Carcinoma In Situ of the Uterine Cervix:Conservative Management in 84 of 190 Cases

Section: Methodsmentioning

confidence: 99%

Consequences in women of participating in a study of the natural history of cervical intraepithelial neoplasia 3

McCredie

Paul

Sharples

et al. 2010

“…During the study period, women received varied management. Some surgical procedures were intended to cure (hysterectomy or cone biopsy), while others were not (wedge biopsy or ring biopsy (defined as removal of a shallow cone <2 cm, or <1.5 cm deep)). We classified each procedure according to the likelihood that the treatment was curative based on the procedure used to remove the lesion, whether or not the margins were clear of CIN3, and whether or not there was cytological evidence of persisting disease in the 6–24 months after excision.…”

Section: Methodsmentioning

confidence: 99%

Outcomes for women without conventional treatment for stage 1A (microinvasive) carcinoma of the cervix

Paul

Sharples

Baranyai

et al. 2018

“…before cytology was available. Alternatively, we are diagnosing too many carcinomas in situ to explain the incidence of invasive cancer, for, as previously shown (Green, 1962), there is a clear disparity between the observed frequency of intraepithelial cancer and that theoretically derived from the known incidence of invasive cancer.…”

Section: Indirect Statistical Evidencementioning

confidence: 97%

Cervical Carcinoma in Situ: True Cancer or Non‐Invasive Lesion?

Green

1964

Self Cite

Summary: The commonly accepted view that cervical carcinoma in situ is necessarily a precursor of invasive cancer is questioned. Evidence to support the contention that carcinoma in situ may pursue a benign course in a large proportion of patients is presented. (a) Clinical evidence. A series of 278 patients with carcinoma in situ dealt with in the years 1951‐62 is considered. Of these, 151 were treated by hysterectomy and 127 by conservative local excision. Fourteen of the latter were re‐coned because of positive cytology and 7 post‐hysterectomy patients showed evidence of vault recurrence. The follow‐up period for the conservative group ranged from 1 to (i) Although many patients have shown positive follow‐up cytology, and cone biopsy has been found to be only about 80% effective in totally excising carcinoma in situ, no lesion has yet progressed to invasion. It is felt that one reason for this is that invasive cancer was, as adequately as possible, excluded at the outset. (ii) None of 14 patients with carcinoma in situ to the biopsy margin, followed after cone biopsy only, have shown progression of the tumour to invasion for periods up to 5 years. (iii) None of 17 patients with “microinvasive” lesions treated conservatively and followed for periods up to 5 years have shown progression of the tumour to invasion. (b) Indirect statistical evidence. A series of 917 patients with invasive cervical carcinoma treated in 2 periods of 8 years each (before and after the advent of cytology in 1954) is presented. The incidence of invasive cervical cancer in gynaecological admissions was falling steadily in the 8 years before cytology was introduced and the rate of fall has not been accelerated since. Also the proportion of early (Stage 1) cases was rising before cytology was introduced and this rise has not obviously been thereby accelerated. (c) Experimental evidence. The work of Saphir et al. (1959) and Kaminetzky (1960) in producing with podophyllin transient lesions of the cervix resembling carcinoma in ‘situ is referred to. Other local injurious influences which could conceivably produce such lesions, characterized by the picture of “frozen mitoses,” include inflammation, pregnancy, and irradiation. A plea is made for the replacement of the various synonyms of carcinoma in situ (all of which contain the word “cancer”) by a term such as “suspicious cervical dysplasia.” It is concluded that the virtual elimination of invasive cancer of the cervix by large‐scale cytology campaigns, as propounded especially by Boyes et al. (1962), is open to doubt.