This information covers the following topics:

• What is small cell cervical cancer?
• Symptoms of small cell cervical cancer
• Diagnosis and staging of small cell cervical cancer
• Treatment for small cell cervical cancer
• Useful links

What is small cell cervical cancer?

Small cell cervical cancer, which is also called small cell neuroendocrine carcinoma, is a very rare and aggressive type of cervical cancer. Each year, it affects less than 3 in every 100 (3%) women diagnosed with cervical cancer [1]. The cancer develops in cells within the neuroendocrine system in the body, which is a system made up of gland cells and nerve cells [1]. The name ‘small cell’ describes the way that these cancer cells look under the microscope, usually they are small with an enlarged nucleus (the part of the cell that contains the genetic material).

Since small cell cervical cancer is very rare, little research has been done into what causes this cancer. There is some evidence that, like other types of cervical cancer, it may be linked to infection with high-risk HPV in some cases [2], but further research needs to be done to confirm this.

Small cell cervical cancer can also be found in combination with other more common forms of cervical cancer, such as squamous cell carcinoma and adenocarcinoma [2]. But small cell cervical cancer is faster growing and more aggressive than the other types of cervical cancer [3].

Symptoms of small cell cervical cancer

Small cell cervical cancer is more likely to present without symptoms than other types of cervical cancer. However if it does present with symptoms they are the same as those of other cervical cancers, including:

• Abnormal vaginal bleeding: during or after sexual intercourse, or between periods
• Post menopausal vaginal bleeding, if you are not on hormone replacement therapy or have stopped it for six weeks
• Unusual vaginal discharge
• Discomfort or pain during sex
• Lower back pain.

If you are experiencing any or all of the above symptoms, or you are concerned about any new symptom you should make an appointment to see your GP as soon as possible. If you are experiencing symptoms, such as abnormal bleeding, you will need to be examined by a practice nurse or GP and should undergo a direct vaginal examination, including the cervix, in order to rule out the very small chance that a cancer is present. Remember, these symptoms can be associated with many other conditions that are not cancer related.

There is some evidence to suggest that on average women diagnosed with small cell cervical cancer tend to be younger than those diagnosed with other cervical cancers [4]. If you are under 25 and concerned about any of the above symptoms there are guidelines, published by the Department of Health in England, for young women (aged 20–24) who are experiencing abnormal bleeding, which you can download. You might find it helpful to take these along with you to discuss with your health care professional at your appointment.

For more information on symptoms or advice for under 25s please visit our information pages.

Diagnosis and staging of small cell cervical cancer

Most small cell cervical cancers are diagnosed when women seek medical attention about symptoms. Therefore, it is particularly important that you make an appointment with your GP as soon as possible if you experience any of the above symptoms, particularly bleeding during or after sexual intercourse, or between periods, or an unusual vaginal discharge.

Small cell cervical cancer is staged in the same way as small cell lung cancer, as either limited disease (when the cancer has not spread beyond the cervix) or extensive disease (when the cancer has spread beyond the cervix). It may also be staged in the same way as other types of cervical cancer, this is called FIGO staging. You can get more information on FIGO staging on our staging information pages. The extent of the disease is assessed using CT and MRI scans. Understanding the extent of the disease helps to determine what the best treatment options will be.

Treatment for small cell cervical cancer

Treatment for small cell cervical cancer is more aggressive and involves more chemotherapy than treatment for more common types of cervical cancer. It also usually involves a combination of both radiotherapy and chemotherapy, with chemotherapy often given both before and after radiotherapy treatment; it may also be given during, in order to increase the effectiveness of the radiotherapy (sometimes known as chemoradiotherapy or chemoradiation).

Surgery may be performed if the tumour is considered ‘operable’ under the same criteria used for non-small cell cervical cancers. If the tumour is not considered ‘operable’ then surgery will not be part of the treatment.
Like with other forms of cervical cancer, the exact treatment pathway depends on the extent of the cancer. Your medical team will work together to decide which treatment combination is best for you.

For more information on treatment of cervical cancer, please visit our treatment pages.

Since small cell cervical cancer is such a rare cancer it can be difficult to find other women who have been affected. If you are going through a diagnosis or treatment for small cell cervical cancer and you would like to connect with other women who have been affected, please contact us on [email protected] and we will do our best to put you in touch with someone.

Useful links

Jo’s Cervical Cancer Trust Forum

Many women use our Forum to both seek and give support and talk to other women who understand what they are going though.
www.www.jostrust.org.uk/forum

Small and Large Neuroendocrine Cervical Cancer

Organisation dedicated to providing support, education, campaigning and awareness building about small and large neuroendocrine cervical cancer
http://necervix.com

Cancer Research UK

Cancer Research UK has more information on small cell cervical cancer and the treatment options that may be offered to you.
www.cancerresearchuk.org/about-cancer/cancers-in-general/cancer-questions/small-cell-cancer-of-the-cervix

Macmillan

The Macmillan cancer support specialists can give you more information and support about small cell cervical cancer on their free Helpline 0808 808 00 00.

References

1. Cancer Research UK, 2012. Small cell cancer of the cervix. www.cancerresearchuk.org/about-cancer/cancers-in-general/cancer-questions/small-cell-cancer-of-the-cervix. Accessed: 06.07.2016.
2. Gupta T et al, 2014. Highly aggressive small-cell neuroendocrine carcinoma cervix: a rare case report. Indian Journal of Clinical Practice 25(4), 367–370. Accessed: 06.07.2016.
3. Small & Large Cell Neuroendocrine Cervical Cancer, 2014. FACT Sheet on Neuroendocrine Carcinoma of the Cervix. http://necervix.com/wp-content/uploads/2014/02/FACT-PT-NEC-Cx.pdf. Accessed: 06.07.2016.
4. Huang CY, 2011. Incidence of cervical cancer and age-specific survival of small cell cervical carcinoma in Taiwan. Acta Obstetricia et Gynecologica Scandinavica 90(12), 1342-1349.