Prevention of cervical and endometrial carcinomas: the part of surgery

Epidemiology and natural history of cervical and endometrial carcinomas ale not identical So, he part of surgery in their prevention is different. For cervical carcinoma mass screening and prevention allowed reduction of rates of incidence and mortality. Surgery concerns such intra-epithelial neoplasias. All the procedures, either destructive, either ablative, expose to failures as recurrence of intra-epithelial neoplasia and more as invasive carcinoma For high grade epidermoid intra-epithelial neoplasia, conisation is the best of ablative procedeures to set up an acurate pathologic diagnosis and consequently to determine adequate therapy : conservative by conisation, total hysterectomy or extended hysterectomy and lymphadenectomy. For in situ adenocarcinoma, removal of the whole cervix or total hysterectomy appears in numerous circumstances more safety. For endometrial carcinoma, there is no efficious screening nor secondary prevention procedure available. Natural history specially pre-invasive disease, is not well known. Atypical hyperplasia is a real pre-invasive desease and evolve to invasive carcinoma in 25 %, and no more than 25 % of this lesions regress under progestative therapy Destructive procedures, biopsic-curetage and even endometrectomy under hysteroscopy don't realise and efficious treatment of atypical hyperplasia and prevention of carcinoma. Total hysterectomy is the only one true prevention of endometrial carcinoma after failure of progestative therapy for patients who desire be pregnant, in first place for women who don't.