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A retrospective study of 164 women aged 45 and older undergoing colposcopy for abnormal Papanicolaou smears showed that 49% had adequate colposcopy and 51%, inadequate colposcopy. Of those with adequate colposcopy, 23% had positive endocervical curettage (ECC). That finding required conization, which detected one case of microinvasive and two of invasive cervical carcinoma. Of those with inadequate colposcopy, 64% had positive ECC. All patients with inadequate colposcopy underwent conization, which detected 4 cases of microinvasive and 11 of invasive carcinoma. Therefore, women with inadequate colposcopy had a higher risk of invasive disease. ECC is a necessary step in the colposcopic evaluation of elderly women.

Five hundred fifty-four patients with abnormal cytologic smears were screened in a special clinic by gynecology residents under faculty supervision using colposcopy and biopsies. Two hundred fifty patients who were evaluated by colposcopy subsequently had conization or hysterectomy. Colposcopically directed biopsies were accurate (comparable to the surgical specimen) in 92%. Three patients had invasive cancer high in the endocervical canal that was found by conization after endocervical curettage and colposcopy had indicated less-severe disease. Persistent or recurrent dysplasia was found in approximately 5% after conization and in none after hysterectomy. Because 23% of patients were lost to follow-up after treatment and an additional 19% had inadequate follow-up, management of CIN III with local destruction (cryocautery, electrocautery, laser) does not seem advisable.

The use of endocervical curettage was evaluated in 200 patients undergoing colposcopy, biopsy, endocervical curettage, and conization. It is suggested that endocervical curettage be performed only in cases of satisfactory colposcopy, since patients with unsatisfactory colposcopy should undergo conization.

Frozen section evaluation was done on 96 conization specimens. One patient had invasive carcinoma, which was correctly diagnosed on frozen section. No patient received inappropriate therapy on the basis of an erroneous diagnosis made from the evaluation of frozen sections. The mean time from initiation of surgery to the surgeon's receipt of the frozen section diagnosis was 0.9 hours. There was no significant increase in the blood loss or intraoperative complication rate when frozen conization was added to either abdominal or vaginal hysterectomy.

Fourteen patients with advanced or locally recurrent squamous cell carcinoma of the uterine cervix were treated with bleomycin, vincristine, and moderately high dose methotrexate with citrovorum rescue. Two patients (14%) had a partial response; no patient had a complete response. Two patients were felt to have significant bleomycin associated pulmonary toxicity. This chemotherapy regimen is not felt to be clinically useful in our patient population.

The authors reviewed 50 cases of carcinoma in situ of the vulva treated at the University of Texas Medical Branch, Galveston, from 1975 to 1984. Sixty-two percent of the patients were premenopausal. The most frequent complaint was vulvar itching. Twenty-six percent of the patients were asymptomatic. Recurrences were frequent (25%) and were associated with multifocal lesions, involved surgical margins and the bowenoid histologic type. Superficially invasive carcinoma was detected in 8% of patients, mostly postmenopausal women with simplex histologic types. Immunohistochemical studies failed to detect papillomavirus- or herpesvirus-associated antigens in any of the cases. Follow-up of 48 patients from six months to ten years revealed no mortality from invasive cancer.

The concentrations of testosterone (T), androstenedione (A), estradiol (E2), and estrone (E1) were measured in peripheral and ovarian venous serum obtained at the time of bilateral oophorectomy from 15 postmenopausal women with endometrial cancer and 9 without cancer. The cancer and noncancer (control) patients were matched for age, weight, and years since menopause. In women with endometrial cancer, significantly higher ovarian than peripheral venous concentrations were found for all hormones measured [T, 3781 +/- 1255 (+/- SE) vs. 213 +/- 43 pg/ml (P less than 0.01); A, 5352 +/- 1845 vs. 1299 +/- 187 pg/ml (P less than 0.04); E2, 52 +/- 11 vs. 23 +/- 3 pg/ml (P less than 0.02); E1, 81 +/- 12 vs. 32 +/- 2 pg/ml (P less than 0.001)], but in the control patients, only the concentration of T was significantly higher (623 +/- 108 vs. 156 +/- 21 pg/ml; P less than 0.001). Ovarian venous concentrations of T and A were significantly higher in thin women with cancer than in obese women with cancer. These results suggest that the ovaries of postmenopausal women with endometrial cancer secrete significantly more T and A than do the ovaries of women without cancer, while secreting only minimal amounts of E2 and E1. This increase in ovarian steroid secretion might play a role in the pathogenesis of endometrial cancer.