Zervixkarzinom (Collumkarzinom)

  • G. Bastert
  • S. D. Costa


Ausgangspunkt prämaligner und maligner Veränderungen ist am häufigsten die Grenzzone zwischen Zylinder- und Plattenepithel. Als Präkanzerosen der Zervix gelten die Zervixdysplasien und das Carcinoma in situ, als zervikale intraepitheliale Neoplasien (CIN) zusammengefaßt:
  1. 1.

    CIN Grad I = leichte Dysplasie mit Aufhebung der Schichtung, Störung der Differenzierung, keine oder nur wenige Mitosen im unteren 1/3 des Epithels;

  2. 2.

    CIN Grad II = mäßiggradige Dysplasie, gleiche Veränderungen wie CIN I nehmen die unteren 2/3 des Epithels ein;

  3. 3.

    CIN Grad III = schwere Dysplasie und Carcinoma in situ mit Schichtungsverlust, Aneuploidie der Kerne, atpyischen Mitosen, entdifferenziertem Epithel.



Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Allen HH, Collins JA (1977) Surgical management of carcinoma of the cervix. Am J Obstet Gynecol 127: 741–744PubMedGoogle Scholar
  2. 2.
    Artman LE, Hoskins WJ, Bibro MC, Heller PB, Weiser EB, Barnhill DR, Park RC (1987) Radical hysterectomy and pelvic lymphadenectomy for stage IB carcinoma of the cervix: 21 years experience. Gynecol Oncol 28: 8–13PubMedCrossRefGoogle Scholar
  3. 3.
    Berman ML, Bergen S, Salazar H (1990) Influence of histological factures and treatment on the prognosis of patients with cervical cancer metastatic to pelvic lymph nodes. Gynecol Oncol 39: 127–131PubMedCrossRefGoogle Scholar
  4. 4.
    Bianchi UA, Sartori E, Pecorelli S, et al (1988) Treatment of primary invasive cervical cancer: Considerations on 997 consecutive cases. Eur J Gynaccol Oncol 9: 47–53Google Scholar
  5. 5.
    Bonomi P, Blessing J, Ball H, Hanjani P, DiSaia PJ (1989) A phase Il evalation of cisplatin and 5-fluorouracil in patients with advanced squamous cell carcinoma of the cervix: A Gynecologic Oncology Group Study. Gynecol Oncol 34: 357–359Google Scholar
  6. 6.
    Boutseclis JG (1972) Intraepithelial carcinoma of the cervix associated with pregnancy. Obstet Gynecol 40: 657–666Google Scholar
  7. 7.
    Brinton LA, Hoover RN (1992) Epidemiology of Gynecologic Cancers. In: Principles and Practice of Gynecologic Oncology, WJ Hoskins, CA Perez, RC Young, eds. J. B. Lippincott Co., Philadelphia, pp 3–26Google Scholar
  8. 8.
    Burghardt E (1993) Cervical intraepithelial neoplasia–Results after conization and hysterectomy. In: Surgical Gynecologic Oncology, E Burghardt, ed. Georg Thieme Verlag, Stuttgart-New York, pp 302–304Google Scholar
  9. 9.
    Burghardt E, Holzer E (1980) Treatment of carcinoma in situ: evaluation of 1609 cases. Obstet Gynecol 55: 539–545PubMedGoogle Scholar
  10. 10.
    Childers JM, Hatch K, Surwitt EA (1992) The role of laparoscopic lymphadenectomy in the management of cervical carcinoma. Gynecol Oncol 47: 38–43PubMedCrossRefGoogle Scholar
  11. 11.
    Christensen A, Lange P, Nielsen E (1964) Surgery and radiotherapy for invasive cancer of the cervic. Surgical treatment. Acta Obstet Gynecol Scand 43 (52): 59–87PubMedCrossRefGoogle Scholar
  12. 12.
    Drescher CW, Reid GC, Terada K, Roberts JA, Hopkins MP, Perez-Tamayo C, Schoeppel SL (1992) Continuous infusion of low-dose 5-Fluorouracil and radiation therapy for poor-prognosis squamous cell carcinoma of the uterine cervix. Gynecol Oncol 44: 227–230PubMedCrossRefGoogle Scholar
  13. 13.
    Fuller AF, Elliott N, Kosloff C, Hoskins WJ, Lewis JL Jr (1989) Determinants of increased risk for recurrence in patients undergoing radical hysterectomy for stage IB and IIA carcinoma of the cervix. Gynecol Oncol 33: 34–39PubMedCrossRefGoogle Scholar
  14. 14.
    Gallion HN, van Nagell JR, Donaldson GS et al (1985) Combined radiation therapy and extrafascial hysterectomy in the treatment of stage IB barrel-shaped cervical cancer. Cancer 56: 262–265PubMedCrossRefGoogle Scholar
  15. 15.
    Greer BE, Easterling TR, McLennan DA, et al (1989) Fetal and matemal considerations in the management of stage IB cervical cancer during pregnancy. Gynecol Oncol 34: 61–65PubMedCrossRefGoogle Scholar
  16. 16.
    Greer BE, Figge DC, Tamimi HK, et al (1990) Stage lag squamous carcinoma of the cervix: Difficult diagnosis and therapeutic dilemma. Am J Obstet Gynecol 162: 1406–1411Google Scholar
  17. 17.
    Grigsby PW, Perez CA (1991) Radiotherapy alone for medically inoperable carcinoma in situ of the cervix: Stage IA and carcinoma in situ. Int J Radiat Oncol Biol Phys 21: 375–378Google Scholar
  18. 18.
    Hasumi K, Sakamoto A, Sugano H (1980) Microinvasive carcinoma of the uterine cervix. Cancer 45: 928–931PubMedCrossRefGoogle Scholar
  19. 19.
    Herd J, Fowler JM, Shenson D, Lacy S, Montz FJ (1992) Laparascopic para-aortic lymph node sampling: Development of a technique. Gynecol Oncol 44: 271–276Google Scholar
  20. 20.
    Hoffmann MS, Kavanagh JJ, Roberts WS, LaPolla JP, Fiorica JV, Hewitt S, Cavanagh D (1991) A phase II evaluation of cisplatin, bleomycin, and mitomycin-C in patients with recurrent squamous cell carcinoma of the cervix. Gynecol Oncol 40: 144–146CrossRefGoogle Scholar
  21. 21.
    Horiot JC, Pigneux J, Pourquier H, Schraub S, Achille K, Keiling R, Combes P, Rozan R, Vrousos C, Daly N (1988) Radiotherapy alone in carcinoma of the intact uterine cervix according to G H Fletcher guidelines: A french cooperative study of 1383 cases. Int J Radiat Oncol Biol Phys 14: 605–611PubMedCrossRefGoogle Scholar
  22. 22.
    Hoskins WJ, Ford JH, Lutz MH, Averette HE (1976) Radical hysterectomy and pelvic lymphadenectomy for the management of early invasive cancer of the cervix. Gynecol Oncol 4: 278–290PubMedCrossRefGoogle Scholar
  23. 23.
    Hoskins WJ, Perez CA, Young RC (1989) Gynecologic Tumors. In: Cancer: Principles and Practice of Oncology, 3rd Ed., VT De Vita, S Hellmann, SA Rosenberg, eds. JB Lippincott Co, Philadelphia, pp 1099–1161Google Scholar
  24. 24.
    Howley PM (1991) Role of the human papillomaviruses in human cancer. Cancer Res 51 (18 Suppl) 5019–5020Google Scholar
  25. 25.
    Hreshchyshyn MM, Aron BS, Boronow RC, Franklin EW Ill, Shingleton HM, Blessing JA (1979) Hydroxyurea or placebo combined with radiation to treat stages IIIB and IV cervical cancer confined to the pelvis. Int J Radiat Oncol Biol Phys 5: 317–322PubMedCrossRefGoogle Scholar
  26. 26.
    Hsu CT, Cheng YS, Su SC (1972) Prognosis of uterine cervical cancer with extensive lymph node metastases. Special emphasis on the value of pelvic lymphadenectomy in the surgical treatment of uterine cervical cancer. Am J Obstet Gynecol 114: 954–962Google Scholar
  27. 27.
    Iwasaka T, Hayashi Y, Yokoyama M (1990) Interferon-gamma treatment for cervical intraepithelial neoplasia. Gynecol Oncol 37: 96–102PubMedCrossRefGoogle Scholar
  28. 28.
    Jobson WV, Muss HB, Thigpen JT, Homesley HD, Bundy B (1984) Chemotherapy of advanced squamous carcinoma of the cervix: A phase I-II study of high-dose cisplatin and cyclophosphamide. J Clin Oncol 7: 341–345Google Scholar
  29. 29.
    Ketcham AS, Hoye RC, Taylor PT, Deckers PJ, Thomas LP, Chretien PB (1971) Radical hysterectomy and pelvic lymphadenectomy for carcinoma of the uterine cervix. Cancer 28: 1272–1277PubMedCrossRefGoogle Scholar
  30. 30.
    Kinney WK, Alvarez RD, Reid GC et al (1989) Value of adjuvant whole-pelvis irradiation after Wertheim hysterectomy for early stage squamous carcinoma of the cervix with pelvic nodal metastasis: A matched-control study. Gynecol Oncol 34: 258–262Google Scholar
  31. 31.
    Kline JC, Schultz AE, Vermund H, Peckham BM (1969) High-dose radiotherapy for carcinoma of the cervix. Method and results. Am J Obstet Gynecol 104: 479–484Google Scholar
  32. 32.
    Kredentser DC (1991) Etoposide (VP-16), ifosfamide/mesna, and cisplatin chemotherapy, for advanced and recurrent carcinoma of the cervix. Gynecol Oncol 43: 145–148PubMedCrossRefGoogle Scholar
  33. 33.
    Kumar L, Bhargava VL (1991) Chemotherapy in recurrent and advanced cervical cancer. Gynecol Oncol 40: 107–111PubMedCrossRefGoogle Scholar
  34. 34.
    Kuske RR, Perez CA, Grisgby PW, Lovett RD, Jacobs AJ, Galakatos AE, Camel HM, Kao MS (1989) Phase I/II study of definitive radiotherapy and chemotherapy (Cisplatin and 5-Fluorouracil) for advanced or recurrent gynecologic malignancies. Preliminary report. J Clin Oncol 12: 467–473Google Scholar
  35. 35.
    Lahousen M (1993) Cervical Cancer–Chemotherapy. In: Surgical Gynecologic Oncology, E Burghardt, ed. Thieme Verlag, Stuttgart-New York, pp 299–302Google Scholar
  36. 36.
    Lahousen M, Pickel H, Haas J 1988 ) Adjuvant chemotherapy after radical hysterectomy for cervical cancer. Bailliere’s Clin Obstet Gynecol 4: 1049–1057CrossRefGoogle Scholar
  37. 37.
    Lai CH, Lin TS, Soong YK, Chen HF (1989) Adjuvant chemothreapy after radical hysterectomy for cervical cancer. Gynecol Oncol 35: 193–198PubMedCrossRefGoogle Scholar
  38. 38.
    Lee YN, Wang KL, Lin MH, Liu CH, Wang KG, Lan CC, Chuang JT, Chen AC, Wu CC (1989) Radical hysterectomy with pelvic lymph node dissection for treatment of cervical cancer: A clinical review of 954 cases. Gynecol Oncol 32: 135–142PubMedCrossRefGoogle Scholar
  39. 39.
    Malfetano JH, Keys H (1991) Aggressive multimodality treatment for cervical cancer with paraaortic lymph node metastases. Gynecol Oncol 42: 44–47PubMedCrossRefGoogle Scholar
  40. 40.
    Masterson JG (1967) The role of surgery in the treatment of early carcinoma of the cervix. Clin Obstet Gynecol 10: 922–939PubMedCrossRefGoogle Scholar
  41. 41.
    Masubuchi K, Tenjin Y, Kubo H, Kimura M (1969): Five-year cure rate for carcinoma of the cervix uteri. With special reference to the comparison of surgical and radiation therapy. Am J Obstet Gynecol 103: 566–573Google Scholar
  42. 42.
    Muirhead W, Green LS (1968) Carcinoma of the cervix. Five-year results and sequelae of treatment. Am J Obstet Gynecol 101: 744–749Google Scholar
  43. 43.
    Neis KJ, Basted G (1989) Möglichkeiten der Therapie mit Interferonen in der Gynäkologie. TW Gynäkologie 2: 346–358Google Scholar
  44. 44.
    Newton M (1975) Radical hysterectomy or radiotherapy for stage I cervical cancer. A prospective comparison with 5 and 10 year follow-up. Am J Obstet Gynecol 123: 535–542PubMedGoogle Scholar
  45. 45.
    Nguyen PD, John B, Munoz AK, Yazigi R, Graham M, Franklin P (1991) Mitomycin-C/5-FU and radiation therapy for locally advanced uterine cervical cancer. Gynecol Oncol 43: 220–225PubMedCrossRefGoogle Scholar
  46. 46.
    Noda K, Teshima K, Uekenti K et al. (1989) Immunotherapy using the streptococcal preparation OK-432 for the treatment of uterine cervical cancer. Gynecol Oncol 35: 367–372PubMedCrossRefGoogle Scholar
  47. 47.
    Park RC, Patow WE, Rogers RE, Zimmermann E (1973) Treatment of stage I carcinoma of the cervix. Obstet Gynecol 41: 117–122PubMedGoogle Scholar
  48. 48.
    Perez CA, Breaux S, Askin F et al (1979) Irradiation alone or in combination with surgery in stage IB and IIA carcinoma of the uterine cervix: A non-randomized comparison. Cancer 43: 1062–1072Google Scholar
  49. 49.
    Perez CA, Camel HM, Kuske RR, Kao MS, Galakatos A, Hederman MA, Powers WE (1986) Radiation therapy alone in the treatment of carcinoma of the uterine cervix: A 20-year experience. Gynecol Oncol 23: 127–140PubMedCrossRefGoogle Scholar
  50. 50.
    Perez CA, Kurman RJ, Stehman FB, Thigpen JT (1992) Uterine Cervix. In: Principles and Practice of Gynecologic Oncology, WJ Hoskins, CA Perez, RC Young, eds. JB Lippincott Co, Philadelphia, pp 591–662Google Scholar
  51. 51.
    Perez CA, Kuske RR, Camel HM, Galakatos AE, Hederman MA, Kao MS, Walz BJ (1986) Impact of pelvic tumor control after definitive irradiation of carcinoma of the uterine cervix: Int J Radiat Oncol Biol Phys 12 (S1): 96CrossRefGoogle Scholar
  52. 52.
    Ramm K, Vergote IB, Kaern J, Trope CG (1992) Bleomycin —Ifosfamide —cis-Platinum (BIP) in pelvic recurrence of previously irradiated cervical carcinoma: A second look. Gynecol Oncol 46: 203–207Google Scholar
  53. 53.
    Reichman B, Markman M, Hakes T, Budnick A, Rubin S, Jones W, Almadrones L, Lewis JL, Hoskins W (1991) Phase Il trial of high-dose cisplatin with sodium thiosulfate nephroprotection in patients with advanced carcinoma of the uterine cervix previously untraeted with chemotherapy. Gynecol Oncol 43: 159–163PubMedCrossRefGoogle Scholar
  54. 54.
    Rotman M, Choi K, Guze C et al. (1990) Prophylactic irradiation of the para-aortic node chain in stage IIB and bulky stage IB carcinoma of the cervix: Initial treatment results of RTOG 7920. Int J Radiat Oncol Biol Phys 19: 513–521PubMedCrossRefGoogle Scholar
  55. 55.
    Schmidt-Matthiesen H, Basted G, Granitzka S, Schmid H (1993) Gynäkologische Onkologie. Schattauer, Stuttgart—New YorkGoogle Scholar
  56. 56.
    Schmidt-Matthiesen H, Kühne H (1986) Präncoplasien and Karzinome der Cervix uteri. In: Klinik der Frauenheilkunde and Geburtshilfe Band 11 — Spezielle gynäkologische Onkologie I, 2nd Ed., KH Wulf, H Schmidt-Matthiesen, eds. Urban and Schwarzenberg, München, pp 153–229Google Scholar
  57. 57.
    Siebel M, Freeman MG, Graves WL (1979) Carcinoma of the cervix and sexual function. Obstet Gynecol 55: 484–487Google Scholar
  58. 58.
    Soper JT, Berchuck A, Creasman WT, Clarke-Pearson DL (1989) Pelvic exenteration: Factors associated with major surgical morbidity. Gynecol Oncol 35: 93–98Google Scholar
  59. 59.
    Tattersall MHN, Ramirez C, Coppleson M (1992) A randomized trial of adjuvant chemotherapy after radical hysterectomy in stage lb—lIa cervical cancer patients with pelvic lymph node metastases. Gynecol Oncol 46: 176–181PubMedCrossRefGoogle Scholar
  60. 60.
    Thigpen JT, Vance RB, Balducci L, Blessing J (1981) Chemotherapy in the management of advanced or recurrent cervical and endometrial carcinoma. Cancer 48: 658–665PubMedCrossRefGoogle Scholar
  61. 61.
    Thomas G, Dembo A, Beale F, Bean H, Bush R, Herman J, Pringle J, Rawlings G, Sturgeon J, Fine S, Black B (1984) Concurrent radiation, mitomycin C and 5-fluorouracil in poor prognosis carcinoma of the cervix: Preliminary results of a phase I—II study. Int J Radiat Oncol Biol Phys 10: 1785–1790Google Scholar
  62. 62.
    Thomas G, Dembo A, Fyles A, Gadalla T, Beale F, Bean H, Pringle J, Rawlings G, Bush R, Black B (1990) Concurrent chemoradiation in advanced cervical cancer. Gynecol Oncol 38: 446–451PubMedCrossRefGoogle Scholar
  63. 63.
    Toki N, Tsukamoto N, Kaku T, Toh N, Saito T, Kamura T, Matsukama K, Nakano H (1991) Microscopic ovarian metastasis of the uterine cervical cancer. Gynecol Oncol 41: 46–51PubMedCrossRefGoogle Scholar
  64. 64.
    Underwood PB, Wilson WC, Kreutner A, Miller MC, Ill, Murphy E (1979) Radical hysterectomy: A critical review of twenty-two years’ experience. Am J Obstet Gynecol 134: 889–898Google Scholar
  65. 65.
    Wall JA, Collins VP, Hudgins PT, Kaplan AL, Adams RM (1966) Carcinoma of the cervix, Review of clinical experience during a 20 year period (1946–1965). Am J Obstet Gynecol 96: 57–63PubMedGoogle Scholar
  66. 66.
    Webb GA (1975) The role of ovarian conservation in the treatment of carcinoma of the cervix with radical surgery. Am J Obstet Gynecol 122: 476–484PubMedGoogle Scholar
  67. 67.
    Zander J, Baltzer J et al (1981) Carcinoma of the cervix. An attempt to individualize treatment. Am J Obstet Gynecol 139: 752Google Scholar
  68. 68.
    Lippman SM, Kavanagh JJ, Paredez M, Delgadillo F, Hong WK, Figuerda F, Olguin A, Freedman RS, Massimini G, Holdener EE, Krakoff IH (1993) 13-cis-Retinoic acid (13cRA), interferon-a 2a and radiotherapy for locally advanced cancer of the cervix. Proc. Am Soc Clin Oncol12:257Google Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1993

Authors and Affiliations

  • G. Bastert
  • S. D. Costa

There are no affiliations available

Personalised recommendations