One hundred and two patients were treated for primary adenocarcinoma of the uterine cervix over a ten-year period from 1973 to 1982. Of these, 51 patients underwent initial surgical management that included a pelvic and para-aortic lymphadenectomy with a radical hysterectomy or a surgical staging operation. Clinical lesion size, grade, and depth of stromal invasion were correlated with lymph node metastasis and survival. The incidence of positive lymph nodes was 14.6% for stage I and 40.0% for stage II. Positive lymph nodes were documented in none of 15 patients with lesions smaller than 2 cm, 16.7% (five of 30) with 2 to 4 cm, and 82.3% (five of six) with larger than 4 cm; 5.3% of grade 1 tumors, 11.1% of grade 2, and 50.0% of grade 3. There were no lymph node metastases (zero of six) in patients with a tumor that had a depth invasion of less than 2 mm, whereas positive nodes were found in 11.1%) (two of 18) patients with 2 to 5 mm of invasion, 28.6% (two of seven) with 5 to 10 mm, and 57.1% (four of seven) with greater than 10 mm of invasion. Five-year survival was 82.9% for stage I and 42.9% for stage II patients; 91.7% with negative lymph nodes, and 10% with positive nodes (P< .0001). The size of the primary tumor (P< .0001), tumor grade (P< .05), and depth of invasion (P< .05) correlated with patient survival. Large tumors (greater than 4 cm) of cervical adenocarcinoma and those of high tumor grade correlate with a high likelihood of pelvic and paraaortic lymph node metastasis. Conversely, no patient with small lesions (less than 2 cm) had lymph node metastasis, whereas one of these patients with a grade 3 lesion invasive to a depth of 5 mm recurred in the lung. Lesions of intermediate dimension (2 to 4 cm) were associated with lymph node metastases when high tumor grade or invasion greater than 5 mm was present. All but one patient with lymph node metastases died with distant metastases