratinizing or non-keratinizing, - further subcategorized as large cell or small cell nonkeratinizing

Adenocarcinoma (10% of all cases) Adenosquamous carcinoma (mixed

adenocarcinoma and epidermoid carcinoma); Small cell carcinoma; Sarcoma (cell types vary); Lymphoma (many cell types)

Treatment: Surgery

For Stage 0 (80% of all cervical cancers), treatment options include cryotherapy, laser therapy, conization, or hysterectomy.

Survival rates for radiation therapy and radical surgery are virtually equal for Stage I and IIA cervical cancer. Surgical treatment: permits preservation of ovarian function, takes less time, maintains the function of the vagina, decreases the possibility of recurrence locally, allows more accurate staging by assessing pelvic and

para-aortic lymph nodes, and eliminates the possibility of radiation-induced injury to

other pelvic organs.

Treatment: Radiation Therapy

Preferred treatment for higher stage cervical cancers, with or without adjuvant chemotherapy.

Pre-operative intracavitary (brachytherapy) or postoperative external beam radiation (XRT) is frequently used for treating extensive cervical cancer.

Radioactive phosphorus (P32) may be used for intraperitoneal treatment of metastases.

Treatment: Chemotherapy

Drugs Commonly Used for Treating Cervical Cancer Hydroxyurea Cisplatin (under clinical evaluation) Ifosfamide alone or in combinations (under

clinical evaluation) 5-FU with or without mitomycin C (for

recurrence)

Missouri Cancer RegistryHelp Line: 800-392-2829

Help interpreting path report for staging http://mcr.umh.edu

For further information, please contact:Sue Vest, Project Managervests@health.missouri.edu

Nancy Cole, Assistant Project Managercolen@health.missouri.edu