Original research
Fertility sparing treatment for in situ and early invasive adenocarcinoma of the cervix

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Abstract

OBJECTIVE:

To explore the outcome and long-term follow-up of fertility sparing surgery for cervical adenocarcinoma in situ and early invasive adenocarcinoma.

METHODS:

Between 1985 and 1996, all women with adenocarcinoma in situ (AIS) and stage I adenocarcinoma were identified. Data were abstracted from clinical records and pathology reviewed.

RESULTS:

One hundred thirty three women with stage I adenocarcinoma of the cervix were treated. Twenty subjects met the criteria for International Federation of Gynecology and Obstetrics stage IA1 lesions. Fourteen subjects were treated with radical hysterectomy, whereas two were treated with simple hysterectomy. Because of the desire to preserve fertility, four women with adenocarcinoma were treated with cervical conization alone, and three women have gone on to deliver viable infants. Forty-two women with adenocarcinoma in situ were identified, of whom 20 were treated with fertility sparing surgery (conization). Five women treated with conization had positive margins recurring in two, and one developed an invasive adenocarcinoma 5 years after conization. None of the women with adenocarcinoma treated with cervical conization have developed recurrent disease after a median follow-up of 48 months. Cone margin status was predictive of residual disease at hysterectomy.

CONCLUSION:

Women with adenocarcinoma in situ and negative margins may be treated with conservative, fertility sparing surgery. Education is essential regarding the risks of residual/recurrent disease because subjects can develop lethal recurrent disease. The fertility sparing management of invasive stage IA1 adenocarcinoma of the uterine cervix may also be entertained among women who desire future fertility and have negative margins of resection.

Section snippets

Materials and methods

Between 1985–1996, cases of cervical adenocarcinoma in situ and stage I adenocarcinoma were identified by searching the tumor registries at the University of California, Irvine Medical Center, and Long Beach Memorial Medical Center after obtaining approval from the Institutional Review Boards (Figure 1). Medical records and office charts were abstracted for Papanicolaou smear history, cervical and cone biopsy results, treatment, disease status, and length of follow-up. All pathologic specimens

Results

One hundred thirty three women with stage I adenocarcinoma of the uterine cervix treated between 1985 and 1996 were identified. Twenty of these women met the criteria for FIGO stage IA1 early invasive adenocarcinoma. Our standard therapy for these subjects has evolved during the last 15 years. Initially, subjects with IA1 cancers were treated with radical hysterectomy and pelvic lymphadenectomy. More recently, simple hysterectomy without lymphadenectomy has been used. Rarely, women who strongly

Discussion

The appropriate treatment of cervical adenocarcinoma in situ has been controversial because some authors have reported multifocal adenocarcinoma in situ high in the cervical canal having been missed even on cervical conization. Thus, hysterectomy has been advocated as the definitive treatment by most authorities. Indeed, the risk of residual adenocarcinoma in hysterectomy specimens seems to be highly dependent upon cone biopsy margin status. In the current study, ten of the 14 (71%) subjects

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Copyright © 2001 The American College of Obstetricians and Gynecologists. Published by Elsevier Inc. All rights reserved.