Radiation of Cancer of the Cervix

Abstract

RADIUM element became a part of the therapeutic resources of the roentgen department of the Boston City Hospital in 1923. From that time until 1935, inclusive, a 13-year period, 289 patients with cancer of the cervix were seen in consultation with the gynecological service. Twenty-seven were judged unsuitable for any form of radiation therapy. Two hundred and sixty-two cases remain with history as to prodromal symptoms, physical findings, biopsy, radiation data, and follow-up believed adequate enough from which to deduce certain statistics and conclusions of value, at least intramurally. The average age was 50 years and nine months. The youngest patient was 21 and the oldest 82 years of age. Hemorrhage was the usual presenting symptom that brought the patient to the hospital, pain rarely. The average duration of the bleeding for the group was eight months. This would appear extraordinary if one did not reflect that women, especially of middle life, are apt to minimize the significance of this danger signal. The duration of the bleeding was not indicative of the stage of the disease. As often as not, recent hemorrhage, especially if massive, was found associated with advanced disease. In classifying the cases as to clinical stage of disease, the League of Nations (1) system was adopted and is as follows: Stage I. The growth is strictly limited to the cervix uteri. Uterus mobile. Stage II. Lesion spreading into one or more fornices with or without infiltration of the parametrium adjacent to the uterus, the uterus retaining some degree of mobility. Stage III. a. Nodular infiltration of the parametria on one or both sides extending to the wall of the pelvis, with limited mobility of the uterus or massive infiltration on one parametrium with fixation of the uterus. b. More or less superficial infiltration of a large part of the vagina, with a mobile uterus. c. Isolated metastases in the pelvic glands, with a relatively small primary growth. d. Isolated metastases in the lower part of the vagina. Generally speaking, all cases not falling into Stages II or IV will be placed under Stage III. Stage IV. a. Cases with massive infiltration of both parametria extending to the walls of the pelvis. b. Carcinoma involving the bladder or rectum. c. The whole vagina infiltrated (rigid vaginal passage), or one vaginal wall infiltrated along its whole length with fixation of the primary growth. d. Remote metastases. At a casual glance, this division of the stages of cancer of the cervix appears involved. Actually, in practice, it is simple and resolves itself into the clinical grouping of early, borderline, advanced, and palliative cases. Table I indicates the grouping of this series. Such a preponderance of hopeless material presenting itself may be ascribed partly, at least, to the social status of the entrants to a large municipal hospital. One hundred and eight received a single radium application prior to transfer to home or a cancer retreat.