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PubMed1998

[Past, present and future of oncology].

The past, present and future of oncology are presented using the example of cervical cancer. In 1908, Walter Schauenstein described the histology of atypical squamous epithelium at the uterine cervix. This was one of the first descriptions of what today is called carcinoma in situ. In the 1950s, Ernst Navratil initiated the concept of the early diagnosis of cervical cancer based on colposcopy and cytology. Erich Burghardt's studies on the morphogenesis of cervical cancer in the 1970s led to a reduction of radicality in the treatment of early invasive types of cervical carcinoma. Conization only and simple total hysterectomy have all but replaced radical procedures for patients with microcarcinomas. Today the treatment of cervical cancer is individualized according to tumor size as determined by preoperative MRI. The lymph node status is determined intraoperatively by frozen section histology and influences the extent of the procedure. Molecular methods and genetic techniques are the future of oncology. However, inherited factors do not seem to play an important role in the development of cervical cancer. Surgery is still the basis of the treatment of this disease.

Carcinoma in Situ↗
PubMedDate not supplied

Histologic follow-up of atypical endocervical cells. Liquid-based, thin-layer preparation vs. conventional Pap smear.

OBJECTIVE: To review the histologic findings in patients diagnosed with "atypical glandular cells of uncertain significance, endocervical cell type" (AGUS-EC) by ThinPrep Pap Test (TPPT) or conventional Pap smear (CPS) and to evaluate the clinical value of subclassifying AGUS-EC as "favor reactive" or "favor neoplastic." STUDY DESIGN: All TPPT and CPS diagnosed as AGUS-EC (favor reactive, unspecified and favor neoplastic) from January 1998 through December 1999 and all available histologic follow-up (defined as endocervical curettage, cervical biopsy, cervical conization or hysterectomy obtained within six months of the time of an AGUS-EC diagnosis) were obtained from a computerized database. RESULTS: AGUS-EC was diagnosed in 0.77% of CPS (683 of 88,825) and 0.59% of TPPT (183 of 30,968) (P = NS). There was no statistically significant difference in any of the follow-up histologic diagnoses between the CPS and TPPT groups. The majority of the follow-up biopsies demonstrated benign processes in both groups. Patients with a diagnosis of AGUS-EC "favor neoplastic" had a greater proportion of true glandular pathology as compared with AGUS-EC "unspecified" or "favor reactive" (P < .001). None of the patients with a diagnosis of AGUS-EC "favor reactive" were found to have true glandular pathology; however, a minority of them proved to have squamous pathology. CONCLUSION: In this study there was no difference in CPS and TPPT in regard to the specificity of a diagnosis of AGUS-EC for true glandular pathology. Subclassifying AGUS-EC as "favor reactive" or "favor neoplastic" may provide valuable information for directing patient follow-up.

Adenocarcinoma↗
PubMedDate not supplied

Villoglandular papillary adenocarcinoma of the uterine cervix: report of a case.

Villoglandular papillary adenocarcinoma is a recently described form of adenocarcinoma of the uterine cervix, which apparently affects young women and seems to have a favorable course with an excellent prognosis. We report on a case of villoglandular papillary adenocarcinoma in a 26-year-old woman. The patient was treated by conization alone and is disease free after a 40-month follow-up.

Adenocarcinoma, Papillary↗
PubMed2001

High prevalence of high grade squamous intraepithelial lesions and microinvasive carcinoma in women with a cytologic diagnosis of low grade squamous intraepithelial lesions.

OBJECTIVE: To evaluate the histologic nature of low grade intraepithelial lesion (LSIL) in a region with a high prevalence of invasive cervical carcinoma and to propose a management protocol. STUDY DESIGN: Comparing the follow-up of 877 women with LSIL during a 43-month period, taking into consideration the histologic nature determined by colposcopic biopsy, endocervical curettage, conization or hysterectomy as the final pathologic diagnosis. RESULTS: During the study period, from July 1994 to February 1998, a total of 128,925 Pap smears were performed at our institute, with 877 (0.68%) diagnosed as LSIL. Among these, 722 women with CIN1-SIL and 32 with human papillomavirus-related changes (HPV-SIL) were enrolled in the study. Of the 543 women with CIN 1/squamous intraepithelial lesion, 145 (27%) cases of high grade squamous intraepithelial lesion were disclosed histologically, as were 16 (3%) cases of microinvasion. Among those followed at an interval of three months with a Pap smear alone, the persistence rate was 46.8%, while the regression rate was 40%. Thirty-two women with HPV/SIL underwent histologic evaluation, revealing 18% CIN 2/3 with no microinvasion. CONCLUSION: A high percentage of CIN 2/3 as well as microinvasive lesions will go unnoticed in the absence of colposcopic evaluation.

Colposcopy↗
PubMed2001

Evaluation and management of the AGUS Papanicolaou smear.

Atypical glandular cells on Papanicolaou smears are an unusual but important cytologic diagnosis. The Bethesda system classifies atypical glandular cells of undetermined significance (AGUS) as glandular cells that demonstrate nuclear atypia appearing to exceed reactive or reparative changes but lacking unequivocal features of adenocarcinoma. AGUS occurs in approximately 0.18 to 0.74 percent of all cervical smears. Because of the high likelihood that AGUS is associated with significant clinical disease, simply repeating the Papanicolaou smear is not sufficient for the management of AGUS. Unlike women with atypical squamous cells of undetermined significance, a significant percentage of women with AGUS will have more serious lesions, such as high-grade preinvasive squamous disease, adenocarcinoma in situ, adenocarcinoma or invasive cancers from sites other than the cervix. Colposcopic examination is recommended for all women with a cytologic diagnosis of AGUS. Those women with AGUS that is suspicious for adenocarcinoma should undergo cervical conization, even in the absence of detectable abnormalities on colposcopic examination.

Adenocarcinoma↗
PubMed2001

[CIN: multicentric study of therapeutic strategies].

BACKGROUND: Cervical Intraepithelial Neoplasia (CIN) is a dysplastic lesion that precedes cervical cancer. The diagnosis is made by colposcopic, cytologic and bioptic exams. Therapy may be physical, pharmacological or surgical. METHODS: We prepared a model of interview (consisting of 9 questions) for 33 colposcopic centers in the Lazio region. Our aim was to evaluate their therapeutic strategies for CIN and cervical condylomata. We referred to SIGO 1999 guidelines for CIN therapy and to European guidelines for cervical condylomata therapy. RESULTS: The centers used drugs more for HPV infections (57%) than for dysplasia (33%). Drug therapy was used more in the past (66.67%). Actually they prefer treating CIN I with electrocoagulation diathermy (DTC), CIN II with loop electrosurgical excision procedures (LEEP) or Laser, CIN III with cold knife conization or LEEP, cervical condylomata with laser or DTC. CONCLUSIONS: The results show that the centers prefer physical therapy. Therapeutic strategies comply with SIGO 1999 guidelines for therapy of CIN and with European guidelines for cervical condylomata partially.

Conization↗
PubMed2002

Surgical management of early stage cervical cancer: ten years experience from one Greek health region.

PURPOSE OF INVESTIGATION: Cervical cancer is the second most common malignancy in women, in both incidence and mortality. In the present study, we report our results of treating 93 consecutive patients with early invasive cervical cancers (Stages I-IIA). METHODS: The patients of this study comprised all women recognized with stage I-IIA cervical cancer during 1991-2000. Patients with stage IA1 cervical cancer without lymphvascular space involvement underwent either conservative management by means of large loop conization or simple hysterectomy. The remaining patients underwent radical hysterectomy and lymphadenectomy or radiation therapy. Mean (+/- SD) duration of follow-up was 6 (+/- 1.7) years. RESULTS: The mean (+/- SD) age of patients with stage I-IIA cervical cancer was 41.3 (+/- 9.1) year. Thirty-five patients with stage [A1 disease were managed conservatively with loop excision and 19 patients subsequently became pregnant. Fifty-two patients with stage IA2, IB and IIA cervical carcinoma underwent radical hysterectomy and lymphadenectomy. CONCLUSION: Young women with stage IA1 cervical carcinoma wishing future fertility who undergo loop excision have a 100% cure rate. Women with stage IA2, IB, and IIA cervical cancer should undergo radical hysterectomy and lymphadenectomy or radiation therapy.

Adult↗
PubMed2002

[Treatment of precancerous changes of the uterine cervix].

The aim of the present review is to view the possibilities for the treatment of the precancer lesions of the uterine cervix, on the basis of the modern tendencies in the gynecological practice. The description and criteria for the applicability of the actively observation, different destructive--chemical, thermo-, cryo-, electro- and laser ablation, as well as excisional methods--classical, surgical, laser and LEEP/LLETZ conization were discussed. The advantages and disadvantages of each method were pointed out. The conclusion is, that the presence of different therapeutic strategies enrich the treatment opportunities, which depends, from one hand of the technical equipment, the experience of the specialists working in this field, and the correct indications of the cases from other.

Antimetabolites, Antineoplastic↗
PubMed2003

Bowel injury occurring during an outpatient LLETZ procedure. A case report.

BACKGROUND: Large loop excision of the transformation zone (LLETZ) of the cervix has almost entirely replaced cold knife conization for the treatment of dysplasia. CASE: A 17-year-old woman, gravida 0, underwent LLETZ of the cervix for treatment of cervical intraepithelial neoplasia 2. A bowel injury occurred during the procedure. The bowel was repaired in the operating room, and no long-term complications resulted. CONCLUSION: While LLETZ is a minor outpatient procedure, serious complications can occur.

Adolescent↗
PubMed1954

Postmenopausal bleeding of nonmalignant origin.

A study was made of the medical records of 102 patients hospitalized because of postmenopausal bleeding. Diagnostic procedures used included vaginal examination, Papanicolaou smears, curettage and cervical biopsy. The major associated pathological conditions (possibly etiological factors) in the series were chronic cervicitis, fibromyoma of the uterus, endometrial polyps, cervical polyps and adenomyosis of the uterus. Sclerosis of the uterine vessels was suggested as another possible cause of this type of bleeding. Neither the amount and type of bleeding nor the pattern of associated symptoms were of diagnostic value.A history of hormonal therapy prior to the onset of bleeding is not sufficient evidence to establish that as the cause of the bleeding and the patient should be as completely investigated as if this history were not present. In over 61 per cent of cases in this series, uterine curettage with or without cervical biopsy, cauterization, conization or trachelorrhaphy, was the only treatment required for both diagnosis and therapy.

Climacteric↗
PubMed1963

Vaginal smears. A plea for more critical evaluation.

To determine whether a conscious effort to reduce the incidence of equivocal (Class III) vaginal cytologic smear readings might have demonstrable clinical value, we have compared a previous study of our predictive efforts with a recent experience in screening a similar number of patients. It was possible to achieve an appreciable reduction in the incidence of Class III smears-from 2.4 per cent to 0.6 per cent. There was a modest increase in the reliability of the Class III smear as an indicator of cancer and a very notable increase in the reliability of the Class IV and V interpretations. While only 66 per cent of the earlier group with Class IV and V smears were shown to have cancer, 86 per cent of the present series with IV and V readings had malignant disease (97 per cent of the Class V group). The ultimate yield of malignancies was similar in the two series, but theoretically the overloading of Classes III, IV and V with women who do not actually have cancer necessarily leads to large numbers of diagnostic surgical procedures that might be avoided. Class III should be used to denote merely a temporary state of inconclusiveness rather than a real suspicion of cancer. With proper collaboration between physician and cytologist, most of the initially confusing situations can be either upgraded or downgraded to the proper rating, and eventually the bulk of patients standing to profit from conization will fall into Classes IV or V.

Conization↗
PubMed2006

[Organ-saving and function-conserving procedures in the treatment of cervical carcinoma].

The paper presents our data on conservative treatment of early cervical carcinoma using laser, ultrasound, electrocautery scissors and electrosurgical conization. Also, menstrual and reproductive function in cured patients as well as frequency of tumor recurrence are discussed. An original procedure for ovarian transposition used in combined treatment of invasive cervical carcinoma is suggested. Potential and methods of monitoring transposed appendages are validated. Findings on 5-year survival are presented. The methods of conservative treatment are evaluated as promising further achievements in oncogynecology.

Adult↗
PubMed2006

Fertility-preserving options for cervical cancer.

Childbearing is one of the most important life goals for many women, and fertility preservation is a very important factor in the overall quality of life of cancer survivors. Cervical cancer frequently affects young women; because some women tend to delay childbearing, fertility preservation must be considered when treatment options are discussed. Over the past decade, the radical trachelectomy procedure has become a well established fertility-preserving option for young women with early-stage cancer; this procedure is associated with low morbidity, good oncologic outcome, and a high proportion of pregnancies that reach the third trimester and babies that are delivered at term. This article will review available literature on the vaginal radical trachelectomy procedure and data from other surgical approaches, such as the abdominal radical trachelectomy. In addition, the potential future application of neoadjuvant chemotherapy followed by fertility-preserving surgery in patients with locally advanced cervical cancer will be examined. Finally, ultraconservative surgical approaches (eg, conization alone with or without laparoscopic lymphadenectomy) in very early-stage disease will be discussed.

Abdomen↗
PubMedDate not supplied

Northern Thai women with high grade squamous intraepithelial lesion on cervical cytology have high prevalence of underlying invasive carcinoma.

The aim of this study was to determine the underlying pathology of women with high grade squamous intraepithelial lesion (HSIL) on cervical cytology. A total of 681 women with HSIL cytology undergoing colposcopic examination at Chiang Mai University Hospital (CMUH) between January 2000 and December 2005 were evaluated for the underlying cervical pathology. The final pathology was diagnosed from the most severe lesions obtained by punch biopsy, loop electrosurgical procedure, cold knife conization or hysterectomy. Underlying high grade cervical lesions including cervical intraepithelial neoplasia grade 2, 3 and adenocarcinoma in situ were noted in 502 (73.7%) women. Invasive cervical carcinoma was identified in 141 (20.7%). The remaining 38 (5.6%) had either low grade or no intraepithelial lesions. No significant difference in the prevalence of underlying high grade and invasive lesions was noted between women with cytologic diagnosis of HSIL from CMUH and other hospitals. In conclusion, northern Thai women with HSIL cytology are at significant risk of having underlying severe cervical lesions, and especially invasive carcinoma which is detected in approximately one-fifth of the cases.

Adult↗
PubMed1996

Enteric type villoglandular papillary adenocarcinoma of the uterine cervix associated with in situ squamous cell carcinoma. Case report and review of the literature.

A very rare case of enteric-type villoglandular papillary adenocarcinoma of the uterine cervix associated with in situ squamous cell carcinoma in a 21-year-old nulliparous caucasian woman is reported. Adjacent to the infiltrative component of an enteric-type lesion, cervical intraepithelial glandular neoplasia (CIGN) was also noticed. Histochemical detection of acetylated sialomucins demonstrates the enteric-type nature of this neoplastic (via metaplasia) process. The patient was treated by conization. Follow-up was uneventful one year after diagnosis.

Adenocarcinoma, Papillary↗
PubMed1996

[Value of extemporaneous pathology sections in cone biopsies].

OBJECTIVE: To assess the usefulness of frozen sections in cone biopsies. METHODS: Retrospective study of 60 cases: 26 without frozen section, from January 1985 to December 1988 (group 1); 34 with frozen section of the endocervical upper part of the cone, from January 1989 to December 1992 (group 2). RESULTS: The average height of the cone was 1.48 cm in group 2, and 2.23 cm in group 1. The cone margins were free of disease in 100% of cases in groupe 2, and in 88.5% in group 1. The rate of secondary hemorrage was 2.9%, compared with of 7.6% in group 1. CONCLUSION: Frozen section of endocervical upper part of the cone allows more economic excisions of healthy tissues as well as suppression of cases with involved cone margins. With technical improvement of electro-surgical units, we changed since 1992 from cold knife conization to large loop excision of the transformation zone, in association with frozen sections.

Adult↗
PubMed1997

AGUS in cervical endometriosis.

OBJECTIVE: To evaluate cervical endometriosis as a source of abnormal glandular cells in cervicovaginal smears. STUDY DESIGN: Histologically documented cases of cervical endometriosis with concurrent cervicovaginal smears were reviewed. The cytologic specimens were evaluated for the presence of glandular abnormalities. RESULTS: There were eight cases of superficial endometriosis (five of which had concurrent tuboendometrioid glandular metaplasia) and two cases of deep endometriosis in this series. Five of the eight cases of superficial endometriosis had abnormal glandular cells in the smears; neither of two cases of deep endometriosis had glandular abnormalities. Four of the eight cases of superficial endometriosis had previously undergone conization for cervical intraepithelial neoplasia (CIN) (squamous intraepithelial lesion [SIL]) and were being monitored for recurrence. Of the five cases of atypical glandular cells of unknown significance (AGUS), one case had concurrent high grade CIN (SIL). Another case was originally misinterpreted as recurrent glandular dysplasia. CONCLUSION: Physicians monitoring patients after treatment for CIN need to be aware that endometriosis and tuboendometrioid metaplasia may be the source of atypical glandular cells and on occasion may be subject to misinterpretation.

Cervix Uteri↗
PubMed1997

[Estimation of the treatment cost of cervical cancer].

BACKGROUND: The goal of this study was to estimate direct costs induced by the first year of treatment of cervix cancers according to the stage at diagnosis. METHODS: Fifteen patients of the Gynaecology Department of the Besançon hospital (Doubs, France) were involved in a prospective study to estimate the real cost of treatment of carcinomas in situ (CIS) by conization and of microinvasive carcinomas (MIC) by simple hysterectomy. Costs of invasive cancers were obtained from a retrospective analysis of 24 hospital records in the Radiotherapy Department. RESULTS: The average real cost of treatment for the CIS was 5023 FF (1995 French Francs). Real treatment cost of the MIC was 15,867 FF. The average cost of treatment for the IB and IIA cancers stage (FIGO classification) was 61,540 FF and 145,314 FF for the IIB to IV stage cancers. CONCLUSIONS: Cost-estimation of cervix cancer treatment according to the stage of diagnosis has to be done before starting a cost-effectiveness analysis of mass screening for cervix cancers. This study will allow us to take into account changes in the stages distribution following on a screening campaign.

Carcinoma in Situ↗