Cervical cancer in the province of Manitoba: a 30-year experience.

OBJECTIVES: This study was undertaken to analyze trends in cervical cancer incidence by histological type and to track the survival rate in the province of Manitoba over a 30-year period. METHODS: Data from the Manitoba Cancer Registry (MCR) relating to all cases of cervical cancer that occurred between 1970 and 1999 in the province of Manitoba were analyzed to calculate incidence and survival rates according to histological subtype. RESULTS: Over this 30-year span, invasive cervical cancer was diagnosed in 1927 women, and carcinoma in situ was diagnosed in 10 006 women. Cervical cancer was the fifth most frequent cancer diagnosis for women in 1970, and by 1999 it had become the eleventh most frequent. The incidence rate for cervical cancer decreased from 21.6/100 000 women in 1970 to 8.8/100 000 women in 1999. The mortality rate for women with cervical cancer fell from 7.3/100 000 women in 1970 to 2.8 /100 000 women in 1999. Squamous cell carcinoma (SCC) was the most frequently diagnosed histologic subtype, but its incidence decreased from 1970 to 1999; the proportion of women with adenocarcinoma increased gradually over the same time from 7% to 22%. Survival rates were comparable in women with SCC and adenocarcinoma. In 1999, the incidence of cervical cancer in Manitoba was comparable to the Canadian rate. However, the mortality rate from cervical cancer was higher in Manitoba than in Canada overall. CONCLUSION: The incidence of cervical cancer and the incidence of cervical cancer-related deaths in Manitoba both dropped between 1970 and 1999. However, the incidence of cervical carcinoma in situ has increased steadily during the same period. These observations may reflect the effect of screening programs on the detection and treatment of cervical cancer precursors. Squamous cell carcinoma is still the most frequently diagnosed subtype of invasive cervical cancer, but the proportion of women with adenocarcinoma has increased. Deaths from cervical cancer showed a non-significant reduction over the study period.

Stage II endometrial carcinoma: limiting post-operative radiotherapy to the vaginal vault in node-negative tumors.

OBJECTIVE: To evaluate the outcomes of patients with node-negative stage II endometrial cancer who received vault brachytherapy without external beam pelvic radiotherapy (EBRT). METHODS: A retrospective review of all stage II endometrioid type endometrial cancer patients referred to Cancer Care Manitoba was undertaken between October 1995 and March 2001. Forty-nine patients were identified with disease confined to the uterus, but not all patients received extended surgical staging (ESS) with pelvic lymphadenectomy. These patients were evaluated for recurrence and morbidity data. RESULTS: Twenty node-negative stage II cancers were identified. Three were treated without adjuvant treatment, 12 received vault brachytherapy and 5 received more conventional treatment with EBRT and vault brachytherapy. No recurrences or deaths occurred in these patients. Mean follow-up was 40 months. No surgical complications were encountered in this group and no morbidity from radiotherapy was observed. CONCLUSIONS: Limiting adjuvant treatment to vault brachytherapy for node-negative stage II endometrial cancer results in less morbidity and excellent survival and is worthy of further investigation.

High-risk surgical stage 1 endometrial cancer: outcomes with vault brachytherapy alone.

OBJECTIVE: Prior to 1995, in our center, patients with surgically staged endometrial cancer with greater than 50% myoinvasion (FIGO 1C) were treated with vault brachytherapy and whole pelvis (WP) radiotherapy despite negative nodes. After October 1, 1995, these patients were treated with vault brachytherapy alone. The aim of this study was to ensure that the survival and recurrence rate had not changed. METHODS: A retrospective review of Cancer Care Manitoba charts was undertaken. All patients diagnosed with endometrioid adenocarcinoma between October 1, 1995, and March 1, 2001, were reviewed. Data for all FIGO surgical stage 1 patients, and a subset of stage 1C patients, were analyzed and compared with those of a historical control group, composed of patient data previously collected in our center (1978 to 1990) [Gynecol. Oncol. 55 (1994), 51]. RESULTS: A total of 172 patients had negative selective pelvic lymphadenectomy and FIGO stage 1 disease. Fifty-three stage 1C patients were spared WP radiotherapy. Median follow-up was 32 months. Recurrence rate in FIGO stage 1 disease was 2.3% (4/172) and for the subset 1C was 5.7% (3/53). The recurrence rate was not statistically significantly different from that of the historical control group, 3.6% for stage 1 (P = 0.562) and 7.2% for stage 1C (P = 0.51). Two- and five-year survival rates for stage 1 patients in this study were 97 and 95%, respectively. In the historical group, 2- and 5-year survival rates were 97 and 94%. CONCLUSION: Whole pelvis radiotherapy can be safely omitted in patients with FIGO stage 1C endometrial cancer if nodal status is known.

Etapificación clínica versus etapificación quirúrgica en carcinoma de endometrio / Clinical stage versus surgical stage in endometrial carcinoma

Ciento sesenta y ocho pacientes con adenocarcinoma de endometrio, estadio I, a quiénes se les practicó una histerectomía abdominal total y salpingooforectomía bilateral, linfadenectomía pélvica selectiva y lavado peritoneal fueron analizadas retrospectivamente. Veintinueve de ellas (17,3%), fueron ascendidas en etapificación. La sobrevida fue significativamente más baja para este grupo, comparándolo con el verdadero estadio I (70 vs. 99%, p = < 0,001). La identificación de grupos de alto riesgo, en adenocarcinoma de endometrio, que clínicamente parecen tener lesiones precoces (estadio I), nos conducirá a tratamientos más individualizados e identificará pacientes que necesiten radioterapia coadyuvante y/o quimioterapia hormonal o citotóxica