Cervical carcinoma in the setting of uterovaginal prolapse: comparing standard versus tailored management

Abstract

Objectives: Cervical cancer in the setting of uterovaginal prolapse is exceedingly rare. Altered anatomy can complicate treatment of underlying cancer. We first present a rare case of cervical cancer with invasion of uterovaginal prolapse as well as a systematic review of similar reported cases in the literature. The objective of this study was to compare the practice patterns and outcomes regarding cervical cancer with invasion of procidentia. Methods:We conducted a systematic search of online databases (PubMed, Embase, Medline and the Cochrane Library) from 1990 to 2018 of all the cases of cervical cancer associated with stage III-IV uterovaginal prolapse. Patient demographics, pathology, surgical management, chemotherapy, radiation and disease-free survival were compared. Results:Fifteen reported cases of cervical cancer in the setting of procidentia were identified (squamous cell carcinoma-14, clear cell carcinoma-1). The mean age at diagnosis was 74 years (range 54-89). Thirteen percent (n = 2) of cases presented with FIGO stage I disease, 67% (n = 10) with stage II, and 20% (n = 3) with stage III. All cases had stage III-IV uterovaginal prolapse. 73% (11) were treated surgically including nine patients who underwent vaginal hysterectomy. Among patients who underwent primary surgery, 7% (1) received adjuvant chemotherapy, 33% (5) adjuvant radiotherapy and 21% (3) both adjuvant chemotherapy and radiation. 33% (5) of surgical cases included procedures to address the pelvic organ prolapse (colpoclesis (n = 3), uterosacral suspension (n = 1) and anterior posterior repair (n = 1)). Two patients died from the disease within 12 months, one patient died from other causes within 1 month, and the remainder of patients were free of disease at last reported follow-up (Table 1). Conclusions:Cervical cancer in the setting of stage III-IV uterovaginal prolapse can be managed successfully with standard treatment strategies (primary surgery with adjuvant therapy as necessary versus chemoradiation). When patients are surgical candidates, techniques to address the underlying prolapse can be used for symptomatic improvement.

Twenty years’ experience of primary vaginal cancer treatment at one cancer centre: does residence status matter?

“…The low survival rate of patients with advanced stage of vaginal cancer is attributed to the lack of effective treatment for this category of patients in our setting. Thus, given the limited options for patients with recurrent and metastatic cervical cancer, which is similar in nature to vaginal cancer, Kahn et al [19] recommend considering the possibility of immunotherapy with pembrolizumab in PD-L1-positive patients. Few studies have examined the role of residence in diagnosis and treatment outcomes in patients with cervical cancer, which is the closest in aetiology to vaginal cancer and other cancers [10][11][12][13].…”

Challenges in Diagnosis and Treatment of a Cervical Carcinoma Complicated by Genital Prolapse

“…Reduction of the prolapse facilitated the radiotherapy treatment and minimized the risk of visceral injury due to radiation. Although in most cases reported vaginal hysterectomy with bilateral iliopelvic lymphadenectomy has been performed prior to additional treatment, a more conservative approach might be beneficial in cases of severe comorbidity similar to our patient [ 14 , 15 ].…”

Chemoradiotherapy in a patient with locally advanced small cell neuroendocrine carcinoma of the cervix complicated by pelvic organ prolapse: A case report

“…Treatment for cervical cancer in the setting of a uterine prolapse varies widely across literature. Most reported cases suggest acceptable clinical and functional outcomes with a radical vaginal hysterectomy with bilateral pelvic lymphadenectomy followed by adjuvant chemoradiation ( Kahn et al, 2020 ). Matsuo et al reported potentially better outcomes following surgery-based treatment with a 5-year survival of 77% compared to 68% in patients receiving RT alone ( Matsuo et al, 2015 ).…”

“…On the other hand, the peak incidence of symptomatic POP occurs between ages 70 and 79 years ( Barber and Maher, 2013 ). A review by Kahn et al identified 15 cases of cervical cancer with uterine prolapse between 1990 and 2017, 14 of which had squamous cell carcinoma (SCC) and 1 had clear cell adenocarcinoma ( Kahn et al, 2020 ). The mean age was 74 years (range 54–89), reflecting the typical age predilection of POP.…”