Invasive cervical adenocarcinoma
- Marcela G del Carmen, MD
Marcela G del Carmen, MD
- Department of Obstetrics, Gynecology and Reproductive Biology
- Harvard Medical School
- Medical Director
- Massachusetts General Physicians Organization
- John O Schorge, MD
John O Schorge, MD
- Chief, Gynecologic Oncology
- Massachusetts General Hospital
- Section Editors
- Barbara Goff, MD
Barbara Goff, MD
- Section Editor — Gynecologic Oncology
- Professor of Gynecologic Oncology
- University of Washington
- Don S Dizon, MD, FACP
Don S Dizon, MD, FACP
- Section Editor – Gynecologic Oncology
- Clinical Co-Director, Gynecologic Oncology
- Founder and Director, The Oncology Sexual Health Clinic
- Massachusetts General Hospital Cancer Center
- Associate Professor of Medicine
- Harvard Medical School
- Deputy Editors
- Sandy J Falk, MD, FACOG
Sandy J Falk, MD, FACOG
- Director, Editorial Relations — UpToDate
- Deputy Editor — Obstetrics, Gynecology and Women's Health
- Instructor of Obstetrics, Gynecology and Reproductive Biology, Part-time
- Harvard Medical School
- Sadhna R Vora, MD
Sadhna R Vora, MD
- Deputy Editor — Oncology
- Instructor in Medicine
- Harvard Medical School
Cervical cancer encompasses several histologic types, of which squamous cell carcinoma (SCC) is the most common (70 percent) (table 1). The incidence of invasive cervical adenocarcinoma and its variants has increased dramatically over the past few decades; this cell type now accounts for about 25 percent of all invasive cervical cancers diagnosed in the United States (US) [1,2]. Neuroendocrine (predominantly small cell poorly differentiated) carcinomas and other rare cell types together comprise 3 to 5 percent of all cases. (See "Small cell neuroendocrine carcinoma of the cervix".)
Most of our knowledge on the treatment of cervical cancer comes from studies in which the majority of the patients had SCC; adenocarcinoma has comprised, on average, 10 percent of the cases. Very few of these studies report separate outcomes for adenocarcinoma, and no prospective study has focused on the treatment of adenocarcinoma as the sole histology. As a result, our understanding of the natural history and optimal management of adenocarcinoma of the cervix is limited.
There are many similarities between adenocarcinoma and SCC of the cervix, and they are treated the same at most institutions. However, there are also several differences in epidemiology, prognostic factors, patterns of failure after primary treatment, and possibly in response to specific treatments . Despite these differences, specific treatment strategies tailored to adenocarcinoma have not yet emerged.
This topic will focus on unique issues pertaining to invasive cervical adenocarcinoma. Clinical features, staging, and management issues that are common to SCC and adenocarcinoma, as well as adenocarcinoma in situ, are discussed in depth separately. (See "Invasive cervical cancer: Epidemiology, risk factors, clinical manifestations, and diagnosis" and "Invasive cervical cancer: Staging and evaluation of lymph nodes" and "Management of early-stage cervical cancer" and "Management of locally advanced cervical cancer" and "Cervical adenocarcinoma in situ".)
EPIDEMIOLOGY AND RISK FACTORS
There are both similarities and differences in the epidemiology of adenocarcinoma of the cervix compared with squamous cell carcinoma (SCC):
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- EPIDEMIOLOGY AND RISK FACTORS
- CLINICAL MANIFESTATIONS
- DIAGNOSIS AND STAGING
- Staging system
- Staging workup
- PROGNOSTIC FACTORS AND DIFFERENCES IN OUTCOME COMPARED WITH SCC
- Differences in patterns of dissemination and recurrence
- Differences in treatment response
- SPECIFIC MANAGEMENT ISSUES
- Microinvasive (IA1-IA2) disease
- Invasive early stage (IB1-IIA) disease
- - Posttreatment extrafascial hysterectomy
- - Role and extent of lymphadenectomy
- - Indications for adjuvant therapy after hysterectomy
- Locoregionally advanced (IIB-IVA) disease
- - Role of therapeutic lymphadenectomy
- - Neoadjuvant chemotherapy
- Stage IVB, persistent and recurrent disease
- - Surgery and/or RT for localized recurrence
- - Chemotherapy
- - Surgery for metastatic disease
- Fertility preservation
- POSTTREATMENT SURVEILLANCE
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS
- - Microinvasive disease
- - Invasive disease
- - Disseminated, recurrent, or persistent disease