The Classification of Cervical Cancer

Publisher Website
Google Scholar
Abstract
As long as carcinoma of the cervix has been recognized and treated as such, a decided difference in the curability of this malignant process has been observed. Many factors of the disease have been explored in an endeavor to account for this disparity. Born of these investigations are our various designs for the classification of cervical cancers; we find that they have been indexed according to their amenability to surgery, according to their gross morphology, according to their histological characteristics, and according to their anatomical extension. The objectives of these groupings have been to facilitate our choice of therapy, to govern us in our prognosis, and to give us a means of comparing the efficacy of various types of treatment under essentially the same conditions. While surgery stood alone as our only therapeutic approach to cervical cancer, the division of cases into operable, borderline, and inoperable was acceptable. Even then, however, such a division was not ideal, as the decision as to operability was inevitably influenced by the radicalness or conservatism of the surgeon's own point of view, as well as the patient's general condition, and depended too little upon the objective factors of the lesion itself. Now, since radiation more often than surgery is concerned in the therapeusis of cervical cancer, it becomes inconsistent to designate a lesion as operable or inoperable, and even more inconsistent to report results in terms of surgical attack when radiation has been the chief, if not the only, treatment. It seems evident that any classification based upon the amenability to a definite type of therapy is undesirable. To Ruge and Veit we owe the now time-honored division of cervical carcinomata into the two gross morphological types—everting and inverting. The everting or cauliflower form of growth, arising from the portio, although alarming in appearance, was thought to be less treacherous, as it expended the greater part of its energy in growing into the cavity of the vagina and showed little tendency to invade the deeper tissues. The inverting or scirrhous type, originating in the endocervix, produced enlargement of the cervix as a whole, was more likely to ulcerate and infiltrate the parametrial tissues, and hence was considered the more malignant form. This classification, to be sure, possesses the advantage of simplicity and, we must admit, is based upon the now well known clinical fact, as stated by Norris, “that neoplasms that are soft, friable, highly vascular, and of the so-called cauliflower type undergo marked primary regression and disappear rapidly under suitable irradiation.“ Too, we are all aware that this papillary type of tumor, due to its greater tendency to bleed, usually gives symptoms and is diagnosed at an earlier stage and for this reason enjoys a much better prognosis.

This publication has 0 references indexed in Scilit: