Cervical adenocarcinoma in situ
- Marcela G del Carmen, MD
Marcela G del Carmen, MD
- Associate Professor
- Department of Obstetrics, Gynecology and Reproductive Biology
- Harvard Medical School
- Associate Professor of Gynecologic Oncology
- Massachusetts General Hospital
- John O Schorge, MD
John O Schorge, MD
- Chief, Gynecologic Oncology
- Massachusetts General Hospital
Adenocarcinoma in situ of the uterine cervix is a premalignant glandular condition. Adenocarcinoma in situ is the only known precursor to cervical adenocarcinoma, and appropriate management can prevent the occurrence of invasive disease in many cases . The usual interval between clinically detectable adenocarcinoma in situ and early invasion appears to be at least five years, suggesting ample opportunity for screening and intervention [2,3].
Glandular neoplasia of the uterine cervix is less common than squamous neoplasia, comprising one quarter of all annual cervical cancers diagnoses in the United States . Over the past few decades, however, the incidence of adenocarcinoma in situ and invasive adenocarcinoma has increased .
The diagnosis and management of cervical adenocarcinoma in situ are reviewed here. Related topics are discussed separately, including:
- Glandular cells on cervical cytology (See "Cervical cytology: Evaluation of atypical and malignant glandular cells".)
- Invasive adenocarcinoma of the cervix (See "Invasive cervical cancer: Epidemiology, risk factors, clinical manifestations, and diagnosis" and "Invasive cervical adenocarcinoma".)
EPIDEMIOLOGY AND RISK FACTORS
The average age of women at diagnosis of cervical adenocarcinoma in situ (AIS) is 36.9 years, based upon a meta-analysis that included 33 studies with 1278 patients with a diagnosis of AIS on cervical cone biopsy .
- Dunton CJ. Management of atypical glandular cells and adenocarcinoma in situ. Obstet Gynecol Clin North Am 2008; 35:623.
- Lee KR, Flynn CE. Early invasive adenocarcinoma of the cervix. Cancer 2000; 89:1048.
- Plaxe SC, Saltzstein SL. Estimation of the duration of the preclinical phase of cervical adenocarcinoma suggests that there is ample opportunity for screening. Gynecol Oncol 1999; 75:55.
- http://seer.cancer.gov/csr/1975_2004/results_merged/sect_05_cervix_uteri.pdf (Accessed on August 29, 2011).
- Wang SS, Sherman ME, Hildesheim A, et al. Cervical adenocarcinoma and squamous cell carcinoma incidence trends among white women and black women in the United States for 1976-2000. Cancer 2004; 100:1035.
- Salani R, Puri I, Bristow RE. Adenocarcinoma in situ of the uterine cervix: a metaanalysis of 1278 patients evaluating the predictive value of conization margin status. Am J Obstet Gynecol 2009; 200:182.e1.
- Quint KD, de Koning MN, van Doorn LJ, et al. HPV genotyping and HPV16 variant analysis in glandular and squamous neoplastic lesions of the uterine cervix. Gynecol Oncol 2010; 117:297.
- Madeleine MM, Daling JR, Schwartz SM, et al. Human papillomavirus and long-term oral contraceptive use increase the risk of adenocarcinoma in situ of the cervix. Cancer Epidemiol Biomarkers Prev 2001; 10:171.
- Smith HO, Tiffany MF, Qualls CR, Key CR. The rising incidence of adenocarcinoma relative to squamous cell carcinoma of the uterine cervix in the United States--a 24-year population-based study. Gynecol Oncol 2000; 78:97.
- Vizcaino AP, Moreno V, Bosch FX, et al. International trends in the incidence of cervical cancer: I. Adenocarcinoma and adenosquamous cell carcinomas. Int J Cancer 1998; 75:536.
- Dahlström LA, Ylitalo N, Sundström K, et al. Prospective study of human papillomavirus and risk of cervical adenocarcinoma. Int J Cancer 2010; 127:1923.
- Bulk S, Berkhof J, Bulkmans NW, et al. Preferential risk of HPV16 for squamous cell carcinoma and of HPV18 for adenocarcinoma of the cervix compared to women with normal cytology in The Netherlands. Br J Cancer 2006; 94:171.
- Mahdi H, Thrall M, Agoff N, Doherty M. Pagetoid adenocarcinoma in situ of the cervix with pagetoid spread into the vagina. Obstet Gynecol 2011; 118:461.
- Ostör AG, Duncan A, Quinn M, Rome R. Adenocarcinoma in situ of the uterine cervix: an experience with 100 cases. Gynecol Oncol 2000; 79:207.
- Terada T. Simultaneous squamous cell carcinoma in situ and adenocarcinoma in situ of the uterine cervix in a 36-year-old Japanese woman. Arch Gynecol Obstet 2010; 281:527.
- Tobón H, Dave H. Adenocarcinoma in situ of the cervix. Clinicopathologic observations of 11 cases. Int J Gynecol Pathol 1988; 7:139.
- Shin CH, Schorge JO, Lee KR, Sheets EE. Cytologic and biopsy findings leading to conization in adenocarcinoma in situ of the cervix. Obstet Gynecol 2002; 100:271.
- Mitchell H, Hocking J, Saville M. Cervical cytology screening history of women diagnosed with adenocarcinoma in situ of the cervix: a case-control study. Acta Cytol 2004; 48:595.
- Geier CS, Wilson M, Creasman W. Clinical evaluation of atypical glandular cells of undetermined significance. Am J Obstet Gynecol 2001; 184:64.
- Schnatz PF, Guile M, O'Sullivan DM, Sorosky JI. Clinical significance of atypical glandular cells on cervical cytology. Obstet Gynecol 2006; 107:701.
- Bull-Phelps SL, Garner EI, Walsh CS, et al. Fertility-sparing surgery in 101 women with adenocarcinoma in situ of the cervix. Gynecol Oncol 2007; 107:316.
- Girardi F, Heydarfadai M, Koroschetz F, et al. Cold-knife conization versus loop excision: histopathologic and clinical results of a randomized trial. Gynecol Oncol 1994; 55:368.
- Mathevet P, Dargent D, Roy M, Beau G. A randomized prospective study comparing three techniques of conization: cold knife, laser, and LEEP. Gynecol Oncol 1994; 54:175.
- Bryson P, Stulberg R, Shepherd L, et al. Is electrosurgical loop excision with negative margins sufficient treatment for cervical ACIS? Gynecol Oncol 2004; 93:465.
- Lea JS, Shin CH, Sheets EE, et al. Endocervical curettage at conization to predict residual cervical adenocarcinoma in situ. Gynecol Oncol 2002; 87:129.
- Denehy TR, Gregori CA, Breen JL. Endocervical curettage, cone margins, and residual adenocarcinoma in situ of the cervix. Obstet Gynecol 1997; 90:1.
- Srisomboon J, Kietpeerakool C, Suprasert P, et al. Factors affecting residual lesion in women with cervical adenocarcinoma in situ after cone excisional biopsy. Asian Pac J Cancer Prev 2007; 8:225.
- Shin CH, Schorge JO, Lee KR, Sheets EE. Conservative management of adenocarcinoma in situ of the cervix. Gynecol Oncol 2000; 79:6.
- Andersen ES, Nielsen K. Adenocarcinoma in situ of the cervix: a prospective study of conization as definitive treatment. Gynecol Oncol 2002; 86:365.
- Krivak TC, Retherford B, Voskuil S, et al. Recurrent invasive adenocarcinoma after hysterectomy for cervical adenocarcinoma in situ. Gynecol Oncol 2000; 77:334.
- Miller B, Dunn J, Dalrymple J, Krivak TC. Pelvic sidewall adenocarcinoma after definitive therapy for cervical adenocarcinoma in situ. Gynecol Oncol 2005; 99:489.
- Massad LS, Einstein MH, Huh WK, et al. 2012 updated consensus guidelines for the management of abnormal cervical cancer screening tests and cancer precursors. J Low Genit Tract Dis 2013; 17:S1.
- American College of Obstetricians and Gynecologists. ACOG Practice Bulletin No. 99: management of abnormal cervical cytology and histology. Obstet Gynecol 2008; 112:1419.
- Partridge EE, Abu-Rustum NR, Campos SM, et al. Cervical cancer screening. J Natl Compr Canc Netw 2010; 8:1358.
- Partridge EE, Abu-Rustum N, Campos S, et al. Cervical cancer screening. J Natl Compr Canc Netw 2008; 6:58.
- Lacour RA, Garner EI, Molpus KL, et al. Management of cervical adenocarcinoma in situ during pregnancy. Am J Obstet Gynecol 2005; 192:1449.
- EPIDEMIOLOGY AND RISK FACTORS
- CLINICAL FEATURES
- Cervical cytology
- Pelvic examination
- Colposcopy, biopsy, and endocervical curettage
- DIFFERENTIAL DIAGNOSIS
- POSTDIAGNOSTIC EVALUATION
- Evaluation of coexistent squamous neoplasia
- Clinical approach
- - Procedure
- - Post-hysterectomy follow-up
- - Outcome
- Fertility preservation
- - Conization margin status
- Negative margin
- Positive margin
- - Post-conization follow-up
- - Outcome
- AIS or adenocarcinoma
- Reproductive outcomes
- PREGNANT WOMEN
- SUMMARY AND RECOMMENDATIONS