Carcinoma of the Fundus of the Uterus

Abstract

THERE ARE varied opinions concerning the best treatment for the patient with carcinoma of the body of the uterus. Masson and Gregg1" feel that the standard treatment of carcinoma of the body of the uterus is a total hysterectomy with bilateral salpingo-oophorectomy. Richardson'5 stated, in I935, that the complete surgical extirpation of the uterus together with both tubes and ovaries still remained the best therapeutic attack on cancer of the corpus uteri. Sackett,16 in 1937, preferred combined therapy whenever it was possible. In I937, Scheffey and Thudium'9 advocated preliminary irradiation with a panhysterectomy in selected cases. Martin'0 takes the position, that if a curettage after irradiation showed malignant tissue, then an operation was advised for certain groups. Kilgore8 stated that, in I936, the California Cancer Commission recommended an hysterectomy with preoperative irradiation in cancer limited to the uterus, and irradiation therapy in cancer extending beyond the walls of the uterus. Because of these varied opinions, the writer has made a study of a group of our own cases, with particular endeavor to evaluate the end-results of treatment.There were iio case records of patients with this pathologic entity, who had been seen in the Scott and White Clinic during the 20-year period, from i92i through I940. Eighteen patients of this number were excluded from this study. Six of the i8 had been treated elsewhere, and came to the clinic for observation only. Four others declined treatment, and eight were found to have diffuse metastasis and were regarded as hopeless, so no treatment was advised. The remaining 92 patients, of the IIo, entered the hospital for treatment, and they form the basis for this detailed review. The diagnosis of carcinoma of the uterine fundus was proved histologically in every case. Follow-up data to date have been obtained on all patients. All patients with both cancer of the uterus and of the ovary were omitted from this study except two. In these, there was little question but that the cancer was primarily of the uterus. Cancers of the fundus and cervix were excluded also, unless the lesion was rather definitely primary in the corpus.The incidence of carcinoma of the fundus is decidedly less than is that of the cervix. Sackett17 reported the ratio of body carcinoma to that of the cervix, as one to five; Crile and Elias,4 one to three; Scheffey and Thudium,19 one to nine and five-tenths. The incidence in our clinic has been approximately one to six. During this same period of time, 17 patients have been seen with sarcoma of the uterus. In our clinic, there have been seen six 90