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Carcinoma of the cervix before the age of twenty years
722
AMERICAS
JOURSL\L
OF
Carcinoma of the Hall, Norman D.: Canad. M. A. .T. 43: 362, 19-M.
OBSTETRICS
Cervix
AND
in the
First
QYSECOLOGY
Three
Decades
of Life,
Of 134 cases of uterine c~arcinorux I,t*czurring in persons under 20 years of age 57 represented c-arczinoma of the cervix. This is 7.4 per caent of all proved cervical ~*arc~inomas seen at the inst,itution. There 11:~s been a proportionate increase in the frequency of cervical carcinoma in women 20 years of age or under during the past tive years as compared with the prclviouy tivr gears. At least :Ii per caent of this group were married befort, the age of ?!I an11 X7 per chent had hat1 one or morr prepnam+s before 20 years of age. Tlw youngrst patient seen was 20 years old. Abnornral bleeding watt the first s~mptcrm in ?5 per carnt of the patient and WAC; the only symptom in .?I1 per (,rnt of the groul,. Of this group, 49 per cqent died within two years after tlrc, diagnosis was made, ant1 only 1 I .5 per czent livrd over two years.
Diddle, A. W.: Carcinoma Cancer 34: 207, 1010.
of the
Cervix
Before
the Age
of Twenty
Years,
Am.
.I.
From .Tuly, 1926, to Dec. 1, 1939, .X5 cakes of carcinoma of the cervix were diagnosed in the University Hospitals (Towa). F’i\-e of the patients were less than 2.3 years of age; one was IT years, two 31, one Y:l, and one 2-C. The available lit,erature reveals lti reports of cervical malignancy occurring befclre the age of 20. Only three of the tumors were designated as epitheliomas, while 9 were adenoc2arcinomas, and in six the type is not indicated. Of the 1~ patients, ti died within nne year. The impression is obtained that thr prognosis of carcsinoma of the cervix before the age of JO is grave because of the accelerated growth impulse in malignant neuplasms during the growing years. The case reported by the author demorlstratex the rapidity with which the neoplasm may invade the surrounding pelvic tissues, even during heavy irradiation therapy. .T. P. GREENHILT..
White,
J. W.:
Carcinoma
of Uterine
Cervix,
Am.
J. 8urg.
45:
4, 1939.
>Microscopic examination of adequate tliopsy material is the only means by which cancer of the cervix can be diagnosed with any degree of precision, and little hazard is involved in properly excising biopsv specimens. Colposcopic examination and the Hehiller iodine test, are of at*adem&: int,erest. Both are greatly subsidiary t,o unaided visualization and biopsy. The Schiller test, is a purely negative diagnostic method. Palpation of the cervical broad ligaments is sat,isfactorily accomplished by a combined vaginorectal examination. The majority of cervical cancers are radiosensitive; and the more active and anaplastic the cells, the less their radioresistance. Cancer appearing in the rervieal stump wit,lrin one year after supravaginal hysterectomy is residual and was present before the operation. If it appears after a longer int,erval, it must be considered a subsequent primary new growth. A8 prophylaxis against the latter event t,he mucosa of the cervical st,ump including the endocervix, if not destroyed bp cautery at the time of operation, must be so destroyed within four weeks thereafter. Radium irradiation efficiently administered is the safest and most rertainly curative method of treat,ment, but it must be supplemented by high voltage roentgen rays in all except the earliest cases. Primary rocntgen therapy, supplemented by postradium roentgen irradiation, offers advantages that require further evaluation. Radium is by no means a simple remedy that may be applied casually without disastrous effect or serious consequences. Therefore, it should be used only by those who have had an opportunity through supervised experience to become expert in its application. Although the absolute curability rate for ranper of the I>ervix is between 20 and XI per cent, half t,he total number of patients treated will dir of the disease within three years. J. 1'. GREENHJLL.
AMERICAS
JOURSL\L
OF
Carcinoma of the Hall, Norman D.: Canad. M. A. .T. 43: 362, 19-M.
OBSTETRICS
Cervix
AND
in the
First
QYSECOLOGY
Three
Decades
of Life,
Of 134 cases of uterine c~arcinorux I,t*czurring in persons under 20 years of age 57 represented c-arczinoma of the cervix. This is 7.4 per caent of all proved cervical ~*arc~inomas seen at the inst,itution. There 11:~s been a proportionate increase in the frequency of cervical carcinoma in women 20 years of age or under during the past tive years as compared with the prclviouy tivr gears. At least :Ii per caent of this group were married befort, the age of ?!I an11 X7 per chent had hat1 one or morr prepnam+s before 20 years of age. Tlw youngrst patient seen was 20 years old. Abnornral bleeding watt the first s~mptcrm in ?5 per carnt of the patient and WAC; the only symptom in .?I1 per (,rnt of the groul,. Of this group, 49 per cqent died within two years after tlrc, diagnosis was made, ant1 only 1 I .5 per czent livrd over two years.
Diddle, A. W.: Carcinoma Cancer 34: 207, 1010.
of the
Cervix
Before
the Age
of Twenty
Years,
Am.
.I.
From .Tuly, 1926, to Dec. 1, 1939, .X5 cakes of carcinoma of the cervix were diagnosed in the University Hospitals (Towa). F’i\-e of the patients were less than 2.3 years of age; one was IT years, two 31, one Y:l, and one 2-C. The available lit,erature reveals lti reports of cervical malignancy occurring befclre the age of 20. Only three of the tumors were designated as epitheliomas, while 9 were adenoc2arcinomas, and in six the type is not indicated. Of the 1~ patients, ti died within nne year. The impression is obtained that thr prognosis of carcsinoma of the cervix before the age of JO is grave because of the accelerated growth impulse in malignant neuplasms during the growing years. The case reported by the author demorlstratex the rapidity with which the neoplasm may invade the surrounding pelvic tissues, even during heavy irradiation therapy. .T. P. GREENHILT..
White,
J. W.:
Carcinoma
of Uterine
Cervix,
Am.
J. 8urg.
45:
4, 1939.
>Microscopic examination of adequate tliopsy material is the only means by which cancer of the cervix can be diagnosed with any degree of precision, and little hazard is involved in properly excising biopsv specimens. Colposcopic examination and the Hehiller iodine test, are of at*adem&: int,erest. Both are greatly subsidiary t,o unaided visualization and biopsy. The Schiller test, is a purely negative diagnostic method. Palpation of the cervical broad ligaments is sat,isfactorily accomplished by a combined vaginorectal examination. The majority of cervical cancers are radiosensitive; and the more active and anaplastic the cells, the less their radioresistance. Cancer appearing in the rervieal stump wit,lrin one year after supravaginal hysterectomy is residual and was present before the operation. If it appears after a longer int,erval, it must be considered a subsequent primary new growth. A8 prophylaxis against the latter event t,he mucosa of the cervical st,ump including the endocervix, if not destroyed bp cautery at the time of operation, must be so destroyed within four weeks thereafter. Radium irradiation efficiently administered is the safest and most rertainly curative method of treat,ment, but it must be supplemented by high voltage roentgen rays in all except the earliest cases. Primary rocntgen therapy, supplemented by postradium roentgen irradiation, offers advantages that require further evaluation. Radium is by no means a simple remedy that may be applied casually without disastrous effect or serious consequences. Therefore, it should be used only by those who have had an opportunity through supervised experience to become expert in its application. Although the absolute curability rate for ranper of the I>ervix is between 20 and XI per cent, half t,he total number of patients treated will dir of the disease within three years. J. 1'. GREENHJLL.