ReviewNeuroendocrine tumors of the gynecologic tract: A Society of Gynecologic Oncology (SGO) clinical document
Research highlights
► Etoposide/cisplatin should be considered for early stage cervical SCC. ► Fertility sparing surgery can be considered for ovarian NETs. ► Gynecologic NETs are rare and data is limited.
Section snippets
SGO clinical document
The Society of Gynecologic Oncology (SGO) working through the Clinical Practice Committee (CPC) has developed a series of Clinical Documents designed in part to improve the overall quality of women's cancer care; reduce the use of unnecessary, ineffective or harmful interventions; as well as facilitate the optimal treatment of patients with a goal to maximize the therapeutic benefit, and minimize the risk of harm, at acceptable cost. SGO Clinical Documents remain strictly confidential and are
Methods
In 2007, at the 38th Annual Meeting on Women's Cancer, sponsored by the SGO, a subcommittee of the CPC was formed to begin development of clinical papers for subject areas where consensus was perceived as lacking. A MEDLINE search of English literature published between January 1966 and March 2011 was performed. All publications with the keywords “cervix”, “ovary”, “uterus”, and “vagina” were combined and then searched for the keyword “neuroendocrine, small cell, carcinoid” in order to develop
Small cell and large cell NECs of the cervix
In 1997, a workshop sponsored by the College of American Pathologists and the NCI proposed standardized terminology for neuroendocrine tumors of the uterine cervix [3]. The nomenclature was created as a parallel to that used for pulmonary endocrine tumors, and four categories were identified: Small cell carcinoma, large cell neuroendocrine carcinomas, typical carcinoid tumors, and atypical carcinoid tumors. Each of the four histologic categories can be associated with an in situ or invasive
Well differentiated neuroendocrine tumors (NETs): Typical and atypical carcinoids
Well differentiated NETs are thought to arise from the neural crest and have enzymatic potential. Similar to the poorly differentiated small and large cell neuroendocrine carcinomas, immunohistochemistry with well differentiated neuroendocrine markers, such as chromogranin, synaptophysin, and neuron specific enolase, can facilitate a histologic diagnosis.
Tumors that develop from the neuroendocrine tissues of the aerodigestive, gynecologic, and genitourinary tracts are called carcinoid tumors,
Summary and recommendations
Questions
- 1.
Given the high rate of metastatic spread, what is the role of surgery in the management of small cell cervical cancer? Hysterectomy is sometimes required to secure the diagnosis of small cell carcinoma of the cervix. In some cases, the limited tissue available on cervical biopsy yields only the diagnosis of a poorly differentiated carcinoma. For those patients in whom the diagnosis is known, hysterectomy can be considered for early stage disease as part of a multi-modality therapeutic
Conflict of interest statement
The authors of this review have no conflict of interests to declare.
Acknowledgments
The authors would like to thank the members of the Clinical Practice Committee with specific recognition of Dr. David Moore, Chair, Dr. Randall Gibb, Dr. Mitchell Edelson, Mary Eiken (SGO administration) and Melissa Finnegan (SGO administration).
References (121)
- et al.
Endocrine tumors of the uterine cervix: incidence, demographics, and survival with comparison to squamous cell carcinoma
Gynecol Oncol
(2003) - et al.
Small cell carcinoma of the cervix: a clinical and flow-cytometric study
Gynecol Oncol
(1991) - et al.
Revised FIGO staging for carcinoma of the cervix
Int J Gynaecol Obstet
(2009) - et al.
Large cell neuroendocrine carcinoma of the cervix: prognostic factors and survival advantage with platinum chemotherapy
Gynecol Oncol
(2011) Small cell lung cancer: are we making progress?
Am J Med Sci
(2010)- et al.
Surgical resection of limited disease small cell lung cancer in the new era of platinum chemotherapy: its time has come
J Thorac Cardiovasc Surg
(2005) - et al.
Multimodality therapy in early-stage neuroendocrine carcinoma of the uterine cervix
Gynecol Oncol
(2001) - et al.
Small cell neuroendocrine carcinoma of the cervix: outcome and patterns of recurrence
Gynecol Oncol
(2004) - et al.
Nicotine effects on proliferation and the bombesin-like peptide autocrine system in human small cell lung carcinoma SHP77 cells in culture
Lung Cancer
(2000) - et al.
Small cell neuroendocrine carcinoma of the cervix: analysis of outcome, recurrence pattern and the impact of platinum-based combination chemotherapy
Gynecol Oncol
(2009)
Prognostic factors in FIGO stage IB–IIA small cell neuroendocrine carcinoma of the uterine cervix treated surgically: results of a multi-center retrospective Korean study
Ann Oncol
Adjuvant therapy for neuroendocrine small cell carcinoma of the cervix: review of the literature
Gynecol Oncol
A potential role for intensive chemotherapy in the treatment of small cell neuroendocrine tumors of the cervix
Gynecol Oncol
Neuroendocrine tumors of the uterine cervix. Clinicopathologic study of five patients
Eur J Obstet Gynecol Reprod Biol
Treatment of small cell carcinoma of the cervix with cisplatin, doxorubicin, and etoposide
Gynecol Oncol
Neuroendocrine cervical carcinoma: a diagnostic and therapeutic challenge
Gynecol Oncol
Small cell undifferentiated (neuroendocrine) carcinoma of the uterine cervix
J Am Coll Surg
Small cell carcinoma of the female genital tract
Semin Oncol
Primary small cell carcinoma of the vagina
Gynecol Oncol
Bartholin's gland carcinoma, malignant melanoma and other rare tumours of the vulva
Best Pract Res Clin Obstet Gynaecol
Correlation between grade and prognosis in metastatic gastroenteropancreatic neuroendocrine tumors
Hum Pathol
Role of neuropeptides and serotonin in the diagnosis of carcinoid tumors
Am J Med
Cardiovascular complications of malignant carcinoid disease
Am Heart J
Carcinoid heart disease associated with primary ovarian carcinoid tumor
Am J Cardiol
Primary ovarian carcinoid tumors
Gynecol Oncol
Strumal carcinoid tumor of the ovary: a case exhibiting severe constipation associated with PYY
Gynecol Oncol
Ovarian carcinoid with severe constipation due to peptide YY production
Gynecol Oncol
Consensus report on the use of somatostatin analogs for the management of neuroendocrine tumors of the gastroenteropancreatic system
Ann Oncol
Small cell of the ovary, hypercalcemic type—analysis of combined experience and recommendation for management. A GCIG study
Gynecol Oncol
Small-cell carcinoma of the ovary: an aggressive epithelial cancer occurring in young patients
Gynecol Oncol
Small cell carcinoma of the ovary with hypercalcemia causes severe pancreatitis and altered mental status
Gynecol Oncol
Small cell carcinoma of the ovary: a rapidly lethal tumor occurring in the young
Gynecol Oncol
Uterine and ovarian conservation in advanced small cell carcinoma of the ovary
Obstet Gynecol
Treatment of neuroendocrine carcinomas with combined etoposide and cisplatin: evidence of major therapeutic activity in the anaplastic variants of these neoplasms
Cancer
One hundred years after “carcinoid”: epidemiology of and prognostic factors for neuroendocrine tumors in 35,825 cases in the United States
J Clin Oncol
Terminology of endocrine tumors of the uterine cervix: results of a workshop sponsored by the College of American Pathologists and the National Cancer Institute
Arch Pathol Lab Med
Evaluation of histologic, morphometric, and immunohistochemical criteria in the differential diagnosis of small cell carcinomas of the cervix with particular reference to human papillomavirus types 16 and 18
Mod Pathol
Small-cell neuroendocrine carcinoma of the cervix. A human papillomavirus type 18-associated cancer
Am J Surg Pathol
Cervical neuroendocrine carcinoma: a clinical and light microscopic study of 14 cases
Int J Gynecol Pathol
Small-cell undifferentiated carcinoma of the cervix. A clinicopathologic, ultrastructural, and immunocytochemical study of 15 cases
Am J Surg Pathol
Unfavorable prognosis of small cell neuroendocrine carcinoma of the uterine cervix: a retrospective matched case–control study
Int J Gynecol Cancer
Large cell neuroendocrine [corrected] carcinoma of the uterine cervix: a clinicopathologic study of 12 cases
Am J Surg Pathol
Argyrophilia, serotonin, and peptide hormones in the female genital tract and its tumors
Int J Gynecol Pathol
Small cell cancer of the uterine cervix
Cancer
Prognostic factors in neuroendocrine small cell cervical carcinoma: a multivariate analysis
Cancer
Cytologic and hormonal findings in a carcinoid tumor of the uterine cervix
Acta Cytol
Survival in cervical cancer with respect to cell type
Cancer
Small cell carcinoma of the uterine cervix
Cancer
FDG-PET/CT in lung cancer: an update
Front Radiat Ther Oncol
High tumor metabolic activity as measured by fluorodeoxyglucose positron emission tomography is associated with poor prognosis in limited and extensive stage small-cell lung cancer
Clin Cancer Res
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