Conservative Treatment of Microinvasive Adenocarcinoma of Uterine Cervix

Abstract

OBIECTIVE: This study aimed to evaluate the safety of conservative treatment in women desiring preservation of fertility with stage IA adenocarcinoma of the cervix. Clinical report of all women with stage IA adenocarcinoma of the cervix, endocervical subtype, with clear margins on cone biopsy, diagnosed in our cancer center inclusive between January 1995 and December 2007, were evaluated, after either conservative therapy or hysterectomy. All diagnoses were reviewed by a pathologist expert in gynecologic oncology. Follow-up methods include at least cervical cytology, colposcopy with direct biopsy if indicated, and cervical curettage. Of 783 laser cone biopsy specimens, 7 were diagnostic for microinvasive adenocarcinoma, endocervical subtype (6 stage IA1 lesions and 1 stage IA2 lesion) with clear margins. No lymphovascular space invasion was seen. No residual invasive disease was observed in the specimens of 2 patients treated with hysterectomy after conization. Five women treated with laser cone biopsy only are free of invasive disease at 44, 66, 72, 86 and 100 months; 1 patient was found to have persistent adenocarcinoma in situ on endocervical cytology. Cone biopsy as definitive therapy is safe in women with stage IA1 adenocarcinoma of the cervix, endocervical subtype, with clear margins and no lymphovascular space invasion. Because of the low reliability of follow-up techniques (cytology, colposcopy, and endocervical curettage), conservative treatment should be reserved only for women strongly desiring to preserve fertility and accepting the risk of recurrent disease.