Clinical and histopathological factors in patients with cervical cancer allowing to identify candidates for less radical surgery

Department of Gynecological Oncology Memorial Cancer Center - Institute of Oncology, Warsaw, Poland.
Ginekologia polska (Impact Factor: 0.6). 02/2012; 83(1):16-21.
Source: PubMed


To determine clinical and histopathological factors in patients with cervical cancer tumors smaller than 2 cm in order to identify those who could be operated less extensively with preservation of reproductive organs and lower morbidity.
We retrospectively reviewed the records of patients with cervical cancer and a maximum tumor of 2cm in diameter who were qualified for primary surgery in the years 2001-2007 at the Department of Gynecologic Oncology Cancer Center in Warsaw.
From the group of 110 operated patients, 96 were included into the study Within the analyzed group the infiltration of the parametrium was found in 4 women (4.2%). All of them had squamous cell cancer; stage IB, grade G3. One patient had a tumor 1.5 cm in diameter and 3 patients had tumors up to 2 cm in diameter. The involvement of lymph nodes was observed in 3 patients with squamous cell carcinoma: in one case the tumor was intermediate grade (G2) and in two cases low grade (G3). The lymph nodes were involved only in patients with tumors greater than 0.5 cm. The lymph vascular space invasion was found in 14 patients (14.7%): in 12 with squamous cell cancer and in 2 with adenocarcinoma. The diameter of the tumor was 0.5-1 cm in 4 women, 1-1.4 cm in 3 women and 1.5-2 cm in the majority (7 women accounted for 29% of all patients in that group). No infiltration of the blood vessels could be seen in all 30 women with tumors smaller than 0.5 cm. We found a statistically significant relationship between the size of the tumor and the incidence of lymph vascular space invasion (p=0.024).
In selective cases fertility organ preserving surgery is possible and safe. In the group of patients with tumor less than 5 mm in diameter no parametrium involvement or lymph metastases were observed. In such situation cervical conisation can be justified. In well-differentiated (G1) tumors less than 2 cm in diameter less radical surgical procedures can also be performed because no treatment failure has been observed.

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    ABSTRACT: The decision whether fertility-sparing surgical management may be successfully applied in women with cervical cancer who wish to preserve their fertility remains a great therapeutic challenge. Such management is possible if no node metastases are expected and the risk of cancer spread beyond the cervix is limited. Thus, precise evaluation of tumor size is necessary. The aim of the study was to establish cytologic, colposcopic and histologic eligibility criteria for fertility-sparing treatment in women with early-stage cervical cancer. The study included 119 women (aged 25-43 years) diagnosed and operated on due to malignant changes within the cervix. Each subject underwent cytologic and colposcopic examination, followed by histologic evaluation of a large, target section from the most suspicious area of the lesion. Histologic evaluation revealed stage IA1 in 60 (50.4%), IA2 in 53 (44.5%), and IB1 in 6 (5.1%) patients. Histologic compatibility between target sections and evaluation of the surgical material was 59 (98.4%), 51 (96.2%), and (100%) for stages IA1, IA2, and IB1, respectively Proper colposcopic assessment of early-stage invasive cervical cancer (IA) allows to identify the most adequate area for large wedge biopsy That in turn makes it possible to establish proper histologic pre-treatment diagnosis, with an over 95% compatibility with the final histologic evaluation, what conditions fertility-sparing surgical treatment.
    Ginekologia polska 06/2015; 86(6):406-13. DOI:10.17772/gp/2396 · 0.60 Impact Factor