Early Invasive Carcinoma of the Cervix

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Abstract
The Term early invasive carcinoma of the cervix has come into prominence in the last two decades. It has been applied differently by various authors with subsequent confusion and dispute as to the proper definition and actual usefulness in diagnosis and treatment. The first reference to early invasive carcinoma of the cervix was by Mestwerdt in 1946 (3). He distinguished a form of early invasive cervical cancer which he called microcarcinoma or microinvasive carcinoma. He defined the entity as “early infiltrating carcinoma of the uterine cervix, the depth of penetration beyond the basement membrane not being greater than 5 mm.” His purpose was to differentiate early invasive from truly invasive carcinoma of the cervix; the thought being that microinvasive carcinoma behaved in a manner similar to carcinoma in situ rather than truly invasive cancer and, therefore, could be treated in a conservative manner. Since that time, numerous reports concerning early invasive carcinoma of the cervix have appeared in the literature (9, 10, 14, 16, 18, 19, 21, 22). The designations defining the spectrum of early lesions of the cervix have been almost as numerous as the reports (6, 7, 11, 23, 26). The general consensus of these reports regarding treatment is in agreement with the opinions of Mestwerdt, i.e., the very early lesion can be treated in a manner similar to that of carcinoma in situ. A smaller group of authors have disagreed with this point of view and have recommended that therapy for early invasive cancer must be the same as that for Stage I cancer (2, 17, 18, 23, 25). The existence of the numerous terms and the conflicting opinions about therapy have confused both the clinician and the pathologist as to what constitutes early invasive cancer and how it should be treated. The problem consists in deciding where to determine the border between Stage 0 and Stage I carcinoma of the cervix in the spectrum of early lesions. These range from true carcinoma in situ through carcinoma in situ with gland involvement, questionable early stromal invasion, microinvasive carcinoma, occult invasive carcinoma, and true early invasive carcinoma. If a lesion is considered to be in the carcinoma in situ aspect of the spectrum, it can and should be treated conservatively with total hysterectomy and a wide cuff excision. If, on the other hand, it is on the invasive side of the spectrum, it should be treated as a Stage I lesion, preferably by radiation therapy or by a total hysterectomy, bilateral salpingo-oophorectomy, and pelvic lymph node dissection. The authors' recent contact with two cases of “so-called” microinvasive carcinoma led to awareness of the difficulties involved in this problem and to a review of our experience and that of others. The patients had been treated in the generally accepted conservative manner and later showed evidence of disease outside the confines of the cervix.