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 neuroendocrine system's hormone-producing cells. This type is around 2 out of 100 (2%) of cervical cancers.
Small cell cancers tend to grow quickly. They are more likely to spread to the lymph nodes or other body areas than the more common types of cervical cancer.
Like other types of cervical cancer, small cell cervical cancer is linked to the human papillomavirus (HPV), mainly types 16 or 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 when you're not having a period. For example, bleeding after sex or after the menopause. Other symptoms include:
- discharge
- pain in the area between the hip bones (pelvic pain)
- pelvic pressure
Small cell cervical cancer that has spread to other parts of the body can cause symptoms such as:
- weight loss
- high calcium levels causing tiredness, bone pain or constipation
- low sodium levels causing nausea and vomiting, headaches, confusion, or muscle weakness.
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 look at the cervix closely. During the test, the colposcopist uses a special type of magnifying glass (a colposcope). They take samples (biopsies) of any abnormal areas on your cervix. 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
Small cell cervical cancer develops from the same cell type as small cell lung cancer. So, 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 differs from 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 (early stage disease)
You usually have surgery for a small tumour in the cervix. This means removing your cervix, womb (radical hysterectomy), and 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 at the same time as radiotherapy (chemoradiotherapy). Or you might have carboplatin and etoposide followed by pelvic radiotherapy.
You usually have up to 6 cycles of chemotherapy. Each cycle lasts 3 weeks.
Extensive disease (advanced stage disease)
If your tumour is more than 5cm you might have chemotherapy first (neoadjuvant chemotherapy). This might be etoposide combined with one of the following:
- cisplatin
- carboplatin
You might have 4 to 6 cycles. Each cycle lasts 3 weeks.
If your cancer has responded well to chemotherapy and the tumour has shrunk to less than 4cm, you might have a radical hysterectomy and lymph node dissection. You will usually have radiotherapy afterwards.
If your cancer hasn’t shrunk enough after neoadjuvant chemotherapy to have surgery, you might have high dose chemoradiotherapy. This will be with external radiotherapy and 
.
Coping with cervical cancer
Coping with a cancer diagnosis 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 decide 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 others who know what you are going through.
Follow up
You will have regular follow 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 tell your doctor if anything worries you.
How often you have follow ups depends on your 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.
