Carcinoma of the Cervix

During the period from Sept. 1, 1942, to Jan. 1, 1951, there were admitted to the University of Iowa Hospitals 710 patients who had cervical carcinoma. Of this number, 84 had received some treatment prior to admission and 626 had been given no previous therapy, the latter forming a group of cases for which the University Hospitals could assume complete therapeutic responsibility. This latter group of patients has been thoroughly studied in order to evaluate certain changes in technic of management and to determine if there has been any improvement in the kind of material admitted. From Table I it can be seen that there has been an increase in the number of patients in the older age groups. From 1926 to 1942, 19.6 per cent of the patients were 60 or above, while during the years 1942 to 1951 there were 27.1 per cent above that age. This does not necessarily mean that carcinoma of the cervix is becoming more common among older persons but rather that more people are living to a greater age. The average age has increased from 48.5 years in the first group (1926 to 1942) to 51.6 in the present series. Table II shows the Schmitz staging of all cases treated entirely at the University Hospitals during the period 1926–1942 and also in the period 1942–1951. These patients were accurately staged on admission, since they were unaffected by previous therapy. There has been no increase in the percentage of Stage I cases in the present series. The percentage of patients with Stage II carcinoma has increased, while that of advanced cancer (Stages III and IV) has decreased. The operability rates (Stages I and II) during the two periods were 26.6 and 33.4 per cent, respectively. In spite of the fact that many educational campaigns against cancer are being waged by professional and lay organizations, at least two-thirds of the patients with cervical carcinoma still have advanced lesions (Stages III and IV) when the diagnosis is first made. The principal treatment of carcinoma of the cervix in our clinic continues to be irradiation therapy. Some patients with residual disease following irradiation were subjected to the Wertheim operation or to pelvic exenteration, and in a few instances interstitial radioactive gold was used. The local lesion on the cervix was treated either with radium or transvaginal x-ray therapy. Parametrial and lymphatic spread received deep x-ray therapy, usually through six skin portals: one anterior and one posterior, 15 × 15 ern. (used only since 1949); two lateral, 10 × 15 cm.; two gluteal, 10 × 10 em. The following factors were used: 200 kv, target-skin distance 50 em., Thoraeus filter, h.v.l. 2 mm. copper. A 3-mm. lead strip, 2.5 em. wide and 0.3 em. thick, was usually placed in the midline of the anterior and posterior portals to protect the bladder and rectum from approximately 50 per cent of the radiation through these portals.