Prognosis and treatment of primary adenocarcinoma and adenosquamous cell carcinoma of the uterine cervix

Purpose: To evaluate a cohort of women with primary invasive carcinomas of the uterine cervix, and to compare the biological characteristics and behavior of a cohort of adenosquamous carcinomas with a cohort of adenocarcinomas and squamous cell carcinomas.

Methods: One hundred and fourteen cases of primary invasive cervical carcinoma presenting between 1 January 1987 and 31 December 1997 were studied. Sixteen (14%) women with adenosquamous cell carcinomas and eight (7%) adenocarcinomas were compared with 90 (79%) women with squamous cell carcinomas. Patients with Stage Ib and IIa were treated by radical hysterectomy and pelvic lymph node dissection. All patients with stage IIb and over were treated by radiation. Patients with bulky, large, barrel-shaped lesions were selected for treatment by a combination of radiation and extrapelvic hysterectomy.

Results: The corrected survival rate for stage Ib patients with adenosquamous cell carcinoma was only 27.2%, compared with a 92.2% corrected survival rate for squamous cell, and a 100% corrected survival rate for adenocarcinoma.

Conclusion: There is a higher proportion of adenosquamous cell and adenocarcinoma of the cervix than generally appreciated. The epidemiological risk factors associated with adenosquamous carcinomas of the cervix are more similar to those of squamous cell carcinomas than of adenocarcinomas. The survival difference between two groups is explained by effects of clinical stage, nodal spread, and vascular space involvement.

Adenosquamous cell carcinoma; Adenocarcinoma; Squamous cell carcinoma; Survival; Uterine cervix

[1] Elliott P. M.,T atersal M. H. N.,C oppleson M.: "Changing characier of cervical cancer in young women". Br. Med. J.,1989, 298, 288.

[2] Shingleton H. M., Gore H., Bradley D. H.,S oongS J.: "Adenocarcinoma of the cervix". Am. J. Obstet. Gynecol., 1981, 139, 799.

[3] Abell M. R.: "Invasive carcinomas of the uterine cervix". In: "The uterus". NorrisH . J.,H ertigA .T .,A bellM . R. eds. Baltimore WilIiams and Wilkins, 1973, 413.

[4] Buckley C. H., Beards C. S., Fox H.: "Pathological prognostic indicators in cervical cancer with particular reference to patients under the age of 40 years". Br. J. Obstet. Gynaecol., 1988, 95, 47.

[5] Yajima A., Fukuda M., Noda K.: "Histopathological findings concerning the morphogenesis of mixed carcinoma of the uterine cervix". Int. J. Gynecol. Pathol.,1984,18, 157.

[6] Hale R., Fox H., Buckley C.H.: "Classification of cervical carcinoma". Histopathol., 1991, 18, 287.

[7] Doughtery C. M.,C otten N.: "Mixed squamous cell and adenocarcinoma of the cervix: Combined, adenosquamous and mucoepidermoid types". Cancer, 1964, 17, 1132.

[8] Wheeles C. R., Graham R., Graham J.B.: "Prognosis and treatment of adenoepidermoid carcinoma of the cervix". Ohstet Gynecol., 1970, 35, 928.

[9] Wright T. C., Ferenczy A., Kurman R. J.: "Carcinoma and other tumors of the cervix". In: "Pathology of the Female genital Tract". Kurman R. J. ed. Springer-Verlag, 1994, 279.

[10] Kleine W.,R au K.,S chwoerorer D.,P fleidererA .: "Prognosis of the adenocarcinoma of the cervix uteri". Gynecol. Oneal., 1989, 35, 145.

[11] Moberg P. J., Einhorn N.,S ilfversward C.,S oderberg G.: "Adenocarcinoma of the uterine cervix". Cancer, 1986, 57, 407.

[12] Wentz W B., Reagan J. W.: "Survival in cervical cancer with respect to cell type". Cancer, 1959, 12, 385.

[13] Gallup D. E.,H arper R. H.,S tock R. J.: "Poor prognosis in patients with adenosquamous cell carcinoma of the cervix". Ohstet. Gynecol., 1985, 65, 416.

[14] Piver M. S., Rutledge F.,S mith J. P.:''Five classes of extended hysterectomy for women with cervical cancer". Obstet. Gynecol., 1974, 44, 265.

[15] Nelson A. J., Fletcher G. H., W harton S. T.: "Indication for adjunctive conservative extrafascial hysterectomy in selected cases of carcinoma of the uterine cervix". Am. J. Roentgenol Ther. Nucl. Med., 1975, 123, 91.

[16] Fletcher G. H.:'Textbook of Radiotherapy". Philadelphia, Lea and Fabiger, 1973, 620.

[17] Teshima S., Shimosato Y., Kissh K.,Kasamatsu T., Ohmi K., Uei Y.: "Early stage adenocarcinoma of the uterine cervix: Histopathologic analysis with consideration of histogenesis". Cancer, 1985, 56, 167.

[18] Gliicksmann A., Cherry C. P.: "Incidence, histology, and response to radiation of mixed carcinomas of the uterine cervix". Cancer, 1956, 9, 971.

[19] Julian C. G., Darkoku N. H., Giliespie A.: "Adenoepidermoid and adenosquamous carcinoma of the uteru s". Am. J. Obstet. Gynecol., 1977, 128, 106.

[20] Berkowitz R. S., Ehrmann R. L., Lavizzo-Mourey R.: "Carcmoma in young women". Gynecol. Oneal., 1979, 8, 311.

[21] Piver M. S.. Chong W. S.: "Prognostic significance of cervical lesion size and pelvic node metastases in cervical carcinoma". Obstet. Gynecol., 1975, 46, 507.