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Joseph L. Kelley, MD:

Thank you for allowing me to answer the question for EyesOnThePrize.org. My answer is as follows:

In the past decades, the frequency of squamous carcinoma of the cervix has fallen, whereas the opposite is true for adenocarcinoma of the cervix. The cause of adenocarcinoma may be very similar to that observed for squamous carcinoma. Specifically, exposure to the human papillomavirus and a number of cofactors such as cigarette smoking and compromised immune status may make this disease more evident. Currently it accounts for roughly 30% of all cervical cancers that are diagnosed in the United States.

Adenocarcinoma of the cervix can exist in several forms, including an in situ variety (non-invasive), a microinvasive, as well as a frankly invasive malignancy. The first two entities are very similar to squamous lesions and are considered precursors to invasive adenocarcinoma. Available information suggests that both entities can be treated comparably by means of local management such as conization (removal of a large portion of the cervix). When childbearing is completed, the option of hysterectomy may be considered. The entity of microinvasive disease is less described and less well accepted in the medical community. It is not known at this time whether or not additional management in the form of lymph node removal should be performed.

Stage for stage, treatment for invasive adenocarcinoma is comparable to that of squamous carcinoma. Early stage lesions that are confined to the cervix with a diameter of 4.0 cm. or less can be treated with a radical hysterectomy and removal of the lymph nodes that line the blood vessels in the pelvis, as well as those along the spinal column. For more advanced disease, the combination of chemotherapy along with radiation therapy is employed.

Studies by the Gynecologic Oncology Group reported similar survival rates for patients with adenocarcinoma and squamous carcinoma, taking into account issues such as the volume of disease and the presence of lymph node spread. There have been studies that are contrary in their findings, however, and additional research is ongoing in this area.

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