Cervical cancer complicating pelvic organ prolapse, and use of a pessary to restore anatomy for optimal radiation: A case report

Dawkins, Josette C.; Lewis, G.K.; Toy, Eugene P.

doi:10.1016/j.gore.2018.08.004

Cited by 16 publications

(20 citation statements)

References 8 publications

(16 reference statements)

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“…As for the modifications which might occur at the level of a procident uterine cervix, ulceration is a frequently encountered finding; however, in all such cases biopsy of this lesion is needed in order to exclude the presence of a synchronous malignant transformation (23).…”

Section: Discussionmentioning

confidence: 99%

Radical Hysterectomy for Cervical Cancer in Patients With Uterine Prolapse

Bacalbaşa

Hălmaciu

Crețoiu

et al. 2020

In Vivo

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Background/Aim: Association between cervical cancer and uterine prolapse represents a scarce eventuality. This is a case series of 11 patients diagnosed with different stages of cervical cancer in association with uterine prolapse. Patients and Methods: Between 2014 and 2020, 11 patients were diagnosed with cervical cancer on prolapsed uterine cervix. Results: The mean age of patients at the time of uterine cervix diagnosis was 68 years. In six cases, the first intent treatment was surgery, while in the remaining five cases it consisted of radio-chemotherapy, followed by radical surgery. The perioperative and postoperative outcomes were compared to those reported in a similar series of patients diagnosed in similar stages of the disease, but in the absence of uterine prolapse, no significant differences being encountered. Conclusion: Although it represents an unusual situation, malignant transformation of the uterine cervix might be encountered even in cases presenting uterine prolapse. In such cases, the therapeutic strategy should be tailored according to the stage of the disease. Chronic inflammation is widely accepted to be associated with the development of certain malignancies such as skin, liver or lung cancer (1). When it comes to cervical cancer patients, the relationship between chronic inflammation, malignant transformation, viral infection and uterine prolapse is a controversial one. Women presenting a complete uterine prolapse are predisposed to a long process of chronic inflammation and direct mechanical irritation of the prolapsed areas, increasing in this way the risks of cervical cancer development; therefore, in such cases, special attention should be given to this aspect, and the patients should be routinely submitted to more specific investigations, such as colposcopy, endocervical and exocervical examination, in order to achieve an early diagnosis of the neoplastic disease whenever it develops (1). Furthermore, virology studies have underlined the fact that the displacement of the uterine cervix in cases in which 2073 This article is freely accessible online.

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Section: Discussionmentioning

confidence: 99%

Radical Hysterectomy for Cervical Cancer in Patients With Uterine Prolapse

Bacalbaşa

Hălmaciu

Crețoiu

et al. 2020

In Vivo

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“…Estrogen receptor (ER) and progesterone receptor (PR) are present on the surface of hormone target cells and are mainly distributed in targets such as uterus and cervix. These can specifically bind to corresponding hormones and play a role in regulating the occurrence and development of cervical squamous epithelial lesions [8,9] . Ki67 is a relatively positive sign of nuclear proliferation.…”

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confidence: 99%

Correlation between ER, PR, P53, Ki67 Expression and High-Risk HPV Infection in Patients with Different Levels of Cervical Intraepithelial Neoplasia

Wang¹,

Jin²,

Ni³

et al. 2020

pharmaceutical-sciences

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Wang et al.: Correlation between ER, PR, P53, Ki67 Expression and High-risk HPV Infection To investigate the correlation between high-risk human papillomavirus infection and the expression of ER, PR, P53 and Ki67 in patients with different grades of cervical intraepithelial neoplasia. A retrospective study was conducted in which from June 2016 to June 2018, 140 specimens of cervical intraepithelial neoplasia were collected from the pathology department of the Beijing Tongren Hospital that included 40 specimens of cervical intraepithelial neoplasia1, 50 specimens of cervical intraepithelial neoplasia2 and 50 specimens of cervical intraepithelial neoplasia1. The expression of ER, PR, p53 and Ki67 were determined by immunohistochemistry. High-risk human papillomavirus infections were detected by polymerase chain reaction fluorescence quantification and were given the correlation analysis. Results of the 140 specimens indicated the rates of human papillomavirus16 and human papillomavirus18 in cervical intraepithelial neoplasia1 specimens were 27.5 and 25.0 % respectively, in cervical intraepithelial neoplasia2 specimens were 64.0 and 60.0 %, respectively and in cervical intraepithelial neoplasia3 specimens were 90.0 and 92.0 % respectively, the difference were statistically significant (p<0.05). There was no significant correlation between human papillomavirus 16 and human papillomavirus 18 positive rate and patient age, tissue differentiation, and tumour size. With the increasing cervical intraepithelial neoplasia grade, the rate of ER, PR, p53 and Ki67 expression in specimens was also increased significantly (p<0.05). Pearson correlation analysis showed there were positive correlation between the rates of human papillomavirus 16 and human papillomavirus 18 and the rates of ER, PR, p53 and Ki67 expression (p<0.05). In conclusion with increasing cervical intraepithelial neoplasia level, rate of high-risk human papillomavirus infection increased along with increased rate of expression of ER, PR, p53 and Ki67.

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“…Rarely, as seen in our patient, due to chronic irritation, primary vaginal cancer may develop secondary to prolonged POP. However, primary vaginal or cervical cancer and POP combination is rarely reported in the literature [4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19]. The increase in the incidence of both POP and primary vaginal cancer with advancing age makes this combination more frequent in elderly people [1].…”

Section: Discussionmentioning

confidence: 99%

“…However, using of pessary can also cause serious complications as bleeding and ulceration, and special care should be taken during this treatment [29]. Recently, Dawkins et al reported a case of 72-year-old woman with cervical cancer with POP, and she was treated with definitive CRT and BT [18]. Gelhorn pessary was placed and perineoplasty was performed before EBRT to reduce POP, and the authors reported no treatment-related side effects.…”

Section: Discussionmentioning

confidence: 99%

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Using a pessary during radiotherapy in reducible pelvic organ prolapse and vaginal cancer: a case report and review of the literature

Gültekin

Esen

Akgör

et al. 2020

jcb

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Purpose: Primary vaginal cancer and pelvic organ prolapse (POP) combination is extremely rare. Although definitive chemoradiotherapy (CRT) and brachytherapy (BT) is the standard treatment for advanced stage primary vaginal cancer, there is a limited data about the treatment of primary vaginal cancer combined with POP due to its rarity. In addition, radiotherapy (RT) process may be difficult in these cases and often result in more toxicity. Case presentation: In this case report, we present a 77-year-old woman with a diagnosis of primary vaginal cancer associated with POP, who was treated with definitive CRT using a pessary to restore vaginal anatomy for optimal radiation. Following CRT, complete response was observed and vaginal cuff BT was performed. The patient tolerated the treatment very well and is still alive without disease at 10-months follow-up. Conclusions: Combined primary vaginal cancer and POP is an extremely rare clinical entity, with only a few cases reported in the literature. When applying CRT in these cases, critical organ doses may be higher than expected due to the downward descent of the pelvic organs. Especially in elderly patients, a pessary can be used as a non-surgical procedure to restore the anatomy for symptom relief during definitive CRT. Additionally, it allows tumors to be targeted more precisely.

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Cervical cancer complicating pelvic organ prolapse, and use of a pessary to restore anatomy for optimal radiation: A case report

Cited by 16 publications

References 8 publications

Radical Hysterectomy for Cervical Cancer in Patients With Uterine Prolapse

Radical Hysterectomy for Cervical Cancer in Patients With Uterine Prolapse

Correlation between ER, PR, P53, Ki67 Expression and High-Risk HPV Infection in Patients with Different Levels of Cervical Intraepithelial Neoplasia

Using a pessary during radiotherapy in reducible pelvic organ prolapse and vaginal cancer: a case report and review of the literature

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