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 [email protected]
Nancy Cole, Assistant Project [email protected]