Carcinoma of the Cervix

Abstract

Radiology occupies a somewhat unique position in regard to the treatment of carcinoma of the cervix uteri. Formerly surgery was the only recognized method of attack: to-day, so superior are the results obtained by radiation that surgeons everywhere are gracefully yielding this field to radiology. Surgery has never been a successful method of treatment except in the very early stages of the disease. Now because of the position of the tissue involved, and because of the fact that the early symptoms are hardly more than those to which many women are at times accustomed, this disease will never lend itself to early diagnosis. On this account the number of cases at all suitable for surgery has always been quite small as compared with the great number which has been seen too late for surgery. The field of surgery in this disease has always been a narrow one. The field of radiology is broad, offering at least something in practically all stages of the disease. Some of the most advanced cases will receive the greatest palliation; a few quite advanced cases will receive a lasting cure; borderline cases are almost as suitable for treatment as early cases; very early cases show a high percentage of lasting cures. But if the position of radiology in the treatment of cancer of the cervix is somewhat unique for what it has accomplished, it is even more so for what it has not accomplished. We have in radiant energy an agent capable of doing far more than is being accomplished by its use to-day. Radiologists in general are not thoroughly awake to the strength of their own weapons, nor sufficiently familiar with certain basic principles underlying their use. We have two sources of radiant energy of such wave length as has destructive influence on cancer cells—radium and the high voltage X-ray tube. There is no point in general medicine upon which more confusion has existed than upon the relation holding between X-rays and radium rays, and some of this lack of clearness of thinking has extended into the field of radiology. After ten years of high voltage X-rays and more than twenty years of radium there is little or no unanimity of opinion as to the place of each of these two sources of radiant energy in the treatment of this disease. What agreement there is, is based more upon empiricism—that is, individual experience—han upon scientific principles. Some men are pointing with pride to 25 per cent five-year cures of all early cases and are quite satisfied with 8 per cent five-year cures of all cases treated; others can show 60 per cent of all early cases well from 2 to 9 years and 30 per cent of all cases well from 1 to 9 years. There is no excuse for this wide variation in the number of cures by different men. All have radium, all have high voltage X-rays, but all have not learned the relative value of each or the joint value of both. And here is the thing that radiology has not accomplished.