Types of Cervical Cancer.

Cervical cancers can be divided by cell type, and the majority will fall into three main categories. Treatment and outlook in most cases depend more on factors like staging than on cellular subtype.

Cervical cancer is the fourth most common malignancy among women worldwide. It begins in the cells of the cervix, which is the internal organ connecting the uterus to the vaginal canal.

Cervical cancers can be grouped into different cellular subtypes, each named for the variety of cells in which the cancer began.

The majority of cervical cancers are classified as squamous cell carcinomas, but some are adenocarcinomas. A small minority are mixed or other rare cellular types. Approximately 99% of cervical cancers, regardless of cell type, are triggered by human papillomavirus (HPV) infection.

Treatment and outlook for people with cervical cancer typically depend on factors like staging (the size of the tumor and whether the cancer has spread beyond the cervix) rather than cell type.

This article reviews the primary cellular subtypes of cervical cancer.

Squamous cell carcinoma of the cervix (SCCC)

Up to 90% of cervical cancers are squamous cell carcinomas, although incidence has dropped in recent decades.

SCCC begins in flat squamous cells that line the cervix. It’s caused by persistent HPV infection and takes several years to develop.

Most people will acquire HPV over their lifetime. Your doctor may recommend screening for cervical cancer with HPV testing as part of your routine care.

Usually, your immune system can clear an HPV infection. But sometimes HPV persists, eventually causing precancerous lesions of the cervix.

Precancerous lesions of the cervix include cervical intraepithelial neoplasia (CIN) or carcinoma in situ (CIS). The good news is that these lesions can be detected with regular Pap smears. Your doctor can monitor or remove precancerous lesions as needed. Sometimes, precancerous lesions resolve on their own, with the help of your immune system.

But without treatment, some precancerous lesions will eventually transform into invasive cervical cancer.

Adenocarcinoma of the cervix (ACC)

Adenocarcinoma is the second most common type of cervical cancer, representing about 20% to 25% of overall cases. Unlike SCCC, the incidence of ACC is on the rise.

Adenocarcinomas begin in the glandular cells of the cervix.

Like SCCC, adenocarcinomas are triggered by persistent HPV infection. ACC develops over a period of years, arising from precancerous lesions that may be detectable on your routine Pap smear.

Adenosquamous carcinoma of the cervix (ASCC)

Occasionally, cervical cancer cells show features of both squamous cell carcinoma and adenocarcinoma. This type of cervical cancer is called adenosquamous or mixed carcinoma of the cervix.

ASCC is rare compared with squamous cell and adenocarcinomas, and incidence is declining in the United States. Similar to the more common cervical cancer subtypes, it’s also associated with chronic HPV infection and develops gradually from precancerous cervical lesions.

Glassy-cell carcinoma of the cervix (GSCC)

This rare subtype of ASCC has been studied separately. GSCC has also been linked with HPV infection. While previously reported as aggressive and associated with a worse outlook than other types of cervical cancer, recent research has shown more promising outcomes.

Rare types of cervical cancer

There are also several rarer types of cervical which are discussed below.

Neuroendocrine tumors

Including carcinoid tumors and small-cell or large-cell carcinomas, these represent approximately 1.4% of cervical cancers.

Like the more common cellular subtypes of cervical cancer, neuroendocrine cervical tumors have been linked to persistent HPV infection, particularly strain HPV-18.

Small-cell and large-cell carcinoma of the cervix tend to grow fast and spread aggressively, especially to the lymph nodes. They are more likely than other cervical cancers to be diagnosed at advanced stages.

Sarcomas

Sarcomas of the cervix represent up to 1% of cervical cancers. Sarcomas usually begin in the muscle cells of the cervix and are more likely to affect older adults. They tend to cause larger tumors and may have a worse outlook than more common cervical cancer subtypes.

Lymphomas

Primary lymphomas of the cervix are quite rare. Lymphomas arise from our white blood cells, in this case usually our B-lymphocytes. These cancers are quite treatable with chemotherapy, radiation, and surgery.

Melanomas

Melanoma of the cervix is exceedingly rare, with fewer than 100 cases reported as of one 2020 research review. Melanomas arise in pigment-producing cells, which are rare in the cervix. Cervical melanoma is often an aggressive cancer, with a poor outlook.

Frequently asked questions about cervical cancer

What is the most aggressive form of cervical cancer?

Neuroendocrine tumors of the cervix, such as small-cell carcinoma, are generally considered the fastest-growing and fastest-spreading types of cervical cancer. But treatment is still available for these cancers.

What are the odds of surviving cervical cancer?

According to the National Cancer Institute (NCI) Surveillance, Epidemiology and End Results program (SEER) database, the overall relative 5-year survival rate for all cervical cancers is 67%.

However, cervical cancer survival varies significantly by stage. For cancers diagnosed at an early stage, 5-year survival may be 91% or greater.

It’s important to remember that these survival rates reflect past data, and may not represent your individual circumstances. Your doctor can help you best understand your outlook.

Can cervical cancer be cured?

When cervical cancer is diagnosed and treated at an early stage, it may be able to be completely removed surgically. The 5-year relative survival rates for common types of early-stage cervical cancers exceed 90%.

Can cervical cancer be prevented?

Yes. Through HPV vaccination and timely gynecologic screenings, scientists hope to nearly eradicate cervical cancer.
Talk with your doctor about whether your HPV vaccination is up to date. If you or your child are age 21 or older, you should also discuss your cervical cancer screening plan.

What are the most common symptoms of cervical cancer?

Precancerous cervical lesions and early-stage cervical cancer are often asymptomatic. This is why the United States Preventive Services Taskforce (USPSTF) recommends regular gynecologic screenings for all people with a cervix beginning at age 21. Screenings may consist of Pap smears and, later, HPV testing.

Symptoms of cervical cancer include:

• unusual vaginal bleeding or spotting (between periods, after sex, or after menopause)
• changing vaginal discharge (watery, bloody, or foul-smelling)
• pain during sex
• pelvic, abdominal, or back pain
• urinary symptoms (frequency, pain, bleeding)
• difficult or painful bowel movements
• leg swelling
• fatigue

What is the most common treatment of cervical cancer?

For precancerous lesions found on routine screening, doctors may choose close monitoring or removal.

For treatment of invasive cervical cancer, doctors may recommend:

• surgery to remove the tumor and any affected lymph nodes or pelvic organs
• radiation therapy
• chemotherapy
• targeted therapy, such as pembrolizumab

These therapies may be used in combination.

Takeaway

Cervical cancer is a relatively common malignancy worldwide. It can be subclassified into different cellular types, based on the kind of cells in which the cancer originated.

The great majority of cervical cancers are squamous cell carcinomas, adenocarcinomas, or adenosquamous carcinomas. All of these subtypes share a common trigger in the human papillomavirus (HPV).

Rather than cell type, factors like cervical cancer stage, your age, and overall health are often more important when considering your treatment plan and outlook.

The good news is that you can reduce your risk of developing common types of cervical cancer by staying up to date on your HPV vaccine and routine gynecology screening visits. Talk with your doctor about cervical cancer prevention and screening.