Cancer of the cervix, FIGO stages IB and IIA: Patterns of local growth and paracervical extension

The relationship between patterns of local growth and paracervical extension of cervical cancer was evaluated in operative specimens of 230 patients with squamous cell carcinoma FIGO stage IB and IIA who were primarily treated, between January 1989 and December 1993, by abdominal radical hysterectomy with pelvic lymphadenectomy. Twelve cervical giant sections, each representing an area of 30 °, including the corresponding paracervical tissues (lateral parametria, vesicocervical ligaments, and uterosacral ligaments), were made parallel to the cervical canal, and serial horizontal step sections at 3 pm were cut. Cervical carcinoma spread endocervically equally in all directions; higher frequencies were observed in the front and back cervical quadrants (about 28%) than in the lateral ones (about 22%) (P=NS). The corresponding tumor extension beyond the cervix was into the vesicocervical ligaments (anterior parametria) and the vesicocervical septum in about 23% of cases, into the uterosacral ligaments (posterior parametria) and the rectovaginal septum in about 15% of cases, and into right and left lateral parametria in about 28% and 34% cases, respectively. Paracervical extension (26%) was significantly related to the maximum depth of stromal invasion (χ2= 19.11; P < 0.01), minimum thickness of uninvolved fibromuscular cervical stroma (χ2= 32.34; P < 0.01), lymphatic invasion (χ2 = 17.91; P < 0.01), pelvic lymph node metastases, (χ2= 48.37; P < 0.01) and tumor size (χ2 = 26.38; P < 0.01). Furthermore, involvement of anterior and posterior paracervical tissues was related to high percentages of the minimum thickness of unaffected cervical stroma in the corresponding front (92%) and back (88%) quadrants, whereas these percentages were much lower (30%) in lateral cervical quadrants with carcinomatous extension to lateral parametria. These patterns of growth suggest that surgery is only radical with respect to lateral parametria in the treatment of cervical cancer