The Pre-radium Treatment of Carcinoma of the Uterine Cervix

Abstract

Most surgeons and gynecologists are now agreed that once a definite diagnosis of uterine cervical cancer has been made, the case is one for radiation treatment, with the possible exception of the infrequent Stage I growths, in which surgery or radium may be used with equal success. Examination The patient should first be carefully examined, not only to determine the extent of the local disease but to ascertain the general condition. It is especially necessary to ascertain if any metastatic malignancy is present, and if the patient is in condition to receive radium treatment. It is important that the gynecologic examination be done gently, as rough examinations have a tendency to disseminate the disease. Upon the results of the gynecologic examination, the patient should be classified as having a Group 1, 2, 3, 4, or 5 cervical cancer, in accordance with the classification of Schmitz. In making the gynecologic examination, it is important to determine if the uterine canal is patent, and if so, to ascertain and record its length (by means of a sound). A biopsy of the lesion should be taken at this time. Biopsy carries insignificant hazards in cervical cancer because the lymph and blood channels are already blocked by the ulceration that is invariably present. Classification of Patients Before considering the method of treatment in a particular patient, it is well that the growth present be classified, in order to provide a convenient means for discussing the therapy. A classification that has proven popular in this country is the one proposed by Henry Schmitz, which is quite simple, and based entirely on the local physical findings. The carcinomata are divided into primary and secondary or recurrent. The factors which determine the grading of the primary carcinomata are as given in the following grouping. Group 1 comprises the earliest lesions, which, unfortunately, are the least frequently seen. The growth is the size of a navy bean, is clearly localized within the cervix, and the uterus has normal movability. (A uterus normally movable can be displaced downward without causing distress to the patient or the use of an unusual amount of force, until the cervix appears at the vaginal outlet when pulled by a tenaculum forceps attached to the cervix.) This group is sometimes called “operable.” Group 2 includes cases in which there is a wide or peripheral invasion of the cervix or body of the uterus, a doughy consistency of the paracervical tissues, and decreased mobility (evidenced by failure of the uterus to be completely displaced downward when pulled by a tenaculum forceps). This group is often called “doubtfully localized” or “borderline.” Group 3 includes cases in which there is infiltration of one or both parametria, with or without regional lymph node involvement or invasion of adjacent organs, but the structures are, as a mass, still movable, though elasticity of the tissues is lost.