[Microinvasive cervical cancer]. / Cancer micro-invasif du col utérin.

ABSTRACT

While the rate of invasive carcinoma of the cervix is relatively constant among women under 40 years of age, the rate of microinvasive carcinoma (MIC) appears to increase steadily in this young age group. The definition of MIC is not universally established and if the probability of dissemination of the disease is low, it is not unconceivable and calls for an adequate surgical treatment that should respect the anatomic and functional integrity of these young women. The diagnosis of MIC relies primarily on conisation that is indicated in severe dysplasia and cervical neoplasia with no evidence of invasion on colposcopic directed biopsies. Conisation is the standard approach that requires a rigorous surgical technique and a thorough histological evaluation of the surgical sample by a skilled pathologist. This pathologic examination should be particularly attentive to the depth of stromal invasion, the width and volume of the lesion and the magnitude of LVI. While the dissemination within the parametrium cannot be well assessed, it appears that the likelihood of pelvic lymph node involvement approximates the depth of stromal invasion of the MIC with a threshold limit of 3 mm. LVI also carries the risk of poor prognosis, particularly in the early stages of the disease, and has been taken into consideration by the Society of Gynecologic Oncologists (SGO). The standard treatment of MIC is also conisation under the condition that the surgical limits are not diseased. If the depth of stromal invasion exceeds 3 mm or if LVI is reported by the pathologist, the lesion should then be treated like an invasive carcinoma of the cervix (i.e. colpohysterectomy and pelvic lymphadenectomy). In some instances however (e.g. early invasion with LVI), a laparoscopy directed pelvic lymphadenectomy could be suggested as a first line investigation associated with conisation. Since early invasive carcinoma of the cervix can now be defined and carries a reduced spreading potential we can propose an adequate treatment allowing functional integrity in these patients in a particularly young age group.