On the therapy of uterine cervix carcinoma in situ]

It is reported of 607 cases of uterine cervix carcinoma in situ from the years 1963 to 1977. During this period, the diagnostic and therapeutic procedures as well as the histological preparation technique have advanced. -- 75% of the cases were primarily conized. About half of these cases were surely radically excised. 323 patients (53,2%) were treated actively by simple hysterectomy, 242 patients (46,8%) were treated conservatively (190 conisations, 19 reconisations, 60 portioamputations, 12 ringbiopsies, 3 radiations). -- After 323 total exstirpations, 2 recurrences of carcinoma in situ in vaginal stump were observed (0,6%). After local treatment of 242 patients, 17 recurrences of the disease appeared (6%), among them 4 cases as invasive cervix carcinoma. 11 cases belong to the group of primarily nonexcised or uncertainly radically excised carcinoma in situ, and in 4 cases a possibility of recurrence has been discussed. -- It has been refered to the importance of the exact conisation technique and subtile histotechnical obtaining of slides in step sections. If the carcinoma in situ radically excised and followed by an attentive follow up in women below 40 years, a conservative procedure is adviced. For women above 40 years an active procedure is indicated, because it offers a high therapeutic reliability and a minimal risk. For cases of nonradically excised carcinoma in situ hysterectomy is indicated. The removal of the vaginal cuff is considered as unnecessary.     

Mucoepidermoid carcinoma of the cervix uteri]

Among 147 re-examined carcinomas of the uterine cervix from the years 1970 till 1975 eight mucoepidermoid carcinomas were found and described. Furthermore we report on one case of a mucoepidermoid carcinoma in situ. The mucous substances are dyed with PAS and the Alcianblue-PAS reaction. A detailed definition of "minimal mucous appearance" is worked out in order to classify a carcinoma as a mucoepidermoid carcinoma. An increase in the mucous producing tendency of squamous cell carcinomas as well as in the number of mucoepidermoid carcinomas during the last two years is stressed.     

Pregnancy after radiation therapy for carcinoma of the cervix

A successful pregnancy after intracavitary radiation therapy for carcinoma of the cervix is described. An additional 13 similar cases from the literature are reviewed. The possible reasons for the occurrence of these pregnancies despite irradiation to the ovaries, cervical canal and endometrium are discussed. The fact is emphasized that no genetic damage to the child was expected.     

Adjuvant radio- and chemotherapy in cervix carcinoma]

The screening for cervical cancer has been reduced both the incidence of and mortality from invasive cervical cancer in the western world. Radical pelvic surgery is an effective treatment for early invasive cervical cancer (FIGO-stage IB and IIA), but for woman with more advanced disease radiotherapy is the standard treatment. However, the survival of the cervical cancer patients has not been improved over the last decade. Previous studies have suggested that chemotherapy and radiotherapy are synergistic. The results of five large studies have shown that cisplatin-based chemotherapy when given at the same time a radiation therapy, prolongs survival in woman with cervical cancer. This was also observed in primary treatment schedule as in adjuvant situation. The side effects were temporary and manageable. The results suggest that chemoradiation is the favorable therapy for cervical cancer in advanced stage and in high-risk-situation.     

Neuroendocrine carcinoma of the cervix: implications for staging and therapy

Ultrastructural examination of four cases of small cell carcinoma of the cervix demonstrated neuroendocrine granules. In each of these cases, distant metastases became evident within 3 months of the initial diagnosis. The sites of metastases included liver, brain, bone marrow, and supraclavicular lymph nodes. Because of light microscopic, ultrastructural, and clinical similarities to pulmonary neuroendocrine carcinoma, three of these patients received combination chemotherapy effective in neuroendocrine tumors arising in the lung. One patient experienced remission of bulky pelvic tumor and supraclavicular metastases which lasted 11 months.     

Significance of family anamnesis in cervix carcinoma]

OBJECTIVE: Except for certain types of familiar cancer, the impact and contribution of familial factors to the development of sporadic cancer is thought to be relatively minor. Some earlier case reports had been suspected genetic background in cervical cancer (CX). MATERIAL AND METHODS: The literature was screened and cervical cancer patients from the Department of Obstetrics and Gynecology of the University Hospital of Leipzig were searched for familiar history of malignant tumors at any sites to establish familial risk for CX. RESULTS: Analysis showed, that 15 to 20% of cervical cancer represented at least one first-degree relative with malignant disease any site. The familial relative risk for in situ or invasive CX was reported to range between 1.8 to 2.0 and the heretability was between 0.11 and 0.15 for in situ and 0.22 and 0.33 for the invasive form. In some families a clustering, i.e. two or more female first-degree sibs were affected by CX, was observed, the frequency ranged between 1.7 and 7%. Analyses of risk by age of onset are rarely done and the results are controversy. Two large studies reported an aggregation of tobacco-related and HPV-associated malignancies, like oro-pharyngeal, lung and anorectal sites, in cervical cancer families. Moreover, it has been shown, that both mothers and daughters, who had invasive CX as the first primary cancer, had an excess of lung cancer as a second tumor site. CONCLUSIONS: The correlation of HPV-associated neoplasms in affected families suggest a role of mild or moderate hereditary immunosuppression in explaining a part of familial predisposition to cervical cancer are biologically founded. Consequently, this would not imply germ line mutations in oncogenes or tumor suppressor genes but in genes modulating immune response and perhaps causing susceptibility to a variety of viral infections.     

Radical hysterectomy as therapy for early carcinoma of the cervix

During a 13-year period, 268 radical hysterectomies and pelvic lymphadenectomies were performed for Stage IB and IIA carcinoma of the cervix at Duke University Medical Center. Fifteen percent of patients had lymph node metastasis. Substage, histologic features, grade, capillary-like space involvement, and lesion size did not appear to affect nodal status. Survival was related to lymph node metastasis, status of surgical margins, and lesion size. Judicious use of radiation therapy after hysterectomy may have improved survival in high-risk patients. These does not appear to be any contraindication to operation in this group of patients as long as the condition is deemed medically operable.     

Multimodality therapy in early-stage neuroendocrine carcinoma of the uterine cervix

OBJECTIVE: Patients with early-stage neuroendocrine cervical carcinoma (NECC) have a high mortality rate despite aggressive therapy. The rarity of this tumor precludes initiation of a randomized, prospective trial. We reviewed our experience in early stage disease and performed a meta-analysis of the literature to identify prognostic factors and determine optimal multimodality therapy. METHODS: Eleven women with International Federation of Gynecology and Obstetrics (FIGO) early stage (IB--IIA) NECC were treated with surgery and chemotherapy at our institutions between 1978 and 1998. Administration of radiation therapy was recorded, but not required for inclusion in this study. A gynecologic pathologist reviewed all histopathologic sections. Medical records were retrospectively reviewed and clinical data obtained. Twenty-three early-stage NECC patients who were similarly treated during the study interval were identified by a Medline search of the English literature and included in the analysis. The Kaplan--Meier method and log-rank test were used for survival analysis. RESULTS: The overall 2-year survival rate for the 34 patients was 38%. The median age was 37 years (range, 20--75 years). Median cervical tumor diameter was 3.2 cm (range 0.5--11.0 cm). Lymphovascular space invasion was present in 21 (78%) of 27 patients (7 unknown). Fifteen (52%) of twenty-nine had lymph node metastases (5 unknown). Fifteen patients received postoperative platinum/etoposide (PE), seven received vincristine/adriamycin/cyclophosphamide (VAC), two received alternating cycles of VAC and PE, and ten received other chemotherapy regimens. Twenty women were treated with radiation therapy. The presence of lymph node metastases was a poor prognostic factor (P < 0.001). PE and VAC chemotherapy was associated with increased survival (P < 0.01). CONCLUSION: NECC is a highly lethal variant of cervical cancer. The presence of lymph node metastases is the most important prognostic variable. Postoperative VAC or PE appears most likely to improve chances for survival.     

Obstructive ureteropathy following radiation therapy for carcinoma of the cervix

Between January 1959 and December 1986, 10 of 328 patients (3%) treated with curative intent using primary radiation therapy for carcinoma of the cervix developed obstructive ureteropathy due to fibrosis. The mean age of the patients with obstructive ureteropathy was 45 years and the median time to obstruction was 26 months. The obstruction was unilateral in 8 cases and involved the parametrial portion of the ureter in at least 5 cases. No predisposing risk factor was found to be associated with the development of obstructive ureteropathy. After corrective surgery, renal function remained normal in 8 patients, and resolution of the hydronephrosis occurred in 4 patients.