Early Invasive Cervical Adenocarcinoma: Is Radical Treatment Indicated?
Kathy Ceballos, Kazuya Onuma, Jan Hauspy, Placide Rubabaza, Ashwyn Rajagopalan, Danielle Shaw, Dean Daya. University of British Columbia, Vancouver, BC, Canada; St. Augustinus Hospital, Antwerp, Belgium; McMaster University, Hamilton, ON, Canada; Halton Health Care Services, Oakville-Trafalgar Site, Oakville, ON, Canada
Background: While it is accepted that microinvasive cervical squamous cell carcinomas can be treated conservatively, there is little published prognostic data and little agreement on the appropriate management of FIGO 1A1 and 1A2 cervical adenocarcinomas. This study focuses on the management and outcome of 55 patients with FIGO 1A1 or 1A2 cervical adenocarcinoma.
Design: The pathology database of a tertiary care hospital was searched for cases of early invasive cervical adenocarcinoma accessioned from 1985 to June 2009. A central slide review and chart review were performed. Cases with a villoglandular, serous, clear cell or neuroendocrine component were excluded. Data was previously published on 32 cases and these are included with additional follow-up data.
Results: 55 patients with early invasive cervical adenocarcinoma were identified. 50 patients (91%) had FIGO 1A1 tumors and 5 patients (9%) had FIGO 1A2 tumors. 46 (84%) of the patients had radical surgery consisting of radical hysterectomy with pelvic lymph node dissection (PLND) (44 patients) or radical trachelectomy with PLND (2 patients). 9 patients (16%) received conservative surgery consisting of simple hysterectomy (4 patients) or cervical conization (5 patients). No lymphovascular space invasion was identified, final margins were clear in all cases and no lymph node metastases were identified in the patients who underwent PLND. Follow up information was available for 54 of 55 patients with a mean follow of 7 years. 21 of 46 patients (46%) who underwent radical surgery experienced complications -- 5 cases of lymphedema (of which one case resolved), 1 case of severe peripheral neuropathy, and 16 cases of transient bladder or sexual dysfunction. In the conservatively managed patients, 1 patient (11%) experienced a post conization infection. No recurrences have been reported to date.
Conclusions: This is the largest reported case series of FIGO 1A1 and 1A2 cervical adenocarcinoma. No lymph node metastases nor recurrences were identified in this cohort of 55 patients, yet 5 of 46 patients (11%) who underwent radical surgery experienced significant long term complications. Conservative surgery should be considered in this low risk patient population.
Category: Gynecologic & Obstetrics
Tuesday, March 20, 2012 1:00 PM
Poster Session IV # 125, Tuesday Afternoon