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Fertility Sparing Treatment for In Situ and Early Invasive Adenocarcinoma of the Cervix

From the University of California, Irvine, Medical Center, Chao Family Comprehensive Cancer Center, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, and Department of Pathology, Orange, California; and Long Beach Memorial Medical Center, Department of Pathology, Long Beach, California.

Address reprint requests to: Bradley J. Monk, MD, University of California, Irvine Medical Center, Medical Center, 101 The City Drive South, Building 23, Room 107, Orange, CA 92868; E-mail: bjmonk{at}uci.edu.

OBJECTIVE: To explore the outcome and long-term follow-up of fertility sparing surgery for cervical adenocarcinoma in situ and early invasive adenocarcinoma.

METHODS: Between 1985 and 1996, all women with adenocarcinoma in situ (AIS) and stage I adenocarcinoma were identified. Data were abstracted from clinical records and pathology reviewed.

RESULTS: One hundred thirty three women with stage I adenocarcinoma of the cervix were treated. Twenty subjects met the criteria for International Federation of Gynecology and Obstetrics stage IA1 lesions. Fourteen subjects were treated with radical hysterectomy, whereas two were treated with simple hysterectomy. Because of the desire to preserve fertility, four women with adenocarcinoma were treated with cervical conization alone, and three women have gone on to deliver viable infants. Forty-two women with adenocarcinoma in situ were identified, of whom 20 were treated with fertility sparing surgery (conization). Five women treated with conization had positive margins recurring in two, and one developed an invasive adenocarcinoma 5 years after conization. None of the women with adenocarcinoma treated with cervical conization have developed recurrent disease after a median follow-up of 48 months. Cone margin status was predictive of residual disease at hysterectomy.

CONCLUSION: Women with adenocarcinoma in situ and negative margins may be treated with conservative, fertility sparing surgery. Education is essential regarding the risks of residual/recurrent disease because subjects can develop lethal recurrent disease. The fertility sparing management of invasive stage IA1 adenocarcinoma of the uterine cervix may also be entertained among women who desire future fertility and have negative margins of resection.

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