The Prognosis and Treatment of Stage I Adenocarcinoma of the Cervix

A review of 125 patients with stage I adenocarcinoma of the cervix is reported. The subtypes included endocervical (60), adenosquamous (38), papillary (15), clear cell (nine), and mucoid (three). The cumulative 5-year survival was 60%, and was significantly related to the following: tumor differentiation--well-differentiated 80%, moderately differentiated 69%, poorly differentiated 41%; lymph node status--nodes positive 28%, nodes negative 82%; the amount of residual disease present in the cervix after radical hysterectomy; and the interval from the previous pelvic examination. Survival was not significantly influenced by histologic subtype, patient age, number of positive lymph nodes, or tumor size beyond 3 cm. Treatment included radical hysterectomy with or without bilateral salpingo-oophorectomy, radiation therapy, radiation therapy with hysterectomy, and hysterectomy followed by radiation therapy. The best cumulative 5-year survival (93%) was found in patients treated by radical hysterectomy without bilateral salpingo-oophorectomy, whereas the poorest survival (18%) was in those treated by standard hysterectomy followed by radiation therapy. Ovarian conservation seems to be an acceptable alternative to bilateral salpingo-oophorectomy in the young patient undergoing radical hysterectomy.