Women with cervical cancer may have questions about their prognosis and survival. Prognosis and survival depend on many factors. Only a doctor familiar with a person’s medical history, type of cancer, stage, characteristics of the cancer, treatments chosen and response to treatment can put all of this information together with survival statistics to arrive at a prognosis.
A prognosis is the doctor’s best estimate of how cancer will affect a person and how it will respond to treatment. A prognostic factor is an aspect of the cancer or a characteristic of the person that the doctor will consider when making a prognosis. A predictive factor influences how a cancer will respond to a certain treatment. Prognostic and predictive factors are often discussed together, and they both play a part in deciding on a treatment plan and a prognosis.
The following are prognostic factors for cervical cancer.
Tumour size, tumour volume and local extent
Tumour size is the tumour’s widest part, or greatest dimension. Tumour volume refers to all 3 dimensions of the tumour – its height, width and thickness. Smaller tumour size and volume is a more favourable prognostic factor than larger tumour size and volume.
Local extent is how far the tumour grows into the stromal tissue (the supporting connective tissue layer of the cervix) and into surrounding tissues. The farther the tumour has grown into the stromal tissue and surrounding tissue, the less favourable the prognosis.
The stage of cervical cancer is an important prognostic factor. Early stage cervical cancer has a more favourable prognosis than later stage cervical cancer. Tumours that invade the sides of the pelvis (called the pelvic walls), the loose connective tissue around the cervix and uterus (called the parametrial tissue) or other areas in the body have less favourable outcomes than cancer that is only in the cervix.
Spread to lymph nodes
Cervical cancer that has not spread to lymph nodes has a better prognosis than cervical cancer that has spread to lymph nodes.
Lymphovascular invasion means that there is cancer in the tumour’s blood vessels or lymph vessels (tubes through which lymph fluid travels in the body). Cancer that has not spread into the blood or lymph vessels is linked with a better prognosis than cancer that has spread to the blood or lymph vessels.
Age and general health
Younger women tend to have a better outlook than older women. Women who have good general health other than the cancer also tend to have a better prognosis.
Type of tumour
Squamous cell carcinoma (SCC) tends to have a better prognosis than adenocarcinoma. Small cell neuroendocrine carcinoma, clear cell carcinoma and glassy cell carcinoma are aggressive tumours that have a less favourable prognosis than other types of cervical cancer, even when they are found at an early stage.
Women with anemia do not seem to do as well and have a poorer outcome than women who do not have anemia. Women with anemia also don’t respond as well to radiation therapy. It is not understood why anemia has this effect on women with cervical cancer. A blood transfusion usually doesn’t work well to reverse this effect.
Find out more about anemia.
Women who smoke tend to have a poorer prognosis than women who don’t smoke.
Squamous cell carcinoma antigen (SCCA) level
A tumour marker is a substance in the body that may indicate the presence of a certain type of cancer. SCCA is a tumour marker that can be found in high levels in people with squamous cell carcinomas.
Women with normal levels of SCCA before treatment tend to have a better outcome than women with high levels of SCCA. Higher levels of SCCA are often linked to higher stage cervical cancer and larger tumours.
Women who have human immunodeficiency virus (HIV) tend to have aggressive cervical cancer with a poor prognosis.
Unlike most cancers, it is unclear if grade has a role in determining prognosis in women with cervical cancer. Some studies have shown that higher grades of cervical cancer are linked with poorer outcomes. Others studies haven’t shown the same link. Grade may be most important as a prognostic factor for adenocarcinoma of the cervix.