Subtypes of endocervical cancer: A retrospective, observational study at Charlotte Maxeke Johannesburg Academic Hospital

Background. Cervical cancer is the second most common malignancy in women, particularly in developing countries. Endocervical adenocarcinoma (ECA) is less common than cervical squamous cell carcinoma (SCC), but its incidence is increasing globally, particularly in young women. The decline in the incidence of SCC is attributed to effective screening programmes. Objectives. To assess the prevalence of ECA and its subtypes and to describe the clinicopathological characteristics of patients with these tumours at a tertiary South African institute between 2017 and 2019. Methods. This was a cross-sectional, descriptive study of 156 ECA patients. Following ethical clearance, demographic data, clinical information and disease characteristics were obtained from departmental histopathological reports. Descriptive statistics were used to calculate the prevalence of ECA. We analysed the association between age, Papanicolaou (Pap) smear results, human papillomavirus (HPV) status, and HIV status with ECA. Results. The prevalence of ECA was 6.8% and it was more commonly diagnosed in younger women. HPV-associated subtypes were the most common variants. The usual type of ECA accounted for 24.4% of cases. HIV status was documented in 64.0% of cases, of which 34.0% were positive. There were no statistically significant associations between ECA subtype and HIV status (p=0.81) or between ECA subtype and Pap smear results. Conclusion. In South Africa, the prevalence of ECA is lower compared with Western countries, reflecting inadequacies in screening modalities of ECA at primary healthcare facilities. HPV prevails as a cause of endocervical carcinoma. HPV morphologic hallmarks serve as a practical guide in classifying ECAs according to their HPV status.