Small cell cancer of the cervix

Small cell cancer of the cervix is a very rare type of cervical cancer. It is a neuroendocrine cancer. These are cancers that develop in the hormone producing cells of the neuroendocrine system. Around 3 out of 100 cervical cancers (3%) are this type.

Small cell cancers tend to grow quickly. They are more likely to spread to the lymph nodes or other areas of the body compared to the more common types of cervical cancer.

Like other types of cervical cancer, small cell cervical cancer is linked to the human papilloma virus (HPV), particularly a type called HPV 18.

Symptoms

The symptoms of small cell cancer of the cervix are the same as for other types of cervical cancer. The most common symptom is bleeding from the vagina at times when you're not having a period. For example, bleeding after sex or after the menopause.

Diagnosing small cell cancer of the cervix

Depending on your symptoms, your GP may refer you to the hospital for tests or to see a specialist (gynaecologist). Small cell cancer may also be picked up through cervical screening.

Colposcopy

Colposcopy is a test to closely look at the cervix using a special type of magnifying glass (a colposcope). Your doctor or specialist nurse (colposcopist) takes samples of any abnormal areas on your cervix (biopsies). They send these to the laboratory to be looked at under a microscope.

Stage of your cancer

The stage of a cancer tells you how big it is and whether it has spread. It helps your doctor decide which treatment you need.

The tests you may have to help stage your cancer include:

• CT scan
• PET-CT scan
• MRI scan

Doctors usually use a similar staging system as for small cell lung cancer. The system is divided into:

• limited disease – the cancer is still within the cervix and hasn’t spread anywhere else
• extensive disease – the cancer has grown into areas outside the cervix, or has spread to other areas of the body

Some doctors may refer to the staging system used for the more common types of cervical cancer - the International Federation of Gynecology and Obstetrics (FIGO) staging system. There are 4 stages, numbered 1 to 4.

Stage 1 is the earliest stage when the cancer is still within the cervix. Stage 4 means the cancer has spread to the bladder or back passage (rectum), or further away such as to the liver or lungs.

Most women diagnosed with small cell cancer of the cervix have early stage disease.

Treatment

Treatment for small cell cervical cancer is different to the main types of cervical cancer.

You usually have a combination of treatments. The treatment you have depends on:

• the size of the cancer and if it has spread (the stage)
• your general health and fitness

Limited disease

You usually have surgery for a small tumour in the cervix. This means removing your cervix and womb (radical hysterectomy), and the nearby lymph nodes.

After surgery

You usually start chemotherapy once you have recovered from your operation. The chemotherapy drugs you are most likely to have are cisplatin and etoposide or carboplatin and etoposide.

You might have radiotherapy at the same time as chemotherapy.

If you can’t have surgery

You are most likely to have chemotherapy and radiotherapy together (chemoradiotherapy) if you can’t have surgery.

The chemotherapy drugs you have are usually carboplatin and etoposide or cisplatin and etoposide.

You will have the radiotherapy daily for around 5 weeks. You also have a boost of internal radiotherapy (brachytherapy) at the end of your course.

Extensive disease

For tumours that have spread into the tissue around the cervix, you are most likely to have chemotherapy and radiotherapy together (chemoradiotherapy).

If the cancer has spread to other areas of the body, such as the lungs (metastatic disease), you are more likely to have chemotherapy on its own. You may have radiotherapy afterwards to the pelvic area and possibly to areas where the cancer has spread.

Coping with cervical cancer

Coping with a diagnosis of cancer can be difficult, both practically and emotionally. It can be especially difficult if you have a rare cancer. Being well informed about your cancer and its treatment can make it easier to make decisions and cope with what happens.

Talking to other people going through a similar experience can help.

You could ask your treatment team about local support groups. Or contact relevant charities and organisations.  

Cancer Research UK’s discussion forum is a place for anyone affected by cancer. You can share experiences, stories and information with other people who know what you are going through.

Follow up

You will have regular check ups once you finish your treatment. Your doctor will examine you and ask about your general health.

This is your chance to ask questions and to tell your doctor if anything is worrying you.

How often you have check ups depends on your individual situation.

Research and clinical trials

There may be fewer clinical trials for rare types of cancer than for more common types.

It is hard to organise and run trials for rare cancers. Getting enough patients is critical to the success of a trial. The results won't be strong enough to prove that one type of treatment is better than another if the trial is too small.