Invasive Carcinoma of the Cervix in Young Women

One hundred and seventy-six cases of cancer of the cervix in women age 35 years or less from 1959 to 1980 were compared with 65 cases occurring in the 5-year period from 1982 to 1986. The incidence of the disease in this age group changed little over this time, increasing from 9% to 11%. However, the incidence of adenocarcinoma cell types increased from 10% in the first period to 25% in the more recent cases. A change in management resulted in increased surgical emphasis in treatment; only 24% were treated surgically in the earlier group compared to 80% in the recent group. There has not been an increase in advanced cases or mortality in those young patients in recent years.     

Rapid Progression to Invasive Cervix Cancer in a Woman Infected with the Human Immunodeficiency Virus

Background: Previous studies have shown an increased risk of cervical dysplasia in women infected with human immunodeficiency virus (HIV), as well as an increased risk of progression to higher-grade lesions. It is not known whether the rate of progression is accelerated over that in immunocompetent women.Case: During September 1991, an HIV-positive woman underwent conization of the cervix showing carcinoma in situ. The surgical margins and endocervical curettings were negative for dysplasia. Papanicolaou smears 4 and 7 months after the conization also were negative. She then presented 33 months postconization with a stage Ib2 cervical carcinoma, which proved resistant to chemotherapy and pelvic radiation.Conclusion: Immunosuppression caused by HIV infection may cause a more rapid progression of cervical intraepithelial lesions to carcinoma.     

Racial Factors in Invasive Carcinoma of the Uterine Cervix

Summary
During a 20 year period, 1116 patients with invasive carcinoma of the cervix were treated. Of these, 147 were Polynesians and 967 were non-Polynesian. None was lost to follow-up.
The 5 year survival of Polynesians is poorer than for non-Polynesians. The reason for this is found in the delay in presenting for treatment and thus the later stage at diagnosis.
The incidence is greater in Polynesians and the age at onset is one decade earlier, but these may be socio-economic influences rather than purely racial ones.
A general improvement in presentation at an earlier stage of the disease has been demonstrated for both races.     

Trends in Invasive Cancer of the Cervix Uteri in New South Wales, 1973–1982

Summary: Data from the New South Wales (NSW) Central Cancer Registry comprising all new cases of, and deaths from, invasive cancer of the cervix uteri registered in persons aged 15 years and over for the 10-year period 1973 to 1982 were examined using log-linear regression to determine whether incidence and mortality had been changing in NSW. Allowing for the estimated fraction of women who had undergone hysterectomy, this cancer had decreased significantly in incidence (- 1.3% per year) as well as mortality (-3.6%). There were no significant trends in relation to age at diagnosis, stage at diagnosis or histological type. Overall, younger age at diagnosis was associated with an earlier stage at presentation and there was no evidence for a trend towards more severe disease in young women during the 10-year period. No evidence was found for an increasing incidence of adenocarcinoma. By 1982 the age-standardized incidence rate was 10.4 per 100,000 (12.5 per 100,000 after adjustment for the hysterectomy fraction). Cancer of the cervix uteri was more common in Inner and Western Sydney and less common in the Northern Metropolitan region of Sydney and rural New South Wales.     

宫颈癌放疗后诱发生殖器癌(附二例报告)

本院自1957年至1980年共行宫颈癌放疗879例,治疗后分别发生外阴癌及宫体癌各1例。外阴癌发生于宫颈癌放疗后31年,先驱症状为外阴瘙痒及白色病变;宫体癌发生于宫颈癌放疗后9年,开腹时已有腹腔内及腹股沟淋巴结转移,病理为低分化粘液腺癌。本文复习了宫颈癌放疗后诱发癌的发生部位及潜伏期,讨论了外阴诱发癌的早期症状及宫体诱发癌的特点。     

Adenocarcinoma in Situ of the Uterine Cervix Progressing to Invasive Adenocarcinoma

Summary: This report documents a case of adenocarcinoma in situ (AIS) of the cervix progressing to invasive adenocarcinoma. The patient, who was 32-years-old at the time of diagnosis of AIS, was followed with negative smears for 7 years after conization when a smear showed malignant glandular cells. A repeat conization demonstrated well differentiated papillary adenocarcinoma. The patient remains well 8 years after radical hysterectomy and lymph node dissection. The clinicopathological features of this case and a brief review of the literature are presented.     

A Case of Polymyositis and Invasive Squamous Cell Carcinoma of the Uterine Cervix

Summary: To our knowledge, this is the fifth reported case of invasive cervical neoplasia associated with idiopathic inflammatory myopathy and illustrates the importance of cervical examination in women with polymyositis.     

外阴癌39例手术治疗及预后分析

目的 总结我院治疗外阴癌的手术方式,分析与外阴癌预后有关的因素。方法 回顾性分析我院１９７９－１９９７年收治的３９例侵袭性外阴癌的临床资料。其中外阴病灶局部切除术５例、部分外阴根治术１３例及全外阴根治术２１例。应用ＳＰＳＳ地不同的手术方式秀关预后因素进行比较分析。结果 ３９例中鳞癌３３例,占８４．６％,其中高、中、低分化分别为２６、５、２例。临床分期为Ⅰ期７例（１７．９％）Ⅱ期１７例（４３．６％）     

Prognostic Factors and Impact of Minimally Invasive Surgery in Early-stage Neuroendocrine Carcinoma of the Cervix

Study ObjectiveTo investigate the prognostic factors and impact of minimally invasive surgery (MIS) in surgically treated early-stage high-grade (HG) neuroendocrine cervical carcinoma (NECC).DesignRetrospective cohort study.SettingAsan Medical Center, Seoul, Korea.PatientsPatients with International Federation of Obstetrics and Gynecology (2009) stages IB1 to IIA HG NECC.InterventionsAll patients underwent radical hysterectomy (RH) with a laparotomy or an MIS approach.Measurements and Main ResultsBetween 1993 and 2017, 47 patients with International Federation of Obstetrics and Gynecology stages IB1 to IIA1 HG NECC were initially treated with RH. Clinicopathologic variables of patients were retrospectively reviewed from electronic medical records. The median follow-up period was 28.2 months (interquartile range, 17.1–42). Stage IB1 disease was the most common (70.2%). Twenty-nine patients (61.7%) underwent RH by MIS. The overall survival (OS) and disease-free survival (DFS) rates were 63.8% and 38.3%, respectively. Lymph node metastasis and resection margin involvement were significant risk factors for DFS (hazard ratio [HR], 2.227; 95% confidence interval [CI], 1.018–4.871; p =.045 and HR, 6.494; 95% CI, 1.415–29.809; p =.016, respectively) and OS (HR, 3.236; 95% CI, 1.188–8.815; p =.022 and HR, 12.710; 95% CI, 1.128–143.152; p =.040, respectively). The Kaplan-Meier survival curves revealed no significant differences in OS and DFS between the laparotomy and MIS groups (50% vs 72.4% log-rank p =.196, 38.9% vs 37.9% p =.975).ConclusionLymph node metastasis and resection margin involvement were poor prognostic factors of survival outcomes in initially surgically treated early-stage HG NECC. No difference was observed in the survival outcomes between the MIS and laparotomy approaches.     

Pelvic Lymph Node Metastases in Early Invasive Carcinoma of the Cervix - Histopathological ''Risk'' Factors

Histopathological features in 89 cases of Stage 1B and early 2A invasive carcinoma of the cervix who underwent Wertheim radical hysterectomy and pelvic lymphadenectomy were studied. Depth of tumour invasion and lymphatic/vascular space permeation by tumour cells were significantly associated with lymph node metastases. The other features such as tumour type, and stromal leucocytic reaction showed no significant relationship to the presence of lymph node metastases.     

宫颈神经内分泌癌治疗的新进展

宫颈神经内分泌癌（neuroendocrine carcinoma of the cervix,NECC）是一种罕见的恶性程度极高的妇科肿瘤。临床上对NECC的组织来源、发病机制并不明确。NECC没有标准的治疗方案,多是结合宫颈鳞状细胞癌、腺癌和小细胞肺癌的治疗经验制定治疗方案。近年来大样本队列基因组研究显示,NECC与宫颈外神经内分泌癌具有不同的基因组学特征,对NECC与宫颈外神经内分泌癌之间的生物学和治疗相关性提出了质疑。由于NECC的罕见性,获得足够数量的患者进行疗效试验的可能性很低,这阻碍了NECC标准治疗方案的制定。基因检测能为NECC靶向药物的个体化治疗提供策略。多项研究结果显示,NECC具有潜在的可调控的治疗靶点,免疫疗法与放射疗法结合可以延长晚期复发性NECC患者的长期生存。综述NECC的分子特征、靶向药物及免疫治疗的研究进展。     

宫颈小细胞癌非手术治疗研究进展

宫颈小细胞癌（small-cell carcinoma of the cervix,SCCC）是罕见的神经内分泌恶性肿瘤,占宫颈癌的3%～5%,是一种具有高度侵袭性的宫颈癌,以早期淋巴结和血行播散为特征,即使在临床上病灶仅局限于骨盆,预后也很差。国际妇产科联盟（FIGO）Ⅰ～ⅡA期患者的5年总生存率为36.8%。广泛转移的SCCC患者,5年总生存率为0,而且复发性疾病是无法治愈的,并且复发疾病诊断后的生存期很短,通常只有7～8个月。SCCC经常快速地远处转移至肺、肝、脑、骨、胰腺和淋巴结,导致大多数情况下治疗失败。SCCC治疗以手术辅以放化疗为主,综述SCCC非手术治疗方法,旨在提高SCCC的非手术治疗效果,改善患者的预后。     

Cancer of the Uterine Cervix and Screening of Aboriginal Women

Carcinoma of the cervix has not been widely reported as an important health problem for Aboriginal women. From four sources, we have studied cervical cancer death rates, abnormalities detected by cervical cytology screening, and the proportion of women who had been screened. First, from the Northern Territory for the years 1979-1983, we present a relative risk of 6.3 (95% confidence interval, 3.0-11.6) for cervical cancer deaths in Aboriginal women compared with all Australian women. Second, the screening and disease rates in Aboriginal women were profiled within a large laboratory in Victoria. Since 1984, a fourfold increase in the number of smears taken at Aboriginal health services is apparent. In women attending these services, a high rate of significantly abnormal smears is evident. Third, to study the extent of screening, we interviewed Aboriginal women in a Victorian country setting and fourth, we examined a random sample of medical records from an Aboriginal Health Service. The proportion screened at least once rose from 5/47 (11%) among women whose most recent consultation with the Health Service was during the years 1974-1980 to 51/170 (31%) women who attended from 1981-1987 (p less than 0.01). Aboriginal communities may interpret these trends favourably as they encourage their women to be screened regularly to reduce cervical cancer mortality.     

Langerhans Cell Population in Early Invasive Squamous Cell Carcinoma Of The Uterine Cervix

Langerhans cell counts were performed using indirect immunoperoxidase staining for S100 protein in 10 cases of early invasive squamous cell carcinoma of the cervix and 20 controls from routine hysterectomy specimens. There was a significant (p < 0.01) reduction in the number of Langerhans cells per unit sectional area of tumour tissue compared to the normal cervical epithelium. The density of Langerhans cells in the 3 patients with tumour metastasis in pelvic lymph nodes was further reduced. The low density of Langerhans cells in invasive squamous cell carcinoma compared to the normal state may reflect poor local immunosurveillance and may be related to progression and spread of the tumour.