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The stages of growth of cancer of the uterine cervix
Department
of Reviews and Abstracts
-_-I_~__-.
..~----~-.- ~-----. .- .__----------.-.--___---~.-.--
------- ~- -.-- -~- -~~--~
Selected Abstracts ---
Anesthesia, Analgesia Neme, B., Onofre
Aranjo, J., and Hero, B.: of the Univerf4itg of S5o Paul0 (Brazil) 223, Nov., 1951.
Spinal Anes&hesia Medical School,
at the Obstetrical Glinic An. brasil. de ginec. 32:
The authors observe that the obstetrical anesthesia in 50 per cent of the 487 cases The indistudied was of the spinal type in the aforementioned Brazilian obstetric clinic. cations for spinal anesthesia were forceps in 36 per cent; cesarean section in 70 per cent; ectopic pregnancy in 77.8 per cent, and fetal destructive operations in 7 per cent. The) correlate, by comparative study, spinal anesthesia to other types, and the relationship of blood pressure, blood transfusion, and neonatal asphyxia to the type of anesthesia. They conclude that spinal anesthesia possesses distinct advantages. There were no maternal deaths. The ideal level of spinal anesthesia for obstetric purposes was elevent,h or twelfth thoracic for vaginal routes and the eighth to the sixth thoracic for abdominal obstetric surgery, They note a parallelism between the height of anesthesia obtained and the degree of hypotension. They conclude by stressing the critical importance of adequate drug dosage if one is to avoid minor disturbances in blood pressure levels. They noticed 6.9 per cent and 11.8 per cent incidence of neonatal asphyxia in spinal and inhalation anesthetics given to mothers. Numerous tables are given with comparative values of 247 cases wherein spinal anesthesia, 161 cases wherein inhalation anesthesia, 58 caees wherein local anesthesia, and 16 cases where mixed types of obstetric anesthesia were &AIR E. Fo~sow~. employed.
Cancer, Zuckermann, de eir.,
Malignancies
Conrad0 : The Stages of Growth
of Cancer of the Uterine
ginec.
1951.
y cancer,
No.
8, p. 235, Aug.,
Cervix,
Rev.
mex.
The author proposes a classification of cervical carcinoma based on the anatomical This classification applies only to and clinical evolutionary stages of its development. epithelial cancer, and cannot be used for the rare cases of cervical cancer of other tissue type (connective, muscular, etc.) because these propagate in a diRerent manner. Growth and invasion of epithelial cancer in the cervix, as elsewhere, occurs primarily by contiguity and lymphatic extension, and secondarily by the hematogenous route. Connective tissue and muscular cancers also generally extend by contiguity and im mediately through blood channels. clinical and anatomical, macroscopic The evolutionary stages of cervical carcinoma, and microscopic, are indicated by the preoperative findings, modified, rectified, or confirmed by the operative findings and histopathological examination of tissues removed. Frequently the evolutionary stage is more advanced than the clinical findings would indicate.
Volume 64 Number ?
SELECTED
The S taye
author’s
proposed
I.-Carcinoma
classification
localized
is as follows:
to cervix
:
A. In situ, preinvasive, intraepithelial, B. Of t,he exocervix, already invasive C. Of the endocervix, already invasive Stnge
II.--Cervical
and
jwtacervical
A. Of the cervix B. Of the cervix (‘. Of the cervix or mgometrium Slnflp
III.-Cervical
carcinoma
-1. Carcinoma R. Carcinoma C. Carcinoma most their
Stage
IV.--Pelvic
cancer
451
ABSTRACTS
involving
the
exocervix
or the endocervix
carcinoma:
and vaginal cul-de-sac and juxtacervical parametrium (especially the entlocervis) with
extension
to lymph
with
extension
glands
and
to the
other
pelvic
rndomrtrium areas:
of the cervix and one or more pelvic lymph glands of the cervix with extension to middle third of vagina of the cervix with involvement of one or both parametria full ext,ent of uterine
origin,
with
or without
distant
to al-
metastases:
A. Cervical carcinoma with parametrial involvement extending to the pelvic* wall, with fixation of uterus and lymphatic propagation; B. Cervical carcinoma with extension to bladder or rectum; vaginal involvement down to the lower third; pelvic lymphatic propagation C. (‘ervical carcinoma extending to other pelvic areas, with propagation to bones, or with extrapelvic ganglionic or visceral metastases MAGIN HAGARRA. De&on, 44:
W. Ralph, Jr., 1042, 1951.
and Eradshaw,
H. H.:
Simple
or Radical
Mastectomy?
South
M. ,7
Treatment of carcinoma of the breast is not a settled issue. Preoperative x-ra! irradiation followed by simple mastectomy has recently been advocated in preference tct the radical operation of Halsted. To appraise the result of simple mastectomy, all cases of breast carcinoma at the North Carolina Baptist Hospital seen between 1942 and 1945 have been analyzed. A t,otal of 95 cases was seen, all of which had histologically proved carcinoma of the breast. Fifty-four of these patients were treated by radical mastectomy, with postoperative x-ray irradiation and 24 are still alive after five years, a survival rat,e of 44.4 per cent. The five-year survival rate for the patients treated by simple mastectomy with preoperative radiation is 54.7 per cent. The treatment of mammary carcinoma by simple mastectomy, in preference to the radical operation, is based on the theory that complete extirpation of the lesion is never assured except in Stage I lesions and in such lesions by definition a simple mastectomy wili In other words, the radical operation does not remove all of the cancer-bearing suffice. tissue in sites remote from the primary lesion and these must be eliminated by irradiation. WILLIAM BTCKEKR..
Extrauterine Pregnancy Zukermann, 1951.
C. :
Ectopic
Pregnancy,
Rev.
mex.
de cir.,
The author reviews the various possible locations frequent the tubal (ampullar and isthmic) and tubovarian infundibular, tuboabdominal and secondarily abdominal cervical, uterine diverticular, ovarian, intraligamentous, nancies.
ginee.
y eLncer,
No.
7, p. 19Q, July.
of ectopic pregnancy, listing as varieties, as rare the interstitial, gestations, and as very rare the and primary abdominal preg-
of Reviews and Abstracts
-_-I_~__-.
..~----~-.- ~-----. .- .__----------.-.--___---~.-.--
------- ~- -.-- -~- -~~--~
Selected Abstracts ---
Anesthesia, Analgesia Neme, B., Onofre
Aranjo, J., and Hero, B.: of the Univerf4itg of S5o Paul0 (Brazil) 223, Nov., 1951.
Spinal Anes&hesia Medical School,
at the Obstetrical Glinic An. brasil. de ginec. 32:
The authors observe that the obstetrical anesthesia in 50 per cent of the 487 cases The indistudied was of the spinal type in the aforementioned Brazilian obstetric clinic. cations for spinal anesthesia were forceps in 36 per cent; cesarean section in 70 per cent; ectopic pregnancy in 77.8 per cent, and fetal destructive operations in 7 per cent. The) correlate, by comparative study, spinal anesthesia to other types, and the relationship of blood pressure, blood transfusion, and neonatal asphyxia to the type of anesthesia. They conclude that spinal anesthesia possesses distinct advantages. There were no maternal deaths. The ideal level of spinal anesthesia for obstetric purposes was elevent,h or twelfth thoracic for vaginal routes and the eighth to the sixth thoracic for abdominal obstetric surgery, They note a parallelism between the height of anesthesia obtained and the degree of hypotension. They conclude by stressing the critical importance of adequate drug dosage if one is to avoid minor disturbances in blood pressure levels. They noticed 6.9 per cent and 11.8 per cent incidence of neonatal asphyxia in spinal and inhalation anesthetics given to mothers. Numerous tables are given with comparative values of 247 cases wherein spinal anesthesia, 161 cases wherein inhalation anesthesia, 58 caees wherein local anesthesia, and 16 cases where mixed types of obstetric anesthesia were &AIR E. Fo~sow~. employed.
Cancer, Zuckermann, de eir.,
Malignancies
Conrad0 : The Stages of Growth
of Cancer of the Uterine
ginec.
1951.
y cancer,
No.
8, p. 235, Aug.,
Cervix,
Rev.
mex.
The author proposes a classification of cervical carcinoma based on the anatomical This classification applies only to and clinical evolutionary stages of its development. epithelial cancer, and cannot be used for the rare cases of cervical cancer of other tissue type (connective, muscular, etc.) because these propagate in a diRerent manner. Growth and invasion of epithelial cancer in the cervix, as elsewhere, occurs primarily by contiguity and lymphatic extension, and secondarily by the hematogenous route. Connective tissue and muscular cancers also generally extend by contiguity and im mediately through blood channels. clinical and anatomical, macroscopic The evolutionary stages of cervical carcinoma, and microscopic, are indicated by the preoperative findings, modified, rectified, or confirmed by the operative findings and histopathological examination of tissues removed. Frequently the evolutionary stage is more advanced than the clinical findings would indicate.
Volume 64 Number ?
SELECTED
The S taye
author’s
proposed
I.-Carcinoma
classification
localized
is as follows:
to cervix
:
A. In situ, preinvasive, intraepithelial, B. Of t,he exocervix, already invasive C. Of the endocervix, already invasive Stnge
II.--Cervical
and
jwtacervical
A. Of the cervix B. Of the cervix (‘. Of the cervix or mgometrium Slnflp
III.-Cervical
carcinoma
-1. Carcinoma R. Carcinoma C. Carcinoma most their
Stage
IV.--Pelvic
cancer
451
ABSTRACTS
involving
the
exocervix
or the endocervix
carcinoma:
and vaginal cul-de-sac and juxtacervical parametrium (especially the entlocervis) with
extension
to lymph
with
extension
glands
and
to the
other
pelvic
rndomrtrium areas:
of the cervix and one or more pelvic lymph glands of the cervix with extension to middle third of vagina of the cervix with involvement of one or both parametria full ext,ent of uterine
origin,
with
or without
distant
to al-
metastases:
A. Cervical carcinoma with parametrial involvement extending to the pelvic* wall, with fixation of uterus and lymphatic propagation; B. Cervical carcinoma with extension to bladder or rectum; vaginal involvement down to the lower third; pelvic lymphatic propagation C. (‘ervical carcinoma extending to other pelvic areas, with propagation to bones, or with extrapelvic ganglionic or visceral metastases MAGIN HAGARRA. De&on, 44:
W. Ralph, Jr., 1042, 1951.
and Eradshaw,
H. H.:
Simple
or Radical
Mastectomy?
South
M. ,7
Treatment of carcinoma of the breast is not a settled issue. Preoperative x-ra! irradiation followed by simple mastectomy has recently been advocated in preference tct the radical operation of Halsted. To appraise the result of simple mastectomy, all cases of breast carcinoma at the North Carolina Baptist Hospital seen between 1942 and 1945 have been analyzed. A t,otal of 95 cases was seen, all of which had histologically proved carcinoma of the breast. Fifty-four of these patients were treated by radical mastectomy, with postoperative x-ray irradiation and 24 are still alive after five years, a survival rat,e of 44.4 per cent. The five-year survival rate for the patients treated by simple mastectomy with preoperative radiation is 54.7 per cent. The treatment of mammary carcinoma by simple mastectomy, in preference to the radical operation, is based on the theory that complete extirpation of the lesion is never assured except in Stage I lesions and in such lesions by definition a simple mastectomy wili In other words, the radical operation does not remove all of the cancer-bearing suffice. tissue in sites remote from the primary lesion and these must be eliminated by irradiation. WILLIAM BTCKEKR..
Extrauterine Pregnancy Zukermann, 1951.
C. :
Ectopic
Pregnancy,
Rev.
mex.
de cir.,
The author reviews the various possible locations frequent the tubal (ampullar and isthmic) and tubovarian infundibular, tuboabdominal and secondarily abdominal cervical, uterine diverticular, ovarian, intraligamentous, nancies.
ginee.
y eLncer,
No.
7, p. 19Q, July.
of ectopic pregnancy, listing as varieties, as rare the interstitial, gestations, and as very rare the and primary abdominal preg-