Volume 25, Issue 107, January, 2021

Adenocarcinoma of the cervix uteri; does it really carry a worse prognosis? A single institutional review from Egypt

Hala Aziz Shokralla¹, Ahmed Elsayed Fathalla^2♦

¹Assistant Professor of Medical Oncology-National Cancer Institute-Cairo University-Egypt
²Assistant Professor of Surgical Oncology-National Cancer Institute-Cairo University-Egypt

^♦Corresponding author
Assistant Professor of Surgical Oncology-National Cancer Institute-Cairo University, Egypt; Email: halaaziz2001@yahoo.com

ABSTRACT

Background: Cervical uteri carcinoma is 4th commonest cancer affecting women worldwide. Its incidence is increasing in developing countries being 2nd commonest cancer & 3rd cause of cancer mortality. Although incidence of squamous cell carcinoma (SCC) is declining in developed areas, adenocarcinoma (AC) is proportionally rising despite effective screening. AC cases are younger, usually whites, diagnosed early with frequent nodal disease. Prognostic parameters for AC include; stage, age, depth of invasion, treatment given, DNA ploidy, S-phase fraction, architectural & nuclear grading, involved LNs and repeated HPV infection especially 16, 18 & 45. Early disease is frequently asymptomatic with nonspecific presentations usually mistaken for simple cervicitis. With disease progression; pelvic or lower back pain, GIT or urinary symptoms appears. Treatment is tailored according to stage, age & PS. Early cases are treated either with surgery or concurrent chemo-radiation (CCRT). Aims: to study clinicopathological features of all cases of AC of the cervical uteri, diagnostic tools, management protocols & outcome. Materials & Methods: A single institution prospective analysis of all cases presented to NCI-Cairo University with AC of the cervix uteri candidate for surgery over a period of 4 years from October 2015 to October 2019. 37 cases were included. Data collected from patients archives then analyzed. Results: Mean age was 54 years ranging (15-80 year). 36 cases were married (~97%). Vaginal bleeding encountered in (33 cases, ~89%). 22 cases (~59%) were post-menopausal. Three cases had positive family history in three cases (~8%). Punch biopsy was done for (26 cases, ~70%). 17 cases (~46%) performed CT only as diagnostic tool. Mucinous subtype occurred in (21 cases, ~ 57%). Grade II found in (14 cases, ~38%). Stage II-b predominated (11cases, ~30%). Preoperative treatment was given to (28 cases, ~ 76%). Surgery was done for (23 cases, ~62%) via open approach (18 cases, ~49%), robotic radical hysterectomy for (2 cases, ~5%) only while (3 cases, ~8%) underwent anterior pelvic exenteration. Postoperative stay ranged (5-32 days) with median 11 days. Commonest complication was surgical site infection (SSI) (13 cases, ~35%). 5 cases (13.5%) showed positive surgical margins. Positive pathological LNs after resection was found in (6 cases, ~16%) while no residual pathology was found in only 2 cases. Adjuvant treatment was needed in (14 cases, ~38%). Conclusion: AC patients experienced worse overall survival & disease-free survival than their counterpart SCC regardless treatment with RT or CCRT. Surgery is the primary treatment only for very early stages (I-a). In advanced tumors neoadjuvant or definitive CCRT is the role saving surgery for salvage. Fast recovery with early discharge & less complication are noticed with minimally invasive techniques. Novel protocols should be introduced to improve outcomes of locally advanced & metastatic patients.

Keywords: Adenocarcinoma, Cervix, Prognosis, NCI, EGYPT

Medical Science, 2021, 25(107), 26-35

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