Treatment of carcinoma of the uterine cervix; a commentary on current methods

A monograph on Cancer of the Female Genital Tract published by the American Cancer Society seems to put greater than warranted stress on the value of operative treatment as compared with radiotherapy of "small" or "early" lesions of the uterine cervix. The terms themselves may be misleading in that many readers may mistakenly take them to mean Stage I lesions. A diagnosis of Stage I is no assurance that extension has not occurred (as it had in 23.5 per cent of 17 cases of Stage I carcinoma observed by the author). In addition, there is suggestion in the monograph that the extent of operation may be reliably determined on the basis of frozen section examination of the obturator and iliac nodes. This overlooks the considerable possibility of metastasis that skips these groups and extends to others beyond (as it did in one of the 17 cases).Moreover, preoperative diagnosis of the stage of a lesion is not wholly reliable. In a series of 37 cases observed by the author in which the preoperative diagnosis was Stage I carcinoma of the cervix, pathological examination of tissues, after total hysterectomy of the Wertheim type, revealed that in nine cases the growth was actually at a more advanced stage. Upon further examination of tissues it was noted also that the excision was inadequate in 33 of the 37 cases.