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 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 Rates Squamous 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 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)
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 • 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)
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 email@example.com Nancy Cole, Assistant Project Manager firstname.lastname@example.org