Cullimore, John Edward; (1991) Prospects for primary and secondary prevention of cervical adenocarcinoma. Doctoral thesis (M.D), UCL (University College London).

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Abstract

This thesis comprises a portfolio of reports examining various aspects of the aetiology, diagnosis, treatment and pathogenesis of Cervical Intraepithelial Glandular Neoplasia. (CIGN), a putative precursor of cervical adenocarcinoma. The first is a multicentre case control study of risk factors for CIGN. This employed a standard questionnaire concerning lifestyle, reproductive, sexual and contraceptive factors and a serum assay for the presence of neutralising antibodies to herpes virus. The risk factor profile obtained for CIGN indicates that it has characteristics of a sexually transmitted disease, manifestation of the disorder possibly being dependent on an altered reproductive/endocrine milieu, as indicated by associations with late onset of menarche and low parity. There was no evidence in support of an association between CIGN and oral contraceptives. With respect to identification of a possible infective agent, the study fails to provide clear evidence of an association between either HSV-1 or HSV-2 and CIGN. The second study is a multicentre prospective assessment of the effectiveness of cone biopsy as primary therapy for CIGN. Regular cytological examination was employed as a means of follow-up. Preliminary results indicate that following cone biopsy, further surgery is unnecessary when the margins of the specimen are free of atypical epithelium. To date there are no cases of residual CIGN or invasive disease in subjects so managed. The final study employs the AgNOR technique to assess the possible presence of zones of poorly recognised epithelial atypia adjacent to adenocarcinoma-in-situ/high grade CIGN. The results give no support to the presence of such areas, and thus provide further experimental support for the validity of conisation as adequate primary treatment of CIGN.

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