PRIMARY ADENOCARCINOMA OF THE CERVIX UTERI

Abstract

Abstract 1. 1. A series of 56 primary adenocarcinomas of the cervix treated at The New York Lying-In Hospital from 1933 to 1961 is presented. This neoplasm comprised 2.3 per cent of all gynecologic malignancies and 4.8 per cent of all cervical carcinomas seen during the same period. 2. 2. The average age of the patients was 52.2 years, and the average age at menopause was 47.5 years. The proportion of Jewish women was higher than that of patients with squamous cell carcinoma of the cervix. Postmenopausal bleeding was the most frequent complaint, and the average duration of symptoms was 7 months. 3. 3. The concept of adenocarcinoma in situ of the cervix is reviewed. No adenocarcinoma in situ lesion was encountered in this series although in situ changes were occasionally observed adjacent to obviously invasive lesions. The clinical staging was: Stage I, 28 cases; Stage II, 13 cases; Stage III, 9 cases; Stage IV, 5 cases; and one case was not staged. 4. 4. Seventy-one per cent of the lesions were well-differentiated. The histologic appearance was quite variable with mixed patterns noted frequently. The various patterns included the following: adeniform, papillary, mucinous, adenoacanthomatous, medullary, scirrhous, and mesonephric. 5. 5. Twenty-nine patients were treated by irradiation alone, 22 by an operation and irradiation, and 5 by an operation alone. Forty-two patients were eligible for 5 year follow-up, and the absolute 5 year survival rate for all stages was 40.4 per cent. 6. 6. While we presently lack valid information concerning the incidence of lymph node involvement and the natural history of adenocarcinoma of the cervix compared to squamous cell carcinoma of the cervix, there does not appear to be a significant difference in radiosensitivity, per se, between the two lesions. The decision to employ an operation, irradiation, or a combination of both in treating adenocarcinoma of the cervix should therefore be based upon an over-all evaluation of the patient rather than upon any supposed difference in radiosensitivity compared to squamous cell carcinoma of the cervix.