Primary adenocarcinoma of the cervix: treatment and results

Summary. Between 1972 and 1983,49 patients with adenocarcinoma of the cervix were treated in four ways: (i) radiotherapy alone, (ii) pre- or postoperative radiotherapy and a total abdominal hysterectomy and bilateral salpingo-oophorectomy, (iii) Wertheim's hysterectomy, and (iv) pre- or postoperative pelvic radiotherapy and Wertheim's hysterectomy. The 5-year survival results for patients with FIGO Stage I disease was 90%; with Stage II disease 60%; with Stage III disease 11% and none survived with Stage IV disease. All the patients, except one (Stage 111), with well-differentiated tumours are alive and disease-free, irrespective of the type of treatment they received whereas only one patient out of the 13 who had poorly differentiated tumour is alive and disease-free. Three patients had bowel damage, one after radiotherapy alone and two after Wertheim's hysterectomy and postoperative radiotherapy. No major surgical complications occurred in this series.     

Primary hepatoid adenocarcinoma of the uterine cervix

Hepatoid adenocarcinoma is characterized histologically by neoplastic epithelial cells that resemble hepatocellular carcinoma (HCC) and produce alpha-fetoprotein (AFP). We describe a case of hepatoid adenocarcinoma of the uterus that, unlike any other previously reported case, was strictly confined to the cervix. A cervical biopsy demonstrated poorly differentiated adenocarcinoma, and hysterectomy and bilateral salpingo-oophorectomy were subsequently performed. Histologically, the lesion consisted of solid sheets of hepatoid cells accompanied with areas of endometroid adenocarcinoma. The tumor cells showed strong and diffuse cytoplasmic immunoreactivity with AFP in both medullary and adenocarcinoma components. Metastases to bilateral pelvic lymph nodes were detected 12 months after surgery. Since undergoing total pelvic irradiation, the patient has been alive and in full remission for 22 months. To our knowledge, this is the first report of primary hepatoid adenocarcinoma of the uterine cervix.     

Combined treatment in adenocarcinoma of cervix

From January 1976 - end of 1979, 427 patients with cervical cancer were treated in the Department of Gynaecology, University of Hong Kong. Twenty-seven (6%) had primary adenocarcinoma of cervix. Eighteen patients with stage I and early stage II were treated by preoperative irradiation and Wertheim hysterectomy. Serial cervical biopsies were taken to assess the response to radiotherapy. All the cervical biopsies as well as the surgical specimens were read by the same pathologist. 83% showed residual dividing tumour cells in the surgical specimens. One hundred and forty-five patients with early squamous cervical cancer were similarly treated during the same period; only 13% had residual tumour in the specimens (chi square test p is less than 0.001). All the patients are being followed up regularly. Fifteen patients with early cervical adenocarcinoma are free from disease. The shortest period of follow-up is 5 1/4 years.     

Prognostic features and treatment of endocervical adenocarcinoma of the cervix

Adenocarcinoma of the cervix represents an increasing percentage of cervical cancers as well as a controversial clinical problem. One hundred seventy-two cases of adenocarcinoma were treated at The University of Michigan Medical Center from 1970 to 1984, representing 16.8% of cervical cancers. Of this group 84 patients were diagnosed with endocervical columnar cell type and form the study population for this report. Survival was influenced by stage, grade, and nodal metastases. Age did not influence survival. Survival in stage I disease was not influenced by treatment modality. Radical surgery or radiation therapy provided equal survival and ovarian conservation did not adversely influence survival. Radical surgery can be considered a primary means of therapy in young women and offers the same advantages over radiation therapy as those offered for squamous cell disease.     

The prognosis and treatment of stage I adenocarcinoma of the cervix

A review of 125 patients with stage I adenocarcinoma of the cervix is reported. The subtypes included endocervical (60), adenosquamous (38), papillary (15), clear cell (nine), and mucoid (three). The cumulative 5-year survival was 60%, and was significantly related to the following: tumor differentiation--well-differentiated 80%, moderately differentiated 69%, poorly differentiated 41%; lymph node status--nodes positive 28%, nodes negative 82%; the amount of residual disease present in the cervix after radical hysterectomy; and the interval from the previous pelvic examination. Survival was not significantly influenced by histologic subtype, patient age, number of positive lymph nodes, or tumor size beyond 3 cm. Treatment included radical hysterectomy with or without bilateral salpingo-oophorectomy, radiation therapy, radiation therapy with hysterectomy, and hysterectomy followed by radiation therapy. The best cumulative 5-year survival (93%) was found in patients treated by radical hysterectomy without bilateral salpingo-oophorectomy, whereas the poorest survival (18%) was in those treated by standard hysterectomy followed by radiation therapy. Ovarian conservation seems to be an acceptable alternative to bilateral salpingo-oophorectomy in the young patient undergoing radical hysterectomy.     

Various healing results in adenocarcinoma and squamous-cell carcinoma of the cervix uteri]

An account is given on the difference in prognosis between squamous cell carcinoma and adenocarcinoma of the cervix. -- The 5-year-healing reaches by adenocarcinoma up to 65.3%, by epithelial carcinoma up to 50.1%. -- Possible causes of carcinoma are referred to. Conclusions are pointed out.     

Early invasive adenocarcinoma of the uterine cervix: criteria for nonradical surgical treatment

OBJECTIVE: This retrospective study was undertaken to identify selection criteria for nonradical surgery for early invasive adenocarcinoma of the uterine cervix. METHODS: Seventy-nine patients with surgically treated cervical adenocarcinomas (with invasion to 5 mm or less) were examined clinicopathologically. The evaluation of stromal invasion was conducted according to the FIGO (1995) staging system. RESULTS: The mean age was 46 (range: 29-73) years, and the median follow-up was 118 (9-348) months. Definitive treatment modalities included radical hysterectomy in 71 (89.9%) cases, modified radical hysterectomy in 2 (2.5%), and simple extrafascial hysterectomy without pelvic lymphadenectomy in 6 (7.6%). Postoperative adjuvant external radiation therapy was given to 5 (6.3%) patients. The histological subtypes were endocervical in 37 (46.8%) cases, endometrioid in 32 (40.5%), and adenosquamous in 10 (12.7%). Forty-one (51.9%) patients had lesions with up to 3 mm of stromal invasion; of these, 24 (58.5%) had lesions with up to 7 mm of horizontal extension (stage IA1). Thirty-eight (48.1%) patients had lesions with stromal invasion greater than 3 mm and no greater than 5 mm; of these, 4 had lesions with no wider than 7 mm of horizontal extension (stage IA2). Of 73 patients with pelvic lymphadenectomy, one (1.4%) tumor (depth: 5 mm; width: 15 mm) had node metastases. Parametrial involvement was present in one (1.4%) patient (lesion depth: 5 mm; lesion width: 16 mm). None had adnexal metastasis. Eighty-eight percent of the patients with stromal invasion up to 3 mm had well-differentiated adenocarcinoma, compared to 53% of the patients with lesions invading more than 3 mm. Of all of the patients, 5 (6.3%) patients who received curative radical hysterectomies had recurrences and died. Among 5 patients, one patient with central pelvic recurrence had a lesion invading to a depth of 3 mm and width of 7 mm, and the others had lesions with more than 3 mm of invasion and 15 to 36 mm of width. CONCLUSIONS: Patients with early invasive adenocarcinoma to a depth of 3 mm or less stromal invasion, including those who meet the criteria for FIGO stage IA1, may be treated with simple extrafascial hysterectomy without lymphadenectomy and oophorectomy.     

Microinvasive adenocarcinoma of the cervix

We evaluated the management of patients with microinvasive adenocarcinoma of the cervix (MIAC), in particular, to determine the place of conservative surgery, and determine if the FIGO classification for MIAC is valid and equivalent to the classification as it applies to microinvasive squamous cancer. A review was undertaken of the database of the Queensland Centre for Gynaecological Cancer (QCGC) from January, 1986 to October, 1998. The records of all patients recorded as having MIAC were retrieved. Microinvasion was defined according to the 1995 FIGO classification as a depth of invasion of no greater than 5 mm and a horizontal dimension of no greater than 7 mm 30 patients were found to have been treated for MIAC. The vast majority (29) were asymptomatic, disease being discovered at the time of routine Papanicolaou smear. There was a 43% incidence of coexisting squamous intraepithelial neoplasia. Multifocal disease was found in 17% of patients and lymph-vascular positivity in 7%. Eighteen patients were treated with radical surgery and 13 with conservative surgery. There were no recurrences over a follow-up interval of 3-116 months. Of the 18 patients treated with radical surgery, none was found to have occult microscopic disease in the parametria or nodal metastases. A total of 27 ovaries were removed, all of which were free of disease. In this small study, MIAC appears to behave in a manner similar to the squamous equivalent. The results provide some justification for the FIGO classification of a microinvasive glandular neoplasm of the cervix. There is some support for a role for conservative surgery in managing this condition, but there is insufficient worldwide experience to make definitive recommendations.     

Epidemiology of adenocarcinoma of the cervix

Three hundred thirty-three patients who presented with cervical carcinoma from November 1980 through June 1985 were compared for potential factors associated with histology. Sixteen percent of all patients presenting with cervical carcinoma during this 5-year period had an adenocarcinomatous histology. Emphasis was placed on demographic and socioeconomic factors. The histologic distribution was the following: epidermoid carcinoma 279, adenocarcinoma 28, and adenoepidermoid carcinoma 26. The latter two histologies were not different for any factors and therefore combined for statistical comparison with epidermoid carcinoma. When epidermoid (E) carcinoma of the cervix was compared with the histologies having an adenocarcinomatous component (A), the following demographic and socioeconomic factors were statistically, different (P less than 0.05): Unemployment (E 69% vs. A 46%) P less than 0.002; Income less than $6000/yr (E 48% vs. A 26%) P less than 0.005; Less than a 12th-grade education (E 85% vs. A 72%) P less than 0.05; Smokers (E 67% vs. A 40%) P less than 0.001; First coital experience less than 18 years (E 58% vs. A 39%) P less than 0.05. Age, parity, and number of sexual partners were not significantly different between the epidermoid and adenocarcinoma groups. The number of patients with stages II, III, and IV was too small to provide a meaningful statistical comparison of survival for the two histologies. Our data suggest that epidermoid and adenocarcinoma of the cervix may represent diseases with distinct populations at risk.     

Fertility-sparing treatment in younger women with adenocarcinoma in situ of the cervix

Objective

For women who have completed childbearing, the treatment of choice for adenocarcinoma in situ (ACIS) of the cervix is hysterectomy. In women who desire future fertility, however, conservative therapy is an acceptable alternative. In this study we compare the outcomes for young women who underwent loop conization or were treated with cold knife conization.

Methods

We performed a retrospective analysis in 112 patients with ACIS, age 30 or younger, treated with cold knife conization or loop conization between 1998 and 2010. Decision to perform office loop conization was based on the size of the cervix and the colposcopic lesion. Main outcomes were negative margins after the procedure and recurrence of ACIS.

Results

Fifty-eight patients (52%) were treated with cold knife conization and 54 (48%) underwent loop conization. The odds ratio for cold knife conization to achieve negative cone margins compared with loop conization was 1.4 (95% CI 0.6-3.5). We observed no difference in residual or recurrent ACIS between patients treated with loop conization versus cold knife conization.

Conclusions

In select young patients who desire future fertility, loop conization and cold knife conization have equivalent rates of negative margins and negative follow-up. For optimal results, patients must have a lesion which can be removed in one pass of a loop, confirmed by expert colposcopy. Loop excision should be considered the treatment of choice in this specific group of patients.     

Primary adenocarcinoma of the cervix. A clinicopathologic study of prognostic variables in 55 cases

Fifty-five primary invasive adenocarcinomas of the cervix, presenting over a 20-year period, were retrospectively studied with particular reference to clinical and pathologic prognostic indicators. Mean age at presentation was 54.5 years (range 27–91), with an age distribution showing two incidence peaks of equal size in the 31–35 and 61–65 groups, respectively. Twenty-four patients died of the disease and the remaining patients were followed up for a mean of 4.9 years (range 1–17). The results were analyzed using a Cox's proportional hazards survival model. The independent good prognostic indicators were early tumor stage ( P < 0.001). and young patient age ( P < 0.001) at presentation. The presence within the tumor of numerous intraepithelial lymphocytes and the concomitant occurrence of background in situ carcinoma were also good prognostic indicators, although these did not operate independently of stage and age. Histologic tumor subtype and grade of tumor differentiation were not significant prognostic factors. Treatment did not have a significant independent effect on survival. No definite conclusions could be drawn about the effect of oral contraceptives on the disease process.     

Prognostic factors in the treatment of stage 1B adenocarcinoma of the cervix

Abstract. One hundred and fifty-seven patients with Stage 1B adenocarcinoma treated between 1955 and 1986 in the Norwegian Radium Hospital were studied. Of these 136 patients had radical hysterectomy and pelvic lymphadenectomy and 21 simple total abdominal hysterectomy and bilateral salpingo-oophorectomy. One hundred and eleven patients had pre-operative brachytherapy. Histological grade of tumor ( P < 0.001) lymph node metastasis ( P < 0.001) and residual tumor in the surgical specimen 4–6 weeks after brachytherapy (P < 0.001) had a significant prognostic effect on the recurrence and survival irrespective of the extent of surgery and radiotherapy. Lymph node involvement was directly related to histological grade of the tumor (P < 0.0001).     

Diagnosis and treatment of a case of adenocarcinoma of the cervix in pregnancy]

The authors report a case of mucinous-papilliferous adenocarcinoma of the cervical canal in a pregnant woman. After performing three Pap tests which demonstrated the presence of normoconformate endometrial cells partly with a normal conformation and partly with nuclear atypia, the patient was monitored with periodical obstetric examinations. A neoformation of the portio was observed at week 28: differential diagnosis was made between a hypertrophic benign tumour and a well differentiated adenocarcinoma. The patient was monitored until birth and colposcopy was then performed with biopsy about one month later. Histological tests were positive for mucinous papilliferous adenocarcinoma. The patient underwent conisation with rotating loop and subsequently Piver 2 surgery owing to the suspected spread of the neoplasm beyond the margin of resection. The operative finding was negative and the patient is now free of disease.