Small and Large Cell Cervical Cancer

Small cell cervical cancer (SCCC) and large cell cervical cancer (LCCC) make up a rare subtype of cervical cancer. They are aggressive forms of a larger group of tumors called neuroendocrine cancers. These cancers occur in the hormone-producing cells of the body's neuroendocrine system, which is composed of cells that are a cross between endocrine (hormone-producing) cells and nerve cells.

Of the 11,000 new cases of cervical cancer diagnosed in the United States each year, approximately 100 cases will be small cell or large cell cervical cancer. Unlike other types of cervical cancer, SCCC and LCCC have no definitive link to the human papilloma virus (HPV). Because these tumors are so rare, the cause is not yet fully understood.

Small cell and large cell cervical cancers are the most common type of neuroendocrine tumor in the cervix, but still accounts for less than 1% of all cervical cancers.

Symptoms of Small and Large Cell Cervical Cancer

While many people with SCCC/LCCC experience no warning signs, some symptoms may include:

• Vaginal bleeding
• Vaginal discharge
• Bleeding after sexual intercourse

Diagnosis

Most cases of SCCC/LCCC are diagnosed because of symptoms, or a gynecologist notices an abnormality on the cervix during a physical exam and performs a biopsy.

Small and large cell cervical tumors can be detected with a Pap smear, but many women with this disease can have normal Pap smears before the tumor is detected. Since these cancers do not have a known premalignant state, Pap tests are an imperfect diagnostic method.

Small Cell and Large Cell Cervical Cancer Treatment

Because small and large cell cervical cancers are aggressive, treatment usually involves a combination of surgery, chemotherapy and/or radiation.

For small tumors of 4 centimeters or less, limited to the cervix, a radical hysterectomy and lymph node dissection are performed, followed by combined chemotherapy and radiation. A second round of chemotherapy may be given to some patients. Cisplatinum and etoposide are the most commonly used drugs to treat SCCC/LCCC.

For larger tumors or metastatic disease, MD Anderson is using combined chemotherapy and radiation, plus additional chemotherapy. This treatment regimen is based on data from studying neuroendocrine lung tumors, since no studies have been done to date in neuroendocrine cervical tumors. 

Clinical Trials

Because small and large cell cervical cancers are so rare, finding eligible patients to participate in clinical trials has been difficult. MD Anderson is the only institution to open a prospective Phase II study with weekly doses of Taxol^® and Avastin^®, but had to close the trial after 13 months when only three patients enrolled. We constantly strive to improve treatment outcomes, which includes tumor response and quality of life. Our cervical cancer research is designed to help us continue this mission.

MD Anderson hopes to establish a worldwide tumor registry for small and large cell cervical cancers, in an effort to collect enough data on treatments and outcomes to discover the cause of this disease and develop more effective treatments.