Cervical cancer associated with genital prolapse -a brief review of the literature and long-term results of successful treatment with radiochemotherapy and surgery in a very frail patient

Background: A case of cervical cancer associated with irreducible procidentia successfully treated with external beam radiation and extracorporeal HDR-AL with concomitant chemotherapy followed by obliterative vaginal surgery is reported for the first time. Case: A 73-year-old woman presented in frail condition suffering from a huge, irreducible uterovaginal procidentia combined with a squamous cell carcinoma of the cervix in FIGO Stage IIa. Successful treatment consisted of sequential application of combined radiotherapy with concur-rent cisplatin chemotherapy followed by total vaginal hysterectomy and partial colpectomy with colpocleisis according to the Labhardt method. The five-year follow-up documents the excellent long-term results with regard to cervical cancer and pelvic floor stability. Conclusion: Especially in patients ineligible for extended surgery, radiochemotherapy followed by an obliterative surgical approach is feasible without aberrant wound healing and constitutes a suitable and efficient option for treating carcinomas of the cervix associated with irreducible genital prolapse.

Cervical cancer; Procidentia; Squamous cell carcinoma

[1] Bump R.C., Norton P.A.: “Epidemiology and natural history of pelvic floor dysfunction”. Obstet. Gynecol. Clin. North. Am., 1998, 25, 723.

[2] Tindall V.R. (ed.) “Jeffcoate’s Principles of Gynecology”, 5th edition, London, Butterworth and Heinemann, 1987.

[3] da Silva B.B., Da Costa Araujo R., Filho C.P., Melo Ja.: “Carcinoma of the cervix in association with uterine prolapse”. Gynecol. Oncol., 2002, 84, 349.

[4] Kiss E.: “Karzinom der prolabierten Portio”. Wien Med Wochenschr., 1966, 116, 1079.

[5] Chowdhury N.R.: “Cancer of the cervix associated with genital prolapse”. Indian J Cancer., 1967, 4, 147.

[6] Karateke A., Tugrul S., Yakut Y., Gurbuz A., Cam C.: “Management of a case of primary vaginal cancer with irreducible massive uterine prolapse-a case report”. Eur. J. Gynaecol. Oncol., 2006, 27, 528.

[7] Iavazzo C., Vorgias G., Vecchini G., Katsoulis M., Akrivos T.: “Vaginal carcinoma in a completely prolapsed uterus. A case report”. Arch. Gynecol. Obstet., 2007, 275, 503.

[8] Schraub S., Sun X.S., Maingon P.H., Horiot J.C., Daly N., Keiling R. et al.: “Cervical and vaginal cancer associated with pessary use”. Cancer, 1992, 69, 2505.

[9] Kriplani A., Relan S., Kumar L., Biswal B.M., Rath G.K.: “Incarcerated procidentia: A rare complication of carcinoma cervix”. Aust. NZ J. Obstet. Gynaecol., 1995, 35, 463.

[10] Landoni F., Maneo A., Colombo A., Placa F., Milani R., Perego P. et al.: “Randomised study of radical surgery versus radiotherapy for Stage Ib-IIa cervical cancer”. Lancet, 1997, 350, 535.

[11] Dunst J., Hansgen G.: “Radio- und Radiochemotherapie beim Zervixkarzinom”. Onkologe, 2001, 7, 854.

[12] Mitra S.: “Extraperitoneal lymphadenectomy and radical vaginal hysterectomy for cancer of the cervix”. Am. J. Obstet. Gynecol., 1959, 78, 191.

[13] Sudhakar A.S., Reddi V.G., Schein M., Gerst P.H.: “Bilateral hydroureter and hydronephrosis causing renal failure due to a procidentia uteri: a case report”. Int. Surg., 2001, 86, 173.

[14] Mueller-Heubach E.: “Prolapsus uteri causing hydronephrosis”. J. Am. Geriatr. Soc., 1969, 17, 1055.