Carcinoma of the cervix: present status and future.

The incidence of invasive carcinoma of the cervix is decreasing in Puerto Rico and Continental U.S.A. This appears to be related to improvements in socioeconomic level and adequate utilization of the Pap smear in the population. Mortality from carcinoma of the cervix has shown a 60% reduction in the last 20 years. Most likely this is related to the observed reduction in the incidence of the invasive forms of the disease, earlier diagnosis, and improvements in therapy. Optimal therapy of the clinically evident invasive forms of the disease is a combination of external irradiation and intracavitary brachytherapy. Surgery would be of value for specific clinical situations as an adjuvant to irradiation (barrel-shaped types), in post-irradiation recurrences, inadequate brachytherapy, etc. The yield in terms of survival and disease-free status in the pelvis is high for the early stages of the disease (approximately 90% 5-year survival and 97% control of pelvic tumor for stage I), but stage IIIB and IV cases show a failure rate of close to 50% or more in the irradiated volume and a high incidence of metastases to the para-aortic nodes and elsewhere.