Cervical Cancer
Source:
SEER’s Training Web Site
http://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 19551992.
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 Rates
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Stage 0
Stage I
Stage II
Stage III
Stage IV
Squamous Cell Carcinoma
100%
60 - 85%
40 - 60%
up to 40%
< 15%
Adenocarcinoma
100%
65 - 75%
30 - 40%
20 - 30%
< 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 treatment
for the various stages of cervical cancer. These are overall survival
figures, so they also include women who die of other causes. The
numbers 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
Atypical squamous cells–
undetermined
significance
ASC–US
Also Known As
Tests and Treatments May
Include
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
High-grade squamous
intraepithelial lesion
HSIL
Mild dysplasia
Colposcopy and biopsy
Cervical intraepithelial
neoplasia–1 (CIN–1)
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 cells
Only involves cells on the surface of the
cervix
Will not become cancerous and invade
deeper layers of cervix for months/years
Also 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
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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)
http://content.Revolutionhealth.com
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 Registry
Help Line: 800-392-2829
Help interpreting path report for staging
 http://mcr.umh.edu
 For further information, please contact:
Sue Vest, Project Manager
vests@health.missouri.edu
Nancy Cole, Assistant Project Manager
colen@health.missouri.edu