User:Terry Geddas/Neuroendocrine Carcinoma of the Cervix

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Neuroendocrine Carcinoma of the Cervix is best defined seperately:

Neuroendocrine: Of, relating to, or involving the interaction between the nervous system and the hormones of the endocrine glands.

Carcinoma:  An invasive malignant tumor derived from epithelial tissue that tends to metastasize to other areas of the body.

Classification
Neuroendocrine carcinoma affects many different parts of the body. “An endocrine tumor is a growth that affects the parts of the body that secrete hormones. Because an endocrine tumor arises from cells that produce hormones, the tumor itself can produce hormones and cause serious illness. A Neuroendocrine tumor originates from the hormone-producing cells of the body’s neuroendocrine system, which consists of cells that are a cross between traditional endocrine cells (or hormone-producing cells) and nerve cells. Neuroendocrine cells are found throughout the body in organs, such as the lungs and gastrointestinal tract, and perform specific functions, such as regulating the air and blood flow through the lungs and controlling the speed at which food is moved through the gastrointestinal tract” (cancer.net).

In the cervix, it is a rare, but very aggressive form of cervical cancer. In its early stages, neuroendocrine carcinoma is asymptomatic (not showing or producing indications of a disease or other medical condition). In more advanced stages, symptoms of Neuroendocrine carcinoma of the cervix are: abnormal vaginal bleeding, increased vaginal discharge, and pelvic pain, painful urination, pain during sex, tiredness, leg swelling, and backache. When left untreated, metastasis or even death may occur.

Types
There are two types of neuroendocrine carcinomas of the cervix: small-cell and large-cell.

Small-Cell Carcinoma (SCC)
Small-cell carcinoma (SCC) of the cervix is an exceptional member of the neuroendocrine group of cervical carcinomas that is frequently intermixed with a non-SCC component in the form of an adenocarcinoma (ADC) or squamous carcinoma. SCC is an aggressive tumor that spreads very quickly early on; this leads to a fatal clinical course and minimal chances of survival for the patients. It resembles small cell cancer of the lungs and accounts for less than 3 % of all cervical cancers. Like small cell cancer in the lungs, the lymph nodes play a major role in spreading the cancer throughout the body. SCC begins in the inner part of the cervix and is very hard to diagnose. Due to the involvement of the lymph nodes, in its late and fatal stages, it can spread beyond the pelvic region to other organs. The prevalence of the lymph nodes involvement and that systemic metastasis is much higher in SCC than in non-SCC, thus more complex treatments are required for SCC. “Because of the distinct natural history of small cell carcinoma of the uterine cervix, and because patients with this condition are considered to have a systemic disease, the treatment strategies for this disease are different from those of other carcinomas” (ajronline.org). According to a report (Yang, et. al. 2003), multi-agent chemotherapy and pelvic radiotherapy before surgery (radical hysterectomy) followed by chemotherapy after surgery produce better outcomes for its patients. Unfortunately, Pap smears alone are not adequate for the diagnosis of SCC; patients may be misdiagnosed with non-SCC on the basis of Pap smear results alone. Imaging studies are necessary for proper diagnosis; it has been proposed that MRI is the highest standard for the imaging evaluation of uterine cervical cancer. The major problem with early accurate diagnosis of SCC is the limitation of routine screening, namely the Pap smear.

Large-Cell Carcinoma (LCC)
Large cell carcinoma (LCC), like small cell carcinoma (SCC) is very rare and only accounts for about 5% of all cervical cancers. Early-stage LCC are extremely aggressive and difficult to diagnose due to the sub-mucosal location of the tumor and intact overlying mucosa. As with SCC, in LCC early cases are asymptomatic. Later stages present with irregular bleeding, vaginal spotting, discharge, and pelvic pain. The basis for treatment of LCC tumors is derived from therapy used for SCC; when diagnosed, multimodal therapy should be considered just as with SCC. “The treatment guideline for small cell neuroendocrine tumor can be used for the treatment of large cell neuroendocrine carcinoma, which is as follows. For localized operable cancer, radical hysterectomy with LN dissection and adjuvant chemo-radiotherapy; for locally advanced cancer limited to the pelvis, concurrent chemo-radiotherapy; and for metastatic cancer, palliative chemotherapy. Cisplatin (60-75 mg/m2) plus etoposide (80-120 mg/m2/day for 3 to 5 days) or paclitaxel is the most commonly used chemotherapy. Other regimens may include Carboplatin (AUC 5-6), Irinotecan (50-60 mg/m2), Cyclophosphamide, Doxorubicine, or Vincristine in different combinations.” (ispub.com)

Risks/Causes
With neuroendocrine carcinoma of the cervix, as with all types of cervical cancer, the risks for women include: HPV, HIV, cigarette smoking, sexual behaviors (i.e. multiple partners, history of STD’s such as Herpes or Chlamydia), having multiple pregnancies, age, income, race (Jewish women are less likely due to their partners being circumcised), and genetics.

Stages
The stages are all similar as well:

•	Stage 0 - full-thickness involvement of the epithelium without invasion into the stroma (carcinoma in situ)

•	Stage I - limited to the cervix

o	IA - diagnosed only by microscopy; no visible lesions

	IA1 - stromal invasion less than 3 mm in depth and 7 mm or less in horizontal spread

	IA2 - stromal invasion between 3 and 5 mm with horizontal spread of 7 mm or less

o	IB - visible lesion or a microscopic lesion with more than 5 mm of depth or horizontal spread of more than 7 mm

	IB1 - visible lesion 4 cm or less in greatest dimension

	IB2 - visible lesion more than 4 cm

•	Stage II - invades beyond cervix

o	IIA - without parametrial invasion, but involve upper 2/3 of vagina

o	IIB - with parametrial invasion

•	Stage III - extends to pelvic wall or lower third of the vagina

o	IIIA - involves lower third of vagina

o	IIIB - extends to pelvic wall and/or causes hydronephrosis or non-functioning kidney

•	IVA - invades mucosa of bladder or rectum and/or extends beyond true pelvis

•	IVB - distant metastasis

(Wikipedia: Cervical Cancer)

Recurrences
Cervical cancers can recur with symptoms of vaginal bleeding and/or discharge, pelvic pain, pain in the back and legs, leg swelling (edema), chronic cough and weight loss. It can recur in the vagina, pelvis, lymph nodes, lung, or liver. “If radiation was not given previously, recurrences that are confined to the pelvis may be treated with external beam radiation with chemotherapy and intracavitary or interstitial radiation therapy. If radiation therapy was already given, the only option is the removal of the vagina, uterus, and the bladder and/or rectum with the creation of an artificial bladder-a pelvic exenteration. The five-year survival rate after a pelvic exenteration is about 50 percent.” (womenscancercenter.com) Chemotherapy is useful in women with recurrent tumors which cannot be removed surgically or in women with metastatic diseases.

Treatments
-Chemotherapy

-Radiation therapy

-Surgery:

-->Removal of organs

-->Radical hysterectomy