Carcinoma of the Cervical Stump

Abstract

Carcinoma of the cervical stump has received considerable attention in gynecological literature for many years. A large number of articles have been written regarding the subject. In 1921 Polak (1) was able to collect only 256 cases from the American literature. Since that time, many cases have been reported. The incidence of cancer of the cervical stump is difficult to determine, as is the incidence of cancer of the cervix. It has been reported in the literature to be from a fraction of 1 per cent to 8 per cent (Black, 2). The general consensus of opinion is that it is probably from 1 to 2 per cent. Fricke (3) has pointed out that the figure may be higher in radiological institutes where large numbers of cases of cervical cancer are seen. In our institute (Soiland, Costolow, and Meland), 1,906 cases of carcinoma of the cervix were seen from 1922 to 1947. During the same interval, 165 cases of carcinoma of the cervical stump were referred to us for examination and radiation treatment. All had been operated upon elsewhere by various kinds of surgeons, experienced and inexperienced. The incidence of carcinoma of the stump is thus 8 per cent of our total series of 2,071 cases (Table I). In 63 of the 165 cases, cancer occurred in the first two years after supravaginal hysterectomy and probably should not be classified as true carcinoma of the cervical stump. If we consider only the remaining 102 cases as true or actual carcinoma of the cervical stump, our incidence is reduced to 4.9 per cent. The question of the prevention of carcinoma of the cervical stump has interested surgeons and gynecologists for many years and has led to many controversies regarding subtotal versus total hysterectomy for fibroids and benign conditions of the uterus. It is not the purpose of this paper to enter into this controversy, and, being a radiation therapist, I would not be eligible. However, to any observer of the literature it would seem that there are a number of established facts of importance regarding these procedures. Apparently the mortality in large centers with skilled operators is about the same for subtotal and total hysterectomy, the morbidity being slightly higher for the latter procedure. Undoubtedly, in the hands of the occasional operator and average general surgeon the mortality is higher with total hysterectomy. Meigs (4) compares the mortality figures for total and supravaginal hysterectomies in the Massachusetts General Hospital as follows: 224 total hysterectomies—mortality 4.4 per cent; 1,771 supravaginal hysterectomies—mortality 2.9 per cent, a difference of 1.5 per cent, or more than twice the incidence of cervical stump carcinoma in the same hospital.