Current Management of In Situ and Invasive Cervical Adenocarcinoma

Cervical adenocarcinomas are increasing in incidence each year, both in the United States and worldwide. This increase largely reflects the inherent difficulty in detecting glandular precursor lesions. Since adenocarcinoma in situ generally requires at least five years to progress to invasive disease, there should be ample time for screening and potential intervention. Conization preserves fertility in young women diagnosed with adenocarcinoma in situ, but carries an inherent risk of residual disease higher in the canal. Highly motivated patients with microscopic stage IA1 and IA2 cervical adenocarcinoma may also be managed by fertility-sparing surgery. The treatment of choice for stage IB1 disease is radical hysterectomy. Fewer than 20% of patients will need adjuvant therapy. Primary radiation with weekly cisplatin is the best option for women with stage IB2 and IIA cervical adenocarcinoma. Virtually all patients treated initially by radical hysterectomy will have high-risk surgical-pathologic features that indicate the need for adjuvant chemo-radiation. Patients with stage IIB to IVA disease should also receive primary radiation with weekly cisplatin, but their prognosis is more guarded. The treatment of recurrent cervical adenocarcinoma should be individualized, depending on the location of disease and the type of previous therapy. In this review, we discuss the current management of in situ and invasive cervical adenocarcinoma.