Clinical applicability of microarray technology in the diagnosis, prognostic stratification, treatment and clinical surveillance of cervical adenocarcinoma

Invasive cervical cancer is a common problem worldwide and while rates of squamous cell carcinoma of the cervix (SCC) have been declining with the implementation of community screening programs, adenocarcinoma of the cervix (ADC) has not shown a similar response to screening. At this time, the two entities are tested for and treated with the same clinical algorithms, namely gynecologic cytology and molecular testing for HPV DNA. However, ADC arises more proximally within the cervical canal and frequently occurs below the superficial mucosal lining, precluding it from being easily diagnosed with cytologic examination. Furthermore, ADC has a more aggressive course than SCC and is significantly less responsive to radiotherapy. These factors combine to produce a lesion that is diagnosed at a higher stage and has an overall poorer prognosis than SCC. While both lesions have pathogenic origins with the high-risk species of Human papilloma viruses (HPV), the high association of ADC with HPV 18, a virus with a higher genome integration rate, suggests that the transformation pathway of ADC differs from SCC. Modern methods of molecular analysis can produce gene expression profiles of various cell types and preliminary studies have shown that SCC and ADC do, indeed, produce a distinct genetic signature and can be reproducibly segregated. This technology has promise for clinical applicability in the diagnosis, the prognostic stratification, formation of a treatment care plan and post-therapeutic monitoring of ADC.