Microinvasive adenocarcinoma of the cervix

doi:10.1016/j.ajog.2011.07.029

American Journal of Obstetrics and Gynecology

Volume 206, Issue 1, January 2012, Pages 80.e1-80.e6

Presented at the 42nd annual meeting on Women's Cancer of the Society of Gynecologic Oncologists, Orlando, FL, March 6-9, 2011.

https://doi.org/10.1016/j.ajog.2011.07.029 Get rights and content

Objective

We compared the outcomes of microinvasive squamous cell carcinoma and adenocarcinoma of the cervix and examined the safety of fertility-conserving treatment.

Study Design

The Surveillance, Epidemiology, and End Results database was used to identify all women with stage IA1 and IA2 cervical carcinoma diagnosed from 1988 to 2005. The treatment and outcomes of women with adenocarcinomas were compared with squamous cell carcinomas.

Results

A total of 3987 women including 988 with adenocarcinomas (24.8%) were identified. Women with adenocarcinoma were more often white and were younger (P < .05 for all). Survival for stage IA1 adenocarcinomas (hazard ratio, 0.79; 95% confidence interval, 0.21–2.94) was similar to that of women with squamous cell tumors. For stage IA2 tumors, survival was similar for squamous cell and adenocarcinomas (hazard ratio, 0.51; 95% confidence interval, 0.18–1.47). For stage IA1 and IA2 adenocarcinomas, survival was similar for conization and hysterectomy.

Conclusion

Survival is similar for microinvasive adenocarcinomas and squamous cell carcinomas. Conization appears to be adequate treatment for microinvasive adenocarcinoma.

Section snippets

Materials and Methods

The National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) database was utilized. SEER is a population-based cancer registry that includes approximately 26% of the US population.²² SEER is composed of a number of geographically distinct tumor registries. The demographic characteristics of the SEER registries have been previously characterized and reported.²³ Data from SEER 17 registries was utilized. The study received approval from the Columbia University Institutional

Results

A total of 3987 women including 988 with adenocarcinomas (24.8%) and 2999 with squamous cell carcinomas with microinvasive disease (75.2%) were identified. The demographic and clinical variables of the cohort are displayed in Table 1. Stage IA1 tumors were noted in 554 of the women with adenocarcinomas (56.1%) and in 1610 of those with squamous neoplasms (53.7%), whereas 43.9% of women with adenocarcinomas and 46.3% of those with squamous cell carcinomas had stage IA2 tumors (P = .19). Women

Comment

Our analysis suggests 2 major findings for microinvasive cervical cancer. First, outcomes are similar for squamous cell carcinomas and adenocarcinomas. Second, conservative fertility-preserving treatment appears to be safe for women with stage IA1 and IA2 adenocarcinomas.

Given the concern that adenocarcinomas are associated with an inferior prognosis, prior staging systems have not acknowledged microinvasive adenocarcinomas as an entity. In contrast, most studies have suggested that women with

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Invasive cervical cancer
2023, DiSaia and Creasman Clinical Gynecologic Oncology
Fertility-sparing Surgery for Patients with Cervical, Endometrial, and Ovarian Cancers
2021, Journal of Minimally Invasive Gynecology
Nearly 10% of the 1.3 million women living with a gynecologic cancer are aged <50 years. For these women, although their cancer treatment can be lifesaving, it's also life-altering because traditional surgical procedures can cause infertility and, in many cases, induce surgical menopause. For appropriately selected patients, fertility-sparing options can reduce the reproductive impact of lifesaving cancer treatments. This review will highlight existing recommendations as well as innovative research for fertility-sparing treatment in the 3 major gynecologic cancers.
For early-stage cervical cancers, fertility-sparing surgeries include cold knife conization, simple hysterectomy with ovarian preservation, or radical trachelectomy with placement of a permanent cerclage. In locally advanced cervical cancer, ovarian transposition before radiation therapy can help preserve ovarian function. For endometrial cancers, fertility-sparing treatment includes progestin therapy with endometrial sampling every 3 to 6 months. After cancer regression, progestin therapy can be halted to allow attempts to conceive. Hysterectomy with ovarian preservation can also be considered, allowing for fertility using assisted reproductive technology and a gestational carrier. For ovarian cancers, fertility-sparing surgery includes unilateral salpingo-oophorectomy or bilateral salpingo-oophorectomy (with lymphadenectomy and staging depending on tumor histology). With higher-risk histology or higher early-stage disease, adjuvant chemotherapy is recommended—however, this carries a 3% to 10% risk of ovarian failure. Use of oocyte or embryo cryopreservation in patients with early-stage ovarian malignancy remains an area of ongoing research.
Overall, fertility-sparing management of gynecologic cancers is associated with acceptable rates of progression-free survival and overall survival and is less life-altering than more radical surgical approaches.
Fertility-sparing trachelectomy for early-stage cervical cancer: A proposal of an ideal candidate
2020, Gynecologic Oncology
To propose an ideal patient candidate with early-stage cervical cancer for undergoing fertility-sparing trachelectomy.
This nationwide, multicenter, retrospective study was conducted by the Japan Society of Obstetrics and Gynecology involving women aged <45 years with clinical stage I-II cervical cancer who had planned fertility-sparing trachelectomy and pelvic lymphadenectomy between 2009 and 2013 (n = 393). Ideal candidates were defined to have a tumor size of ≤2 cm, no lymph node metastasis, no deep stromal invasion, and no high-risk histology (n = 284, 69.6%). Less-ideal candidates were defined to have any one of these four characteristics (n = 109, 30.4%). Propensity score inverse probability of treatment weighting was used to assess survival outcomes.
Less-ideal candidates were more likely to undergo hysterectomy conversion (22.9% versus 3.2%), receive postoperative radiotherapy (11.9% versus 0.4%), or chemotherapy (32.1% versus 3.2%) compared with ideal candidates (all, P < 0.05). The weighted model revealed that among those who underwent trachelectomy (ideal candidates, n = 275 and less-ideal candidates, n = 84), less-ideal candidates had significantly decreased disease-free survival (5-year rates: 85.5% versus 95.5%; HR 3.93, 95% CI 1.99–7.74; P < 0.001) and cause-specific survival (92.5% versus 98.6%; HR 5.47, 95% CI 1.68–17.8, P = 0.001) compared with ideal candidates. Similarly, less-ideal candidates were significantly associated with decreased disease-free survival compared with ideal candidates among those who were young age, had small tumors or squamous histology, and underwent surgery alone (all, P < 0.05).
Less-ideal candidates had approximately four-fold higher recurrence risk and cancer mortality compared with ideal candidates. Ideal candidates for fertility-sparing trachelectomy for early-stage cervical cancer proposed in our study may be useful as the future framework for developing guidelines for fertility-sparing trachelectomy in Japan.
Primary treatment patterns and survival of cervical cancer in Sweden: A population-based Swedish Gynecologic Cancer Group Study
2019, Gynecologic Oncology
Citation Excerpt :
The objective in early stage of cervical cancer is therefore to reduce the risk for treatment-related morbidity e.g. offering fertility-sparing treatment. Hence, conisation is standard of care in stage IA1 [8–10], but in our study only one third of patients were treated accordingly. Instead simple hysterectomy was frequently performed.
Survival in cervical cancer has improved little over the last decades. We aimed to elucidate primary treatment patterns and survival.
Population-based study of patients included in the Swedish Quality Registry for Gynecologic Cancer diagnosed 2011–2015. Main outcome was 5-year relative survival (RS). Age-standardised RS (AS-RS) was estimated for the total cohort and for the pooled study population of squamous, adenosquamous-, adenocarcinoma.
Median follow-up time was 4.6 years. The study population consisted of 2141 patients; 97% of the 2212 patients in the total cohort and the 5-year AS-RS was 71% and 70%, respectively. RS stage IB1: surgery alone 95% vs. 72% for definitive chemoradiotherapy (CT-RT) (p < 0.001). In stage IIA1 74% had CT-RT, and 47% of operated patients received adjuvant (CT)-RT. RS stage IB2: surgically treated 81% (69% received adjuvant (CT)-RT) vs. 76% for (CT)-RT (p = 0.73). RS stage IIB: 77% for CT-RT + brachytherapy (BT), 37% for RT + BT (p = 0.045) and 27% for RT-BT (p < 0.001). Stages III-IVA; <40% received CT-RT + BT, RS 45% vs. 18% for RT-BT (RR 4.1, p < 0.001). RS stage IVB 7%.
Primary treatment of cervical cancer in Sweden adhered to evidence-based standard of care. Areas of improvement include optimising treatment for stages III-IVA, and avoiding combining surgery and radiotherapy.
Focus on mucinous adenocarcinoma of the uterine cervix
2019, Gynecologie Obstetrique Fertilite et Senologie
Le cancer du col utérin est le quatrième cancer de la femme dans le monde, et la quatrième cause de mortalité par cancer chez la femme. Le carcinome épidermoïde est le cancer du col utérin le plus répandu (environ 75 % des cas), et l’adénocarcinome est en deuxième position. Le classement des adénocarcinomes du col utérin a été redéfini par l’OMS en 2014. L’adénocarcinome endocervical classique est le plus fréquent. Les adénocarcinomes mucineux ont été définis par cette classification en différents sous-types : gastrique, intestinal, et à cellules en bague à chaton. Cette revue de la littérature présente les caractéristiques de ces différents sous-types de cancer du col utérin, peu connus. Il s’agit des données physiopathologiques, cliniques, cytologiques, histologiques, pronostiques, et leur prise en charge.
Cancer of the uterine cervix is the fourth most common cancer in women worldwide, and the fourth leading cause of cancer death in women. Squamous cell carcinoma is the first type of cervical cancer (about 75% of cases), and adenocarcinoma the second. Adenocarcinoma of the uterine cervix were redefined in the 2014 WHO classification. Endocervical adenocarcinoma, usual type, is the mose common. Mucinous adenocarcinoma were classified by this classification into different subtypes: gatric type, intestinal type and signet-ring cell type. This literature review shows the caracteristics of these various subtypes of cervical cancer, little known. These are physiopathological, clinical, cytological histological, pronostic caracteristics, and their treatments.
Adenocarcinoma of the uterine cervix: Pathologic features, treatment options, clinical outcome and prognostic variables
2019, Critical Reviews in Oncology/Hematology
Citation Excerpt :
Diagnostic imaging techniques, such as computed tomography [CT], magnetic resonance [MR], and eventually positron emission tomography [PET]/CT, should be used for an adequate staging at presentation, especially in patients with apparently locally advanced disease (National Cancer Comprehensive Network, 2019). Several studies on surgically- treated patients with stage Ia-IIa cervical cancer failed to detect different oncologic outcomes between adenocarcinoma and squamous cell carcinoma (Ruengkhachorn et al., 2016; Look et al., 1996; Harrison et al., 1993; Shingleton et al., 1995; Spoozak et al., 2012; Winer et al., 2015). Conversely, other investigations on patients with early stage disease who underwent primary radical hysterectomy with or without adjuvant radiotherapy or concurrent chemoradiation, reported a poorer disease-free survival [DFS] and overall survival [OS] for adenocarcinoma compared with squamous cell carcinoma (Irie et al., 2000; Nakanishi et al., 2000; Noh et al., 2014; Landoni et al., 1997; Hopkins and Morley, 1991; Park et al., 2010).
Adenocarcinoma accounts for 10–25% of all cervical cancers, and its relative and absolute rate has raised over the past decades. Most, but not all the authors, reported that adenocarcinoma has a greater propensity to lymph node, ovarian and distant metastases and a worse prognosis compared with squamous cell carcinoma. However, whether histologic type is an independent prognostic factor is still a debated issue. Moreover, adenocarcinoma is a very heterogenous disease, including different histological subtypes. Whereas radical hysterectomy and definitive radiotherapy achieve the same clinical outcome in early stage squamous cell carcinoma, surgery seems to obtain better survival compared with definitive radiotherapy in early stage adenocarcinoma. Chemoradiation is the standard treatment for locally advanced cervical cancer regardless of histologic type, although several retrospective studies showed that patients with adenocarcinoma were more likely to die than those with squamous cell carcinoma both before and after concurrent chemoradiation era. The prognostic relevance of biological variables, such as cyclin-dependent kinase inhibitors, p53, cyclooxygenase-2 [COX-2], cell surface tyrosine-kinases and programmed death-ligand [PD-L1], is still under investigation. Palliative chemotherapy is the only treatment option for persistent or recurrent cervical adenocarcinoma not amenable with surgery and radiotherapy. The use of immune checkpoint inhibitors as well as a therapeutic strategy targeting cell surface tyrosine kinases should be adequately explored in this clinical setting.

View all citing articles on Scopus

: The authors report no conflict of interest.

: Cite this article as: Spoozak L, Lewin SN, Burke WM, et al. Microinvasive adenocarcinoma of the cervix. Am J Obstet Gynecol 2012;206:80.e1-6.

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ResearchOncologyMicroinvasive adenocarcinoma of the cervix

Objective

Study Design

Results

Conclusion

Section snippets

Materials and Methods

Results

Comment

Gynecol Oncol

Gynecol Oncol

Gynecol Oncol

Gynecol Oncol

Gynecol Oncol

Gynecol Oncol

Gynecol Oncol

Gynecol Oncol

Obstet Gynecol

Obstet Gynecol

Gynecol Oncol

Gynecol Oncol

Research
Oncology
Microinvasive adenocarcinoma of the cervix