Cervical Cancer

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The incidence of adenocarcinoma of the cervix appears to be increasing relative to squamous cancers. Adenocarcinoma has a poorer prognosis at every stage when compared with squamous cancer, and the prognosis for adenosquamous cancer is poorer still. Adenocarcinomas tend to grow endophytically and, therefore, are often undetected until a larger tumor volume is present. The colposcopic findings for glandular disease are not as distinct as those for squamous lesions.

When atypical glandular cells of undetermined significance (AGUS) are diagnosed on Pap smear, the presence or absence of squamous intraepithelial lesion, adenocarcinoma in situ

or adenocarcinoma should be confirmed. The diagnosis of AGUS indicates changes in the glandular cells that exceed changes to be expected in a benign or reparative process but that are not abnormal enough to be clearly neoplastic. Colposcopic evaluation
with endocervical curettage should be performed; in perimenopausal and postmenopausal patients, an endometrial biopsy should also be obtained. The endometrium must also be assessed in patients with the finding of atypical glandular cells of unknown origin. In one study, percent of patients with endometrial cancer were found to have an AGUS Pap smear within the year before diagnosis.Approximately 80 percent of cervical cancers are squamous in origin, while 20 percent are adenomatous, mixed or metastatic to the cervix (Table 5). As with other malignant diseases, the presence of metastasis with cervical cancer (i.e., lymph node or renal involvement) indicates a poorer prognosis (Table 6). Close follow-up is necessary in any patient diagnosed with and treated for invasive cervical cancer. Cytologic screening is recommended at three-month intervals for the first two years after treatment and semiannually thereafter in patients with or without a cervix. Squamous cell cancer antigen and other proteins specific to cervical cancer are currently under investigation. These protein markers have been used to monitor therapy, detect recurrences and triage patients for intensive treatment protocols. The usefulness of these markers in diagnosis continues to be an area of active investigation.

Prognosis and Follow-Up
Table 6 - Estimates of Four-Year Survival After Recommended Therapy
FIGO stage of disease Estimated four year survival after therapy (%)
Ia 94
Ib 79
II 39
III 26
IV 0

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