Hysterectomy—definitive therapy for carcinoma in situ?
James S. Krieger, M.D.
Department of Gynecology
Lawrence J. McCormack, M.D.
Division of Pathology
HYSTERECTOMY has long been the favorite treatment for carcinoma in situ of the uterine cervix. This operation has often been termed “complete therapy”1 in contrast to conservative forms of treatment or “incomplete therapy.” Many authors2–7 have come to consider hysterectomy as definitive therapy for carcinoma in situ in the uterine cervix.
The operation does constitute definitive treatment, but only in so far as the cervix is concerned. Since carcinoma in situ is not a condition peculiar to the cervix, and may be found in numerous sites in the female lower generative tract, inferences in regard to the definitive nature of hysterectomy are not only groundless, but represent potentially dangerous thinking. To adhere to the concept that the operation is complete therapy often results in incomplete postoperative progress examinations, leaving the distinct possibility that recurrent disease will be overlooked.
For the last 14 years, we have been testing the theory that there is no single definitive treatment for carcinoma in situ. Treatment has been individualized and graded in accordance with the extent of the disease and its response to treatment.8 This response has been judged on the basis of careful, periodic, pelvic examination, and repeated cellular studies.
Conization has constituted the primary mode of therapy for cervical carcinoma in situ. It has been the only surgical treatment required in 314 of 414 patients. Hysterectomy has been performed only on the basis of the following criteria: (1) results of cellular studies have been abnormal after conization; (2) cervical stenosis after conizations. . .