Prognostic significance of endometrial extension from primary carcinoma of the uterine cervix

This is a retrospective analysis of 302 patients with histologically confirmed primary carcinoma of the cervix on whom a dilatation and curettage was performed during the initial workup. The prognostic significance of endometrial extension of this tumor was investigated. Four different types of specimens were identified: 1) endometrial extension of cervical carcinoma; 2) cervical carcinoma in the curettings only; 3) a mixture of normal endometrium and epidermoid carcinoma in the curettings; 4) no cervical carcinoma noted (negative D & C). The patients were staged according to the FIGO classification. Patients with Stage I carcinoma and positive D & Cs showed significantly lower 3‐ and 5‐year survival rates (50–60%), as opposed to those with negative D & C (approximately 80–85%). In Stage II, the endometrial extension of the cervical carcinoma decreased the 3‐year survival rates to 50–56%, in contrast to 73% with negative D & C. At 5‐years, the survival rates were 45% with positive D & C, in contrast to approximately 70% in those with negative D & Cs. Patients with Stage I cervical carcinoma and positive curettings showed a 20% incidence of distant metastasis, in comparison to only 4.5% in the patients with negative D & C (p ≦ .05). Patients with Stage II cervical tumors and positive D & C had a 21% incidence of distant metastasis, in contrast to 10.7% in those with negative D & C. It is strongly recommended that a dilatation and curettage be routinely obtained in the evaluation of patients with cervical carcinoma. The plan of treatment should be modified; whenever possible, packing of the endometrial cavity with Heyman capsules should be performed. The indication for hysterectomy following irradiation, the value of which has been demonstrated on patients with Stage II carcinoma of the endometrium or in carcinoma of the cervix with barrel‐shaped configuration, needs further evaluation on patients with endometrial extension of cervical carcinoma, because of the high incidence of distant metastasis.