Prospective management of stage IA(1) cervical adenocarcinoma by conization alone to preserve fertility: a preliminary report.
OBJECTIVE
Microinvasive cervical adenocarcinoma has an excellent prognosis and emerging data support the hypothesis that it should be treated in the same way as its squamous counterpart. We report our preliminary experience prospectively treating stage IA(1) cervical adenocarcinoma by conization alone in women who strongly desired to preserve their fertility.


METHODS
Since May 1998, all patients with stage IA(1) cervical adenocarcinoma who expressed a strong desire to preserve fertility have been offered cold knife conization (CKC) and careful surveillance without hysterectomy. Women with lesions identifiable only microscopically, up to 3 mm invasive depth, up to 7 mm tumor width, and a conization specimen including the entire lesion with negative margins were eligible for conservative management. Postconization surveillance consisted of a Pap smear and endocervical curettage every 4 months. Medical records were reviewed for clinical data, follow-up, and disease status.


RESULTS
Five women ages 26-33 elected CKC and surveillance. Four were nulliparous and one primiparous. Four tumors were endocervical cell type; one was adenosquamous. Three were grade 1, one was grade 2, and one grade 3. None had lymph-vascular space invasion. None of the patients has developed recurrent disease after 6-20 months of follow-up.


CONCLUSIONS
Our preliminary data suggest that patients with FIGO stage IA(1) cervical adenocarcinoma who strongly desire to preserve their fertility may be treated by conization alone if they are fully informed of the unknown risks for disease recurrence and are carefully followed. A multicenter trial is the next logical step to test the efficacy of this approach.
Division of Gynecologic Oncology, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA.
J O
JO
Schorge
K R
KR
Lee
E E
EE
Sheets
D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery*; D000328:Adult; D002278:Carcinoma in Situ / Q000473:pathology / Q000601:surgery; D019092:Conization / Q000379:methods*; D005260:Female; D005298:Fertility; D006801:Humans; D007247:Infertility, Female / Q000517:prevention & control; D009367:Neoplasm Staging; D011446:Prospective Studies; D002583:Uterine Cervical Neoplasms / Q000473:pathology / Q000601:surgery*