Treatment of Microinvasive Adenocarcinoma of the Uterine Cervix: A Retrospective Study and Review of the Literature

Abstract

This study retrospectively assessed the effectiveness of various treatments used in 38 patients having FIGO (International Federation of Gynecologists and Obstetricians) stage IA1 or IA2 microinvasive adenocarcinoma (AC) of the uterine cervix. Twenty-nine patients had stage IA1 cancers, and 9 had stage IA2 tumors. Four patients, 2 in each group, had lymph-vascular space invasion (LVSI). Initially 20 patients had hysterectomy; there were 8 radical operations, 8 simple (intrafascial) abdominal surgeries, and 4 vaginal hysterectomies. Thirteen patients had pelvic lymph node dissection (PLND) at the time of hysterectomy. Eighteen patients had cervical conization, 4 of them in association with pelvic node dissection. Eleven of the 18 patients having fertility-preserving treatment had a total of 18 pregnancies that ended in 13 live births, 2 terminations, and 3 spontaneous abortions. Two patients had hysterectomy following initial conization. No recurrences were observed during an average follow-up of 6 years. One woman developed grade 3 vulvar intra-epithelial neoplasia following hysterectomy for stage IA2 AC of the cervix. Among the 1565 patients in a literature review were 814 who underwent PLND, 12 of whom had positive lymph nodes. None of the 25 patients with LVSI had node involvement. None of the 356 parametria assessed was involved by disease. Recurrences were documented in 2.4% of 1223 women followed up. None of the 59 women with stage IA1 disease who initially was treated by conization alone had recurrent disease. Twenty-one pregnancies in patients having fertility-preserving treatment yielded 16 live births. The investigators conclude that conization alone is a reasonable and safe treatment option for stage IA1 AC of the cervix. PLND need be done only if LVSI is present. Pending further studies, conization also is appropriate for women with stage IA2 disease, adding PLND if LVSI is present.