From the Guidelines
The primary treatment for cervical adenoma involves a fertility-sparing approach, with radical trachelectomy being a reasonable option for patients with stage IA2 or IB1 cervical cancer with lesions less than or equal to 2 cm in diameter, as recommended by the NCCN guidelines 1.
Diagnosis and Treatment Approach
The management algorithm for cervical adenoma typically involves a stepwise approach beginning with diagnosis confirmation through colposcopy and biopsy. Initial treatment usually involves surgical excision, most commonly using the loop electrosurgical excision procedure (LEEP) or cold knife conization to remove the abnormal tissue.
- The NCCN guidelines recommend cold knife conization as the preferred approach, but LEEP is acceptable as long as adequate margins, proper orientation, and a non-fragmented specimen without electrosurgical artifact can be obtained 1.
- Select patients with stage IA2 or IB1 cervical cancer, especially those with tumors of less than 2 cm in diameter, may be eligible for conservative surgery, including radical trachelectomy 1.
Fertility-Sparing Treatment Options
Radical trachelectomy may offer a reasonable fertility-sparing treatment option for patients with stage IA2 or IB1 cervical cancer with lesions that are less than or equal to 2 cm in diameter.
- Vaginal radical trachelectomy (VRT) may be used for carefully selected patients with lesions of 2 cm diameter or less 1.
- Abdominal radical trachelectomy (ART) provides a broader resection of the parametria than the vaginal approach and is commonly used in stage IB1 lesions 1.
Post-Treatment Care and Follow-Up
Following excision, the tissue is sent for histopathological examination to confirm diagnosis and ensure complete removal.
- Post-procedure care includes abstaining from sexual intercourse and tampons for 2-4 weeks, and patients may experience mild cramping and vaginal discharge.
- Follow-up involves regular Pap smears and colposcopy at 4-6 months initially, then annually for at least 2 years to monitor for recurrence. The NCCN guidelines provide a comprehensive approach to the management of cervical adenoma, prioritizing fertility-sparing treatment options and emphasizing the importance of careful patient selection and post-treatment follow-up 1.
From the Research
Cervical Adenoma Algorithm
- The diagnosis of cervical adenoma involves a combination of clinical evaluation, imaging, and biopsy results 2.
- Fine-needle aspiration biopsy is a safe and accurate method for evaluating cervical adenopathy, with a diagnostic accuracy of 96% 2.
- The algorithm for cervical adenoma diagnosis and treatment involves:
- Initial evaluation with fine-needle aspiration biopsy to determine the presence of malignant or benign cells 2.
- Imaging studies, such as MRI, to assess the extent of the disease and guide treatment decisions 3.
- Surgical treatment, which may include open hysterectomy, sentinel node biopsy, or radical pelvic lymphadenectomy, depending on the stage and extent of the disease 3, 4.
- Radiochemotherapy, including external-beam radiotherapy and brachytherapy, for patients with locally advanced cervical cancer 5, 3.
- The choice of treatment depends on the stage and extent of the disease, as well as the patient's overall health and preferences 5, 3, 4.
- Recent studies have highlighted the importance of tailored treatment approaches, including less radical procedures for selected patients, lymph node staging, and fertility preservation 4.
- The use of fine-needle aspiration histological biopsy has been shown to be a reliable and highly accurate examination method for discriminating between malignant and benign thyroid nodules and enlarged cervical lymph nodes 6.