Histological topography of carcinoma in situ of the cervix uteri

HE MAJORITY of authors accept the fact T that in the treatment of carcinoma in situ of the cervix uteri, the method of choice is the removal of the uterus-hysterectomy. This view is fundamentally correct and conforms with the principles of general oncology. However, such treatment raises certain problems. First, a great percentage of the patients with carcinoma in situ are young-in the reproductive period-and therefore, removal d the uterus in these women not only changes their biological status but also has psychological drawbacks. Second, a small cancerous lesion with its limited dynamics (slow develop ment without metastases), from the theoretical point of view, may make it possible to reduce radical treatment to a minimum. In this connection, during recent years in almost all centers concerned with the treatment of carcinoma in situ there have been attempts to apply, in chosen cases, operative procedures that spare the uterus; such procedures include amputation of the cervix uteri, electroconization, electrocoagulation, and even cone biopsy. Before an operation for the complete removal of the uterus is undertaken, a satisfactory evaluation of the lesion is necessary. The detection of carcinoma in situ must be followed by the exclusion (with the greatest possible degree of accuracy) of invasion. It is also important to ascertain whether the cancer involves the external rim of the portio vaginalis; if so, a more extensive vaginal cuff resection is indicated. Hysterectomy makes possible the serial examination of the whole operative specimen and the eventual discovery of invasion. When necessary, more radical treatment should be carried out by postoperative irradiation. Complete removal of the uterus is such a comprehensive operation that it is of practically no importance whether the carcinoma in situ penetrates deeply into the