The Influence of Syphilis in Cancer of the Cervix Uteri

The problem of the influence of syphilis upon the neoplastic process in general has not been solved. Some investigators, on the one hand, have ascribed to syphilis an etiological role. Others deny any relationship betwcen the two diseases. The consensus of opinion (2), however, is that an inter-relation exists between the two in the case of carcinoma of the buccal cavity, though the mode of interaction is not known. In addition to a causative role is the influence that syphilis may exert on thc clinical course of a tumor through the personal equation involved or through some alteration in the pathology of the disease. Regardless of the lack of objective data bearing upon this subject there is a widespread impression among radiologists that when cancer appears in a syphilitic patient the prognosis is very much less favorable than in the absence of a spirochetal infection. In a recent article Rosh (5) has summarized the opinion of radiologists as follows: "We may state at this point, that patients who had a previous syphilitic infection show a tendency to earlier recurrence. It is our impression that this applies to the untreated syphilitic as well as to the treated ones, particularly in the younger age groups." To a lesser degree the opinion is held among pathologists and clinicians that cancer is more highly malignant in the syphilitic patient. Black ( i ) concluded that "A final possibility is that in leaving syphilis untreated during the treatment of cancer the prognosis may be worsened, but I do not know of any evidence to this effect." Recently Schrader (6) reported 47 cases of cervical cancer occurring in women with positive serology for syphilis, a group representing approximately 4 per cent of his total series. In this group of 47 only 7 had had adequate antiluetic therapy. He concluded that syphilitic women, with or without adequate antisyphilitic therapy, respond poorly to radiation treatment and suggested that radiation morbidity from such causes as bladder and rectal distress and anemia is greater than in those free from syphilis. The following investigation was undertaken to study this problem, using data obtained at the time a positive diagnosis of cervical uterine cancer was made. The symptoms, physical findings, and histopathology have all been tabulated and considered. No attempt has been made to include the results of treatment as this aspect will be dealt with in full at a later date. The data available do not give reliable information on the treatment given for syphilis in the 7 cases which had been diagnosed prior to the diagnosis of cancer. Three of them had rcceived known efficient treatment for a period of 4 and 5 years. Unfortunately the question of leukoplakia and condylomas preceding the development of carcinoma in this series cannot be answered from our records.