Incidence Of Cervical Adenocarcinoma Research Articles

Expression of LRIG1 and LRIG3 correlates with human papillomavirus status and patient survival in cervical adenocarcinoma

The incidence of cervical adenocarcinoma, which accounts for 10-20% of all cervical cancers, has increased continuously in developed countries during the last two decades, unlike squamous cell cervical carcinoma. This increasing trend, noted particularly among women under the age of 40 years, has occurred despite extensive cytological Pap smear screening. A deeper understanding of the etiology of cervical adenocarcinoma, better preventive measures and reliable prognostic markers are urgently needed. The human leucine-rich repeats and immunoglobulin-like domains (LRIG) gene family includes: LRIG1, LRIG2 and LRIG3. LRIG expression has proven to be of prognostic value in different types of human cancers, including breast cancer, early stage invasive squamous cervical cancer, cutaneous squamous cell carcinoma, oligodendroglioma and astrocytoma. LRIG1 functions as a tumor suppressor, while less is known about the functions of LRIG2 and LRIG3. This study evaluated the expression of the three LRIG proteins in tumor specimens from 86 women with pure cervical adenocarcinoma by immunohistochemistry. Possible correlations between LRIG expression and known prognostic factors, including human papillomavirus (HPV) status, FIGO stage and histology were investigated. Patient survival data were collected retrospectively and the possible prognostic value of LRIG protein expression was investigated. High staining intensity of LRIG1 and high fraction of LRIG3-positive cells were significantly associated with patient survival, and positive correlations were found between LRIG1 and LRIG3 staining intensity and HPV status. Thus, the LRIG proteins may be important determinants of cervical adenocarcinoma progression and their diagnostic and prognostic potential should be studied further.

El adenocarcinoma de cérvix como causa infrecuente de sangrado vaginal en la mujer joven

Cervical adenocarcinoma is a less frequent variant than squamous carcinoma. The incidence of cervical adenocarcinoma has been increasing over the last several years. Villoglandular papillary adenocarcinoma usually affects young women and generally has a good prognosis. The treatment of this adenocarcinoma is surgical, with conisation being sufficient in localised cases, but a hysterectomy is often necessary to try and preserve the ovaries and maintain endocrine function.

Cervical adenocarcinoma: Moving towards better prevention

Although cervical screening has led to a significant decline of invasive cervical cancer (ICC) in developed countries, it remains the third leading cause of cancer in women worldwide. While the majority of the decline in ICC can be attributed to a reduction in squamous cell carcinoma (SCC), the incidence of cervical adenocarcinoma (ADC), absolute and relative to SCC, has been rising steadily, especially in younger women. This paper examines oncogenic human papillomavirus (HPV) infections, the risk of developing cervical ADC and its prognosis. It analyzes differences between ADC and SCC and considers current and future methods for prevention. PubMed, publicly available websites and congress abstracts were searched for data and literature. HPV-16, -18 and -45 account for approximately 90% of ADC worldwide. Typically, α-7 genotypes, which include HPV-18 and -45, are more commonly associated with ADC than SCC. The difficulty in detecting ADC through screening as well as changing sexual habits and increased HPV transmission may account for its increase; an increase in SCC may not be observed because of improved detection of pre-malignant SCC compared with pre-malignant ADC. HPV testing shows promise for screening women ≥30years of age, but α-7 genotypes may be underrepresented in precancerous lesions. Clinical trial data indicate that current vaccines have high efficacy against HPV-16/18-related cervical intraepithelial neoplasia. Moreover, these vaccines also demonstrate a different level of protection beyond the HPV vaccine types, therefore increasing the overall vaccine efficacy. Such broad coverage could translate into a considerable reduction in the incidence of ADC. Prophylactic HPV vaccination may have a significant impact on the prevention of ADC and may significantly impact future strategies for primary and secondary prevention of cervical cancer.

Racial and ethnic disparities in the incidence of invasive cervical cancer in Florida

Although cervical cancer incidence has declined in the past decade, considerable racial and ethnic differences remain. The objective of this study was to examine differences in incidence by histology and cancer stage in Florida stratified further by race, ethnicity, and 5-year time intervals. Women who were diagnosed with invasive cervical cancer in Florida between January 1985 and December 2004 were included in the analysis. Age-adjusted incidence rates by race and ethnicity were estimated for different histologic types and stages of cancer. The annual percentage of change in incidence also was calculated for each histologic type. Rate ratios were estimated by race and ethnicity using whites and non-Hispanics as the reference group. Overall, the incidence in Florida of cervical squamous cell carcinoma and transitional cell carcinoma declined significantly from 9.1 per 100,000 women in 1985 to 5.6 per 100,000 women in 2004 (P < .05), whereas the incidence of cervical adenocarcinoma remained stable (P > .05). The incidence of invasive cervical cancer was 9.6 per 100,000 women among whites and 13.13 per 100,000 women among African Americans from 2000 to 2004. African-American women were nearly 2 times more likely to be diagnosed at regional and distant cancer stages than white women for all periods examined. Furthermore, among African-American women aged >40 years, the age-specific incidence of invasive cervical cancer increased considerably, whereas the rates among other racial groups decreased. The increasing rate of invasive cervical cancer among African-American women aged >40 years in Florida, coupled with their diagnosis at a later stage of cancer, is of great concern. Most screening organizations recommend stopping screening at age 65 years. The observations from these analyses highlighted the need to focus prevention and screening efforts on African-American women living in Florida, and particularly on women of postreproductive age.

Increase in Cervical Adenocarcinoma Rate in Goiânia, GO, Brazil

To analyze the incidence and mortality trends of cervical adenocarcinoma in Goiânia, Brazil. The cases were identified from the database of the Population-based Cancer Registry of Goiânia. The primary site was confirmed from the medical files. For all variables studied, frequencies and linear and polynomial logistic regressions were calculated. The Statistical Package for the Social Sciences and Excel softwares were used. Cervical adenocarcinoma accounted for 7.02% of all cancer cases, between 1998 and 2002. The mean age was 44 years for the in situ form and 52 years for the invasive form, and the age group with the highest incidence was from 45 to 49 years. Adenocarcinoma not otherwise specified (68.1%) and stage I were most frequent. The standardized rate incidence increased from 1.47 per 100,000 to 2.84 per 100,000 in 1988 and 2002, respectively (R = 0.424 and P = 0.008). The mortality rates due to cervical adenocarcinoma were 0.89 per 100,000 in 1988 and 0.51 per 100,000 in 2002. An increasing incidence of cervical adenocarcinoma was observed in Goiânia, although the mortality rate remained stable.

Survival and clinicpathologic characteristics of invasive adenocarcinoma of the uterine cervix

16559 Background: Carcinoma of the uterine cervix is one of the most common malignancies among women. The relative proportion and absolute incidence of cervical adenocarcinoma (AC) compared with squamous cell carcinoma (SCC) has increased; in the 1950s 5% of all cervical carcinomas were adenocarcinoma, in the 1990s this proportion increased to 25%. It remains controversial whether or not patients with adenocarcinoma have a worse prognosis; questions remain about whether cervical adenocarcinoma metastasizes earlier or is detected later by the cervical Papanicolaou test, or whether a poorer response to radiotherapy or the inclusion of special subtypes (such as clear cell carcinoma, which is known for its dismal prognosis) could account for an apparent poorer prognosis. Methods: This retrospective study was done in the Clinical Oncology Department of the Brazilian National Cancer Institute with 278 cases of primary AC of the uterine cervix diagnosed between 2002 and 2004. Clinical and pathological data were reviewed; survival was analyzed according to the Kaplan- Meier method. Results: Median age at presentation was 48 years; 50,4% of the patients were married and 66,9% were white. On histologic evaluation pure adenocarcinoma was found in 80,9% of the cases (n = 225), adenosquamous carcinoma in 14,4% (n = 40), clear cell carcinoma in 2,9% (n = 8) and other variants in 1,8% (n = 5). At diagnosis anemia was found in 29,5% of the patients, but 61,5% had metrorrhagia; 6,8% had hydronephrosis and 7,6% had high creatinine levels. Using FIGO stage 38,8% were stage I, 38,8% stage II, 17,9% stage III and 4,5% stage IV. Surgical treatment was used in 93 cases, radiochemotherapy combination in 69 cases and brachitherapy 129 cases. The median survival time was 34,9 months; 1-year, 3-year and 5-year overall survival rates were 81,2%; 67,2% and 54% respectively. The median survival time for the FIGO stage I, II, III and IV was 38,1; 35,4; 18,5 and 3,6 months. Conclusions: Adenocarcinomas are becoming more common, this report shows a similar survival to that found in previous reports and demonstrates a high rate of early FIGO stages. No significant financial relationships to disclose.

Significant decrease of adenocarcinoma in situ not reflected in cervical adenocarcinoma incidence in the Netherlands 1989–2003

Over the period 1989–2003, the incidence of cervical adenocarcinoma (n=1615) was stable whereas that of cervical adenocarcinoma in situ (n=1884) significantly decreased (P=0.008), mainly caused by adenocarcinoma in situ lesions with a concurrent squamous dysplasia.

Comparative sensitivities of ThinPrep and Papanicolaou smear for adenocarcinoma in situ (AIS) and combined AIS/high-grade squamous intraepithelial lesion (HSIL): Comparison with HSIL

Despite the historic belief that cytologic screening offers little protection against cervical adenocarcinoma (CAC), there is emerging evidence that, by detecting the precursor lesion, adenocarcinoma in situ (AIS), cervical screening may reduce the incidence of CAC as it has for cervical squamous carcinoma. Because liquid-based cytology is fast replacing the conventional Papanicolaou smear (PS), it is important to establish that it is at least as effective in detecting AIS. The authors calculated the sensitivities of PS and ThinPrep (TP) for 100 women with histologic AIS (from 160 PS slides and 60 TP slides), for 94 women with AIS+high-grade squamous intraepithelial lesion (HSIL) (from 151 PS slides and 50 TP slides), and for 558 women with HSIL (from 788 PS slides and 383 TP slides). All smears were taken up to 36 months before the histologic diagnosis. In no category was there a significant difference between PS sensitivity and TP sensitivity. The HSIL category had a significantly higher overall sensitivity than the other categories. However, when sensitivity was defined as cytologic detection of high-grade disease, there was no difference between any of the categories. For the detection of a high-grade glandular lesion, the presence of a concurrent histologic HSIL was associated with reduced sensitivity for the detection of AIS. The current results indicated that it may prove possible for cervical screening, with either PS or TP, to reduce the incidence of CAC.

Inverse correlation between RASSF1A hypermethylation, KRAS and BRAF mutations in cervical adenocarcinoma

Objective. Although the incidence of cervical adenocarcinoma is increasing, few genetic and epigenetic changes in its progression have been described. We hypothesized that RASSF1A methylation and KRAS and BRAF mutations may play an important role in cervical adenocarcinoma. Methods. Archival primary carcinoma tissues ( n = 258) in uterine cervix consisting cervical adenocarcinomas ( n = 115) and squamous cell carcinomas ( n = 143) were evaluated for activating mutations of BRAF and KRAS and promoter hypermethylation of RASSF1A using methylation specific PCR and specific sequence analysis. HPV E7 Type-specific PCR was used for HPV-16 and -18 status. Results. KRAS mutations were found in 16 adenocarcinomas (13.9%), while BRAF mutations were found in 5 (4.3%). RASSF1A methylation was found in 27 adenocarcinomas (23.5%) and inversely correlated with KRAS and/or BRAF mutation ( p = 0.002) in cervical adenocarcinoma. In cervical squamous cell carcinomas, KRAS mutations were detected only in 1 (0.7%) cases and RASSF1A hypermethylation was detected in 2 (1.4%). The frequency of KRAS mutation and RASSF1A methylation were significantly different between adenocarcinomas ( P < 0.001) and squamous cell carcinomas ( P < 0.001). Neither KRAS mutation nor RASSF1A methylation were associated with HPV status. RASSF1A hypermethylation and KRAS mutations and BRAF mutations are inversely correlated and play an important role in the development of adenocarcinomas. Conclusions. These results are suggesting that these two histological types of cervical cancer arise through different molecular pathways in tumor development. Different genetic/epigenetic alterations may explain the possible different therapeutic responsiveness between adenocarcinoma and squamous cell carcinoma of uterine cervix seen in clinic.

Decreasing incidence of cervical adenocarcinoma in Ontario: Is this related to improved endocervical Pap test sampling?

In many developed countries, the incidence of cervical cancer has decreased. These reductions have been specific to squamous cell carcinoma (SCC) and have not included adenocarcinoma (AC). Incidence of AC has increased steadily over the last 20 years. The intent of this article is to examine trends in cervical adenocarcinoma incidence in Ontario over a 20-year period in relation to screening practices. All cases of cervical cancer between 1981 and 2002 were extracted from the Ontario Cancer Registry (a population-based, provincial-wide database). Age-standardized incidence rates were calculated overall, by broad age groups and by morphological type (SCC and AC). Time trends were assessed using JoinPoint methodology. In Ontario, opportunistic cervical cancer screening has been accompanied by significantly decreased rates of SCC since at least 1981. Conversely, the incidence of AC rose by 3.1% per year (95% CI: 1.6%, 4.6%) between 1981 and 1995, and subsequently declined by 4.0% per year (95% CI: -7.4%, -0.5%). From the mid- to late-1990s, instructions were distributed to clinicians, reinforcing the importance of dual specimen collection (i.e., using both spatula and endocervical brush). At the same time, laboratories routinely provided physicians with kits that included both spatula and brush. The subsequent decline in AC incidence may be due, in part, to improved specimen collection. As well, the decline may be partly due to increased awareness of AC precursors among cytopathologists and clinicians, and/or improvements in laboratory training and quality assurance.

Comparison of DNA hypermethylation patterns in different types of uterine cancer: Cervical squamous cell carcinoma, cervical adenocarcinoma and endometrial adenocarcinoma

The incidence of cervical adenocarcinoma (CA) is rising, whereas the incidence of cervical squamous cell carcinoma (CSCC) continues to decrease. However, it is still unclear whether different molecular characteristics underlie these 2 types of cervical carcinoma. To better understand the epigenetic characteristics of cervical carcinoma, we investigated the DNA promoter hypermethylation profiles in CA and CSCC. In addition, we investigated whether DNA hypermethylation patterns might be used for the molecular diagnosis of CA and endometrial adenocarcinoma (EA). Using the bisulfite-modification technique and methylation-specific PCR, we examined the aberrant promoter hypermethylation patterns of 9 tumor suppressor genes (APC, DAPK, CDH1, HLTF, hMLH1, p16, RASSF1A, THBS1 and TIMP3) in 62 CSCCs, 30 CAs and 21 EAs. After Bonferroni correction adjustment (statistically significant at p < 0.0055), we found that the aberrant hypermethylations of CDH1 and DAPK were more frequent in CSCCs than in CAs (80.6% vs. 43.3%, p = 0.001; 77.4% vs. 46.7%, p = 0.005), whereas HLTF and TIMP3 were more frequently methylated in CAs (3.2% vs. 43.3%, p < 0.001; 8.1% vs. 53.3%, p = 0.001). The hypermethylations of RASSF1A and APC were more frequent in CAs than in CSCCs, but this was not significant (9.7% vs. 33.3%, p = 0.008; and 14.5% vs. 40.0%, respectively, p = 0.009). In addition, RASSF1A hypermethylation was significantly more frequent in EAs than in CAs (81.0% vs. 33.3%, p = 0.001). In conclusion, the existence of these unique methylation patterns in these cancers suggests that their tumorigenesis may involve different epigenetic mechanisms.

Incidence Trends of Adenocarcinoma of the Cervix in 13 European Countries

Rapid increases in cervical adenocarcinoma incidence have been observed in Western countries in recent decades. Postulated explanations include an increasing specificity of subtype-the capability to diagnose the disease, an inability of cytologic screening to reduce adenocarcinoma, and heterogeneity in cofactors related to persistent human papillomavirus infection. This study examines the possible contribution of these factors in relation with trends observed in Europe. Age-period-cohort models were fitted to cervical adenocarcinoma incidence trends in women ages <75 in 13 European countries. Age-adjusted adenocarcinoma incidence rates increased throughout Europe, the rate of increase ranging from around 0.5% per annum in Denmark, Sweden, and Switzerland to >/=3% in Finland, Slovakia, and Slovenia. The increases first affected generations born in the early 1930s through the mid-1940s, with risk invariably higher in women born in the mid-1960s relative to those born 20 years earlier. The magnitude of this risk ratio varied considerably from around 7 in Slovenia to almost unity in France. Declines in period-specific risk were observed in United Kingdom, Denmark, and Sweden, primarily among women ages >30. Whereas increasing specificity of subtype with time may be responsible for some of the increases in several countries, the changing distribution and prevalence of persistent infection with high-risk human papillomavirus types, alongside an inability to detect cervical adenocarcinoma within screening programs, would accord with the temporal profile observed in Europe. The homogeneity of trends in adenocarcinoma and squamous cell carcinoma in birth cohort is consistent with the notion that they share a similar etiology irrespective of the differential capability of screen detection. Screening may have had at least some impact in reducing cervical adenocarcinoma incidence in several countries during the 1990s.

MRI of endocervical glandular disorders: three cases of a deep nabothian cyst and three cases of a minimal-deviation adenocarcinoma

The incidence of cervical adenocarcinoma is increasing. Nabothian cysts are a common gynecologic condition; if multiple and/or large cysts are present, it is difficult to differentiate them from a minimal-deviation adenocarcinoma (MDA), which is classified as a special type of cervical adenocarcinoma. We report three cases of deep nabothian cysts and three cases of MDAs. Magnetic resonance imaging (MRI) findings, signs, and symptoms of these cases are described. The absence of a watery discharge and an MR image displaying a round or oval cyst without enhancement after intravenous gadolinium are helpful in the diagnosis of a deep nabothian cyst.

Increasing trends of cervical adenocarcinoma incidence in Central Italy despite Extensive Screening Programme, 1985–2000

Incidence rates of adenocarcinoma of the uterine cervix have been reported to be increasing in several countries, but not in Italy. The aim of the present study was to analyse trends in cervical cancer incidence by histological type in two districts of Central Italy (Florence and Prato), covered by the Tuscany Cancer Registry (RTT), where cytological screening had been available since the 1970s. Incident cervical cancers during 1985–2000 were 1012. Estimated Annual Percent Change (EAPC) by age-groups and histological type were computed. Incidence increased for adenocarcinoma (EAPC = +5.7%; 95% confidence interval (CI) +2.8; +8.6); whereas, it decreased for squamous cancer (EAPC = −1.9%; 95% CI −3.8; 0) and for other or not specified types (EAPC = −4.4%; 95% CI −10.0; +1.5). Adenocarcinoma increased significantly among younger women (<55 years) but not among older ones, whereas squamous cell cancer decreased among older women only. The burden of cervical cancers might increase in the future if no specific preventive strategies for adenocarcinoma are implemented.

Improvement in protection against adenocarcinoma of the cervix resulting from participation in cervical screening.

The incidence of adenocarcinoma of the cervix did not decline in Western countries in the 1970s and 1980s despite the availability and use of cervical cytologic screening. The impact of improved endocervical sampling and better recognition of the cytologic precursors to adenocarcinoma during the 1990s in reducing the risk of adenocarcinoma is currently unknown. Using records from a statewide registry, the authors compared the screening histories of 160 women with adenocarcinoma (33 microinvasive cases and 127 invasive cases) who were diagnosed between 1995 and 2001 with the screening histories of 640 control women in a matched case-control study. A decreased risk of invasive adenocarcinoma was associated with a recent negative Papanicolaou (Pap) smear and at least one smear with an endocervical component since 1994. An increased risk of invasive adenocarcinoma was associated with a history of previous cervical abnormalities and greater than 5 years between Pap smears. There was no significant difference between cases and controls with regard to the number of negative Pap smears. There was little apparent difference in the screening histories of patients with microinvasive tumors and the controls, with the control women appearing to have no greater relative protection than the cases. With biennial screenings, the authors estimate that a 46% reduction in the cumulative incidence of invasive adenocarcinoma could be achieved, and with annual screening, a 65% reduction could be achieved. The incidence of cervical adenocarcinoma should begin to decline in the current decade among screened women.

Stage IIB–IVB Cervical Adenocarcinoma: Prognostic Factors and Survival

Objective. The incidence of cervical adenocarcinoma is increasing relative to squamous cell carcinoma and all cervical cancers. Few reports have described the outcome of patients with advanced cervical adenocarcinoma. The purpose of this study was to determine the prognostic factors and survival for patients with stage IIB–IVB disease.Methods. Institutional Review Board approval was obtained to perform a computerized search of all women diagnosed with cervical adenocarcinoma at our three institutions between 1982 and 2000. Medical records were retrospectively reviewed. Clinical follow-up was obtained from the SGO database and tumor registry and via correspondence with health care providers. Statistical analysis was performed using logistic regression for clinical variables and the log-rank test to compare Kaplan–Meier survival estimates.Results. Eighty-three women with FIGO stage IIB–IVB cervical adenocarcinoma were identified. The median patient age was 53 years (range, 22–88). The median follow-up of 17 (20%) surviving patients was 33 months (range, 6–147); 66 (80%) died during the study interval. Stage IIB disease, young patient age, and grade 1 histology were independent variables having a favorable impact on survival (each P < 0.02). Stage IIB patients (n = 41) were more likely to be alive at 2 (64% vs 8%) and 5 years (30% vs 0%) than women with stage IIIA–IVB disease (n = 42; P < 0.01).Conclusions. Women diagnosed with advanced stage cervical adenocarcinoma have a poor prognosis. Prospective, multicenter trials of platinum-based chemoradiation or other novel therapies are urgently needed in the treatment of this highly lethal disease.

Cervical adenocarcinoma in situ: a systematic review of therapeutic options and predictors of persistent or recurrent disease.

The incidence of cervical adenocarcinoma in situ is increasing in frequency, and our limited knowledge about this lesion presents the physician with a therapeutic dilemma. Treatment for this lesion has included conservative therapy, large loop excision or cold-knife cone biopsy, or definitive therapy consisting of hysterectomy. But, rates of residual adenocarcinoma in situ after cone biopsy with negative margins vary from 0% to 40%, and residual disease rates as high as 80% have been noted when the margins are positive. Despite these recent data on follow-up after conservative therapy such as cone biopsy, it seems that this method is safe and gaining acceptance by many physicians and patients. However, the short follow-up duration and small number of patients limit the conclusions of many studies. The relative infrequency of this diagnosis has precluded extensive clinical experience with the natural history of this lesion.

The significance of cell type and tumor growth markers in the prognosis of unscreened cervical cancer patients

ter Harmsel B, van Muyden R, Smedts F, Hermans J, Kuijpers J, Raikhlin N, Petrov S, Lebedev A, Ramaekers F, Trimbos B. The significance of cell type and tumor growth markers in the prognosis of unscreened cervical cancer patients. Int J Gynecol Cancer 1998; 8: 336–344. The clinical significance of p53, Ki-67-Ag, and BCL-2 as markers for patient prognosis in cervical carcinoma was compared to established prognostic tumor parameters. The examined population consisted of 159 unscreened Russian women, presenting with Stage I (n= 74) and Stage II (n= 85) cervical carcinoma. Relevant clinical information was available in all cases. Thirty-five percent of cases were either adenocarcinoma or contained an adenocarcinomatous component. Lymph node status and stage of disease appeared to be statistically significant parameters for patient survival. Depth of tumor infiltration was a significant indicator of 5-year relapse risk, while tumor size and histologic classification were not predictive. When analyzed separately, p53, Ki-67-Ag, and BCL-2 were not significantly correlated with clinical parameters. However, high Ki-67-Ag combined with high BCL-2 indices predicted a shorter relapse-free interval than did low Ki-67-Ag combined with low BCL-2 index. We conclude that the relatively high incidence of cervical adenocarcinomas is merely due to an increased awareness in the histologic classification criteria of this tumor subtype. Furthermore, histologic parameters are not of value in predicting patient outcome. Although tumor stage and lymph node status are superior to individual markers of tumor growth and genomic instability in determining patient prognosis, a combination of markers for proliferation index and protection from apoptotic cell death shows a tendency to predict clinical outcome.

International trends in the incidence of cervical cancer: I. Adenocarcinoma and adenosquamous cell carcinomas.

Time trends in the incidence of cervical adenocarcinoma and adenosquamous cell carcinomas during the period 1973-1991 were examined using data provided by 60 population-based cancer registries from 32 defined populations in 25 countries. Three components of the incidence trend were studied: age, calendar period of diagnosis and birth cohort. Cumulative incidence rates per 1,000 for 2 groups with age ranges 25-49 and 50-74 years were calculated from the model that best described the incidence data. There was a significant increase in the cumulative incidence of cervical adenocarcinomas in women born in the mid-1930s and in successive cohorts thereafter in some populations in the United States (whites and Hispanic women), Australia, New Zealand (non-Maori), England, Scotland, Denmark, Slovenia, Slovakia and Japan (Osaka) and among Chinese women in Singapore, with a general decline in the incidence in women born in earlier periods. In Sweden and Slovenia there is a suggestion of an increasing trend in both age groups. A decrease in incidence in both age groups was apparent in Finland, France and Italy. There were no changes in incidence in 24 registries covering other European, Asian and black populations in the United States. Part of the increase may be attributable to an increasing prevalence of human papillomavirus infection, and part to improvements in screening.

Synchronous endometrial and endocervical adenocarcinoma

Kumar D, Kumar S, Payne D, Tyring SK, Dinh TV. Synchronous endometrial andendocervical adenocarcinoma. Int J Gynecol Cancer 1997; 7: 466–470. The majority of synchronous multiple primary neoplasms of the female reproductive tract are of endometrial and ovarian origin. We did not find a description of synchronous endocervical and endometrial adenocarcinoma in our search of the literature. We describe the clinicopathologic features of three patients, who presented with post-menopausal bleeding and were found to have separate primary adenocarcinomas of the endocervix and endometrium. Polymerase chain reaction and in situ hybridization studies were negative for human papilloma virus DNA sequences. All patients underwent hysterectomy and bilateral salpingo-oophorectomy and received post-operative radiation therapy. One patient died of her disease. The other two are alive without evidence of disease. Since the incidence of cervical adenocarcinoma is increasing more such cases will be diagnosed, raising important therapeutic issues. Routine cytology cannot reliably predict the exact origin of tumors in the uterus. Biopsies from endometrium and an endocervical curettage may assist in the diagnosis of such dual primaries before surgery, particularly if the histology at the two sites is different.