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From July, 1962, to January, 1974, 348 patients with invasive cervical cancer had evaluation, staging, and treatment with irradiation at the University of Kentucky Medical Center. Fifteen of these patients (4.5 per cent) developed enteric obstruction or fistula six to 30 months following therapy. The presence of pelvic inflammatory disease prior to therapy was associated with a significant (p < 0.001) increase in these complications, irrespective of patient age, parity, or vascular status. Small (<100 μ in diameter) serosal vessels in the large and small bowel were studied in nonirradiated patients who died with extensive pelvic infection and in age-matched control subjects. The incidence of serosal vessel endarteritis, fibrin thrombosis, and perivascular fibrosis were significantly more common in patients with pelvic inflammation. It is suggested that the localized reactive microangiopathy associated with pelvic inflammation may play an etiologic role in the development of enteric injury following radiation therapy for cervical cancer.

Cervical conization was performed on 756 patients at the University of Kentucky Medical Center from July 1, 1964, to January 1, 1973. Sixty-six patients were pregnant at the time of conization. Eighty-six per cent of patients with cytologic findings of carcinoma in situ had histologic verification of carcinoma in situ or severe dysplasia, and there was absolute correlation between cytology and histology in 75 per cent of patients with occult invasive cancer. Cervical biopsies without colposcopic direction predicted either severe dysplasia or carcinoma in situ in 77 per cent of cases but were accurate in only seven of 24 patients with occult invasive cancer. Carcinoma in situ was present in 30 per cent of hysterectomy specimens following conization but recurred in only seven per cent of patients followed without hysterectomy. Recurrent carcinoma in situ following hysterectomy was more common in patients with residual intraepithelial cancer in the uterus but was independent of the size of the vaginal cuff removed. Major postconization complications requiring hospitalization occurred in 3.4 per cent of nonpregnant patients and in 7.5 per cent of pregnant patients.

From July, 1962, to January, 1972, 271 patients with cervical cancer were evaluated, staged, and treated with radiation therapy at the University of Kentucky Medical Center. Six of these patients developed large bowel or bladder fistulas in the absence of recurrent tumor. Radiation-related bowel or bladder injury was found to occur more commonly in patients with pre-existing hypertension or diabetes mellitus. The pathophysiology of vascular disease as an etiologic factor in radiation complications is discussed.

Carcinoembryonic antigen (CEA) was elevated (>2.5 ng. per milliliter) in 29 of 100 patients with cervical intraepithelial neoplasia (CIN). CEA concentration was related to the amount of intraepithelial neoplasia and to the presence of glandular extension. Lymphoplasmacytic infiltration of tumor cells was unrelated to CEA levels. CEA values returned to normal within 8 weeks following surgery in 77 per cent of patients. A persistently elevated (>5.0 ng. per milliliter) plasma CEA value following conization was associated with residual CIN in the cervix. These results suggest that sequential CEA determinations may be of value in the follow-up of those cervical cancer patients who initially have high plasma antigen levels.

From July 1962, to January 1972, 271 cases of invasive cervical carcinoma were evaluated, staged, and treated by radiation therapy at the University of Kentucky Medical Center. The total tumor and paracervical dose varied from 7,000 to 9,000 rads, and 5,000 to 6,000 rads was delivered to the lateral pelvic walls. Within 6 to 60 months following therapy, 8 (2.9 per cent) of these patients developed small bowel obstruction in the absence of tumor. Surgical procedures were performed on 4 patients, and histologic examination of the resected bowel showed changes consistent with previous irradiation. All 271 patients were evaluated with respect to age, gravidity, height, weight, pretreatment hemoglobin, stage of disease, diabetes mellitus, and hypertension. In the population studied, the thin, diabetic, hypertensive patient was found to be particularly susceptible to the development of small bowel injury following radiation therapy for cervical carcinoma.