Endometrial extension of carcinoma of the uterine cervix: a prognostic factor that may modify staging

A retrospective review was done of 473 patients with histologically proven primary carcinoma of the uterine cervix on whom a dilatation and curettage (D & C) was performed during the initial workup. The pathologic features of the D & C specimens were classified as: (1) endometrial stomal invasion of cervical carcinoma; (2) tumor only, cervical carcinoma in D & C, normal endometrium absent; (3) admixture of normal endometrium and cervical carcinoma (contamination); (4) D & C negative for tumor. The patients were staged according to the FIGO classification. Eighty-two percent (388) of the patients were treated with radiation alone and the rest with a combination including surgical procedures (usually radical hystrectomy with lymphadenectomy). The three- and five-year survival rates were 10% to 20% lower for patients with D & C showing stromal invasion or tumor only than in patients with admixture or negative D & C. These results were coupled with an appreciably higher number of distant metastases in the patients with positive D & C and a lower incidence in patients with negative D & C. The authors suggest that endometrial extension of carcinoma of the uterine cervix may be an important factor in the staging classification of these patients and recommend that D & C always be done in the initial evaluation. Because of the high incidence of distant metastasis, effective adjuvant therapy must be developed to improve the present therapeutic results.