Small-Cell Cervical Cancer: Symptoms, Causes, and Treatment.

Published 7 months ago

Small-cell cervical cancer is a rare type of cervical cancer that grows and spreads quickly. The outlook for people with small-cell cervical cancer is poorer than with other more common types of cervical cancer.

The American Cancer Society estimates that 13,960 diagnoses of cervical cancer will be given in 2023. Most of these diagnoses will be squamous cell carcinomas, which are the most common types of cervical cancer.

There are rarer types of cervical cancer as well. One of these rare cervical cancers is small-cell cervical cancer (SCCC). SCCC only accounts for up to 3% of all cervical cancer diagnoses.

Continue reading to discover more about SCCC. We’ll cover its symptoms, risk factors, and how it’s diagnosed and treated.

What is small-cell cervical cancer?

SCCC is a rare cervical cancer, and it’s a type of neuroendocrine cancer.

Neuroendocrine cancer starts in hormone-producing cells called “neuroendocrine cells.” These cells are found throughout the body, including in the cervix.

SCCC is an aggressive type of cervical cancer, which means that it typically grows and spreads quickly.

Other types of cervical cancer

Compared with SCCC, other types of cervical cancer are much more common. These include:

squamous cell carcinoma, which represents up to 90% of cervical cancers and starts in the cells that line the outer part of your cervix
adenocarcinoma, which begins in the mucous-producing cells of the cervix
mixed carcinomas, which are a type of cervical cancer that has features of both squamous cell carcinoma and adenocarcinoma

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What are the symptoms of small-cell cervical cancer?

The symptoms of SCCC are similar to those of other types of cervical cancer.

It’s possible not to have any noticeable symptoms when cervical cancer is in its early stages. When symptoms are present, they may include:

atypical vaginal bleeding, such as bleeding that happens:
- between periods
- after menopause
- after sex
periods that last longer and are heavier than is normal for you
vaginal discharge that may contain blood
pelvic pain, including pain during sex

If cervical cancer has spread outside of the cervix, it may cause symptoms such as:

blood in your urine
trouble with urinating or having a bowel movement
swelling in your legs
feelings of fatigue or weakness
loss of appetite
unintended weight loss
pain at the site of spread

What causes small-cell cervical cancer and who’s at risk for it?

Cancer in general happens when cells in your body have changes in their DNA that cause them to grow uncontrollably.

Because SCCC is very rare, its specific risk factors aren’t well defined. As with other types of cervical cancer, an common risk factor for SCCC is having a human papillomavirus (HPV) infection.

HPV is a virus that’s transmitted through direct contact, typically during sex. Because many HPV infections are asymptomatic, it’s possible to have HPV and not know it.

SCCC has been closely linked with a specific type of HPV called “HPV18.” HPV18 is a high-risk type of HPV that’s linked to precancerous and cancerous changes in the cervix.

Recommended screening for cervical cancer

The U.S. Preventive Services Task Force recommends the following screening schedule for people assigned female at birth by age:

Ages 21 to 29: Get a Pap smear once every 3 years.
Ages 30 to 65: Get a Pap smear once every 3 years, get a high-risk HPV (hrHPV) test every 5 years, or get a Pap smear plus hrHPV test every 5 years.

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How is small-cell cervical cancer diagnosed?

If the results of cervical cancer screening are atypical or you have symptoms of cervical cancer, a doctor will order a colposcopy. A colposcope is a device with a light and magnifying lens that lets the doctor closely examine your cervix.

The doctor will add a vinegar-based solution to your cervix to help flag any suspicious areas. A biopsy is often done during a colposcopy.

A biopsy sample can be viewed under a microscope to check for signs of cervical cancer. If cancer is found, tests can be done to determine the type of cancer and its characteristics.

If your condition is diagnosed as SCCC, additional tests can help to stage your cancer. Tests can include:

imaging tests, such as:
- an MRI scan
- a PET-CT scan
- an ultrasound
- a chest X-ray
blood tests such as a complete blood count and metabolic panel
other visual examinations such as a cystoscopy and sigmoidoscopy

Small-cell cervical cancer stages

The staging of SCCC is similar to other types of cervical cancer. Each stage is subdivided further based on specific criteria, but the basic stages of cervical cancer are:

Stage 1: Cancer is found only in the cervix.
Stage 2: Cancer has spread to the upper part of the vagina or to the tissue around the uterus.
Stage 3: Cancer has spread to the lower part of the vagina, pelvic wall, or both. Cancer may also be found in nearby lymph nodes or may be causing kidney problems.
Stage 4: Cancer has spread to more distant areas of the body, which is called “metastasis.” Research from 2022 found that two of the most common metastatic sites for SCCC are the lungs and liver.

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How is small-cell cervical cancer treated?

Because it’s very rare, the ideal treatment of SCCC isn’t clearly defined. An SCCC treatment plan can include one or a combination of:

Surgery: Surgery for SCCC often involves what’s called a “radical hysterectomy.” Nearby lymph nodes may be removed as well. Sometimes chemotherapy may be given after surgery, which is referred to as “adjuvant chemotherapy.”
Chemotherapy: Chemotherapy for SCCC is typically given as a combination of the drugs etoposide and cisplatin.
Radiation therapy: Radiation therapy for SCCC may be given externally or internally (brachytherapy). Sometimes, chemotherapy and radiation therapy are used together, a treatment which is called “chemoradiation.”

What’s the outlook for someone with small-cell cervical cancer?

SCCC is an aggressive type of cervical cancer, which means that it’s more likely to have already spread to the lymph nodes or more distant tissues by the time of diagnosis.

The outlook for people with SCCC is worse than other types of cervical cancer, even in its early stages. A 2016 study found that, compared with people who have more common cervical cancers, SCCC was related to a higher risk of death at all stages.

A 2022 study notes that the 5-year overall survival for SCCC is between 31% and 51%. The 5-year overall survival rate refers to the percentage of people with SCCC that are alive 5 years after a diagnosis.

Researchers have found that the following factors are associated with a worse outlook for people with SCCC:

being an older age at the time of SCCC diagnosis
having a more advanced stage of SCCC at diagnosis
receiving radiation therapy as your initial treatment

Takeaway

SCCC is a rare but aggressive type of cervical cancer, and it starts in hormone-producing cells called “neuroendocrine cells.”

The outlook for people with SCCC is typically poor. As with many cancers, the outlook is better when the cancer is identified and treated early. Talk with a doctor if you have concerning symptoms such as atypical vaginal bleeding or pelvic pain.

It’s also important to receive regular screenings for cervical cancer. Additionally, because HPV infection is one of the known risk factors for SCCC, receiving the HPV vaccine helps to protect against SCCC and other cervical cancers.