Mechanisms of failure in patients with carcinoma of the uterine cervix extending into the endometrium

A group of 389 patients was reviewed retrospectively who had histologically proven invasive carcinoma of the cervix and on whom a dilatation and curettage (D & C) was performed during the initial workup. Four types of pathological specimens on the D & C were identified: 1. (1) Endometrial extension with cervical carcinoma 2. (2) Tumor only in the curettings 3. (3) Admixture of normal endoemtrium and epidermoid carcinoma 4. (4) Negative D & C (no cervical carcinoma in curettings). All patients were staged at the time of initial treatment according to the FIGO classification. 274 patients were treated by radiation alone and 115 with a combination of irradiation and surgery. The survival rates on the patients with positive D & C was 10% to 15% lower in all stages than in those with negative D & C's. In addition, patients with Stage I cancer and positive D & C had a 19% incidence of distant metastasis, in contrast to 6% in the patients with no tumor in the endometrial curettings. In Stage II the incidence of distant metastasis was approximately 20% in both groups. In Stage III, patients with positive D & C had a 64% incidence of distant metastasis as opposed to 35% in those with negative D & C. The pelvic recurrence rate was approximately the same in the patients with negative or positive D & C. The addition of the surgical procedures to the radiation therapy did not influence the prognosis significantly, probably because of the high incidence of distant metastasis. The complication rates on the patients treated by radiation alone was 8.0% and in those treated by radiation and surgery 8.7%. Because of the need for higher doses of irradiation to the uterine wall, Heyman capsule packing should be part of the intracavitary treatment of these patients. The indication for a hysterectomy combined with irradiation is not supported by the present data, because of the high incidence of distant metastasis in patients with positive D & C.