How do you approach adjuvant treatment for node positive high grade gastric type endocervical adenocarcinoma following radical hysterectomy?

Gastric-type endocervical adenocarcinoma (GEA) was first recognized as a distinct histologic subtype of cervical adenocarcinoma in 2020 by the World Health Organization. Adenocarcinomas account for approximately 25% of newly diagnosed cervical cancer cases worldwide, with GEA comprising around 10% of this total burden. In Japan, GEA comprises 20-25% of all adenocarcinomas and is much higher than Western populations.

Unlike typical cervical adenocarcinoma, GEA is not secondary to HPV infection. The histologic spectrum ranges from the bland low-grade appearance of minimal deviation adenocarcinomas to those with more dysplastic changes. Cytologic screening can be challenging, and since tumors often are located high in the endocervical canal, d...