Microinvasive carcinoma of the cervix

doi:10.1016/0002-9378(83)90852-9

American Journal of Obstetrics and Gynecology

Volume 145, Issue 8, 15 April 1983, Pages 981-989

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Abstract

One hundred seventy-seven patients with squamous cell carcinoma that invaded the cervical stroma to a depth of 5.0 mm or less were the subjects of this investigation. Fifty-one patients were treated primarily by vaginal hysterectomy, 42 by total abdominal hysterectomy, and 84 by radical hysterectomy with pelvic lymphadenectomy. In 52 patients with lesions that invaded the cervical stroma to a depth of 3.0 mm or less, 984 lymph nodes were examined and none contained metastatic tumor. Conversely, lymph node metastases were present in three of 32 patients with lesions that had stromal invasion of 3.1 to 5.0 mm. After therapy, all patients were followed up from 2 to 14 years, and none was lost to follow-up. Among 145 patients with lesions that invaded the stroma to a depth of 3.0 mm or less, only two developed recurrences, both of which were intraepithelial. Among the 32 cases of carcinoma that invaded the stroma 3.1 to 5.0 mm, there were three invasive recurrences, and two deaths.

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Citation Excerpt :

Current management of early stage cervical cancer is primarily surgery in the majority of patients. Patients with FIGO (International Federation of Gynecology and Obstetrics) stage 1A1 disease can be treated with an extrafascial hysterectomy only, if lymphovascular space invasion (LVSI) is absent [1]. More advanced early stage lesions, FIGO stage 1A2–2A, require either radical surgery or radiotherapy.

To evaluate surgical outcomes and survival outcomes of cervical cancer patients who underwent complementary surgery after an extrafacial hysterectomy

Patients with cervical cancer, who underwent extrafacial hysterectomy initially and thereafter underwent complementary surgery were reviewed retrospectively. Complementary surgery consisted of radical parametrectomy, proximal vaginectomy and pelvic lymphadenectomy.

Twenty patients were evaluated. Histopathologic subtype was squamous cell carcinoma in twelve patients, adenocarcinoma in six patients and adenosquamous carcinoma in two patients. Route of surgery was laparotomy in 19 patients and laparoscopy in one patient. Two patients were staged as stage 1A2, nine were staged as stage 1B1, four were staged as stage 1B2, one was staged as stage 2A1, one was staged as stage 2B and three were staged as stage 3C1. The median tumor size was 16.5 (Range, 4–40) mm. Grade ≥ 3 complications related to surgery occured in 8 (40%) patients. Four of them were managed intraoperatively and recovered problem free. Remaining four (20%) needed reoperation. Pathology reports revealed involvement of parametrium in one (5%) patient, involvement of the proximal vagina in one (5%) patient, matastasis to pelvic lymph nodes in 3 (15%) patients. Five (25%) patients received adjuvant radiotherapy. Consequently, 5-year and 10-year cumulative survival was calculated as 94%.

Complementary surgery and radiotherapy show similar oncologic outcomes in patients with early-stage cervical cancer who had undergone simple hysterectomy initially. Complementary surgery is associated with slightly higher rate of morbidity compared with radiotherapy, however significant proportion of complications can be noticed and repaired intraoperatively.
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This chapter has been extensively revised to address several important issues in the field of cervical neoplasia. These include new information about the origin of cervical squamous neoplasia and its impact on our perceptions of lesion development. This leads in to a discussion of the conundrum of lesion grading, specifically the laboratory management of lesions that fall between cervical intraepithelial neoplasia grade 1 (CIN1) and grade 3 (CIN3). Strategies for managing this problem are offered, and the concept of squamous intraepithelial lesion (SIL) of intermediate (or indeterminate) grade is unveiled. The underpinning of this concept is the absence of any biomarker that can be depended upon to segregate low-grade squamous intraepithelial lesion (LSIL) from high-grade squamous intraepithelial lesion (HSIL) in light of the widespread variations in interpretation between observers and the lack of compelling information to support p16 as either a marker of HSIL or a predictor thereof. Other important topics include new approaches to superficially invasive squamous carcinoma, new management schemes, and the promise of vaccination programs. Finally, the concept of prophylactic ablation of the squamocolumnar junction (SCJ) is addressed as another possible approach to cervical cancer risk reduction in vulnerable populations.
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Citation Excerpt :

Individualization of treatment to reduce therapy-associated early and late morbidity is the most current trend in cervical cancer surgery [6,7]. Despite advances over the past 3 decades in decreasing the treatment-related morbidity, the cure rate associated with radical surgery (approximately 90%) has not changed appreciably [20]. The limited risk of parametrial and node involvement in case of MIC unbalances the morbidity of radical hysterectomy and pelvic node removal [21].

The objective of this analysis was to present the clinical outcome of the patients with FIGO stage IA2 squamous cell cervical cancer treated at the Department of Obstetrics and Gynecology between 1973 and 2009, and to clarify the discrepancies in clinical guidelines regarding the radicality of treatment applied in patients with stage IA2 squamous cell cervical cancer.

In our study we enrolled 89 women, diagnosed with FIGO stage IA2 squamous cell microinvasive carcinoma (MIC) in the period 1973–2009. The analysis involved the following parameters women's age at operation, type of operation, cell type, mitotic activity, invasive growth pattern, host defense reaction, lymph-vascular space invasion and patient's survival. Additionally, using the Rainer′s scoring system, the prognostic score for each MIC was calculated.

The mean women's age at operation was 41.48 ± 10.67 years. The mean depth of invasion was 3.09 ± 1.13 mm, and the mean area of carcinoma 4.05 ± 2.40 mm². In 66 (74.2%) women the suggested treatment was conization, according to the Rainer's scoring system and individualization of treatment based on decision of the tumor board. Three of the 89 patients diagnosed with MIC stage IA2 died; only in one patient the cause of death was cervical carcinoma. At the end of the observed period the survival rate was 98.0%.

We may conclude that conservative management of stage IA2 MIC is safe when exact evaluation of tumor extension and surgical margins of the cone are considered, and results in very low risk of recurrence, lymph node disease, and death caused by cancer. We believe that our experience will contribute to the achievement of the international consensus concerning the treatment of IA2 MIC.

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: Presented by invitation at the First Annual Meeting of the American Gynecological and Obstetrical Society, Hot Springs, Virginia, September 8–11, 1982.

^*: American Cancer Society Professor of Clinical Oncology.

View full text

Microinvasive carcinoma of the cervix

Abstract

Am. J. Obstet. Gynecol.

Gynecol. Oncol.

Probeexzision and Kolposkopie in der Fruhdiagnose des Portiokaszinomas

Zentralbl. Gynaekol.

Diagnosis and management of microinvasive (Stage IA) carcinoma of the uterine cervix

Cancer

A critical review of the frequency of lymph node metastasis and death from microinvasive carcinoma of the cervix

Obstet. Gynecol.

Microinvasive carcinoma of the uterine cervix

Obstet. Gynecol. Surv.

Stage IA squamous cell carcinoma of the uterine cervix

Am. J. Obstet. Gynecol.

Microinvasive carcinoma of the uterine cervix

Cancer