Cancer and Pre‐cancer of the Cervix

Abstract

Luesley DM, Barasso R editors . Cancer and Pre-cancer of the Cervix . 437 pages. Illustrations. Tables. London : Chapman and Hall , 1998 . Price GBP 85.00 . During the last decade there has been substantial progress in our understanding of cervical cancer. Modern molecular biological techniques have shown that human papilloma virus is the cause of this disease. Considerable knowledge has accumulated on the oncogenic potential of different HPV subtypes and how oncogenicity is expressed and regulated in the infected cells. Recent experience in the laboratory is currently transferred to the clinic and new follow-up and treatment strategies are being introduced: Cost-effective and safe conization by loop excision, chemotherapy or combined chemo-radiotherapy as primary treatment modalities in advanced stages of cervical cancer, the use of CT and MR to image the spread of cervical cancer, the use of laparoscopy to dissect lymph nodes have all changed the practical handling of the disease. In the present volume 42 experts contribute to illustrate these matters in 26 chapters. The authors have written their chapters independently of each other, which may explain some overlapping of presented data. The normal histology of the cervix and the colposcopic and histologic features of the transformation zone are presented in the introducing chapters. Fox, discussing histopathology of cervical cancer, stresses other factors than just cancer invasion to be evaluated, ie, vascular space invasion, confluent growth pattern, estimation of horizontal growth as well as the use of mucin staining to diagnose adenocarcinoma. The use of new techniques, flow cytometric DNA analyses, the expression of oncogenes and suppressor genes and cell proliferation markers to detect early stage cancer with bad prognosis are discussed. Although, worldwide, the reduction in cervical cancer is regarded as a benefit of screening programs Skrabanek claims that running national programs are without clear benefits and exaggeration of their benefits is unethical. The editors, however, do not appear to agree with his arguments. Epidemiological and molecular biological data of HPV as the single main etiological factor for cervical dysplasia and cancer are presented. Techniques to detect HPV in cervical smears and tissue specimens are described. Positive arguments to include HPV screening in conjunction with Pap smear screening are presented. Cervical immunology, immunosuppression and the role of lymphokines and cytokines are discussed in relation to HPV infection and progression of disease. The diagnosis, treatment and follow up of dysplasia is thoroughly described. The importance of colposcopy and careful case selection in a screening program is stressed. Conventional radical as well as minimal invasive techniques for the treatment of invasive cancer are described in detail. Experiences on laparoscopy in lymphadenectomy in conjunction with radical vaginal hysterectomy or trachelectomy or as a staging procedure before radical operation or exenteration are presented by Dargent. Criteria for exenterative procedures are discussed by Heintz. One chapter is devoted to current techniques and indications for radiotherapy in primary or postoperative treatment. A comprehensive review on the role of chemotherapy, especially in neoadjuvant treatment in advanced cancer, is given. Aspects of quality of life and the psychosocial impacts of preinvasive and invasive disease are discussed in two chapters. Generally, many of the authors focus on the importance of individualizing the treatment for one single woman, avoiding overtreatment. The present volume nicely summarizes experts’ views of today's knowledge on preinvasive and invasive cervical cancer and can be recommended to people in this field: molecular biologists, epidemiologists, gynecologists, oncologists and cyto-pathologists.