Long term follow up of women after hysterectomy with a history of pre‐invasive cancer of the cervix

Abstract

Objective A long term review of women after hysterectomy with a history of pre‐invasive carcinoma of the cervix. Design 193 women had cervical intra‐epithelial neoplasia and two had adenocarcinoma in situ either at hysterectomy or at previous cone biopsy. These were followed up by annual cytology. Setting South Glamorgan Health Authority. Subjects Of 195 women who had a hysterectomy, 143 have been followed up cytologically for more than 10 years and 43 for more than 20 years: a total of 2800 women years of experience. Main outcome measures Timing of abnormal smears. Results A detailed reviw of the five women with abnormal smears. The estimated percentage of women who remain negative is 98% at five years, 98.4%, at 10 years and 96.5 % at 20 years. Conclusion Cytological screening ofall women who had a hysterectomy with a history of CIN is indicated for the first two years after hysterectomy. Thereafter the estimated incidence of 0.7 per 1000 women years is higher than the general population but it is not a sufficient reason to screen more frequently. We recommend screening for the carcinoma of the vagina to be every three years which is the same screening frequency as for cervical carcinoma in the general population.

Surveillance for Recurrent Cancers and Vaginal Epithelial Lesions in Patients With Invasive Cervical Cancer After Hysterectomy

“…7 However, limited data suggest that women who have had a hysterectomy for cervical cancer or CINs may be at an increased risk of local recurrent cancer or VAIN in up to 5% to 10% of cases. [15][16][17][18][19][20] Although the five-year survival rate for stage I cervical cancer exceeds 90%, local recurrence rates are high, ranging from 10% to 20%. 21,22 Since patients with locally recurrent disease can be offered salvage treatments with the potential for cure, the SGO and the ACOG recommend review of symptoms and physical examination every three to six months for the first two years and a yearly Pap smear to detect local recurrence and preinvasive disease.…”

“…14 However, women who have had a hysterectomy for cervical cancer or CINs may be at an increased risk of vaginal cancer based on several reports that found VAINs in approximately 5% to 10% of women hysterectomized due to cervical carcinoma. [15][16][17][18][19][20] More than 12,000 women are diagnosed with cervical cancer each year in the United States, and 50% of them have stage I disease. 21 The primary treatment options for stage I disease include radical hysterectomy with pelvic lymph node dissection, radiation, and chemotherapy, with the five-year survival rate exceeding 90%.…”

American Cancer Society, American Society for Colposcopy and Cervical Pathology, and American Society for Clinical Pathology Screening Guidelines for the Prevention and Early Detection of Cervical Cancer

“…124 In a study of 193 women with CIN at hysterectomy, the incidence of abnormal vaginal cuff cytology at least 2 years after hysterectomy was 0.7 per 1,000; at 20 years, 96.5% of the women continued to have normal cytology. 125 Thus, even if women with hysterectomy were at an increased risk of vaginal cancer, there is no proven method to effectively intervene before vaginal cancer develops.…”

American Cancer Society, American Society for Colposcopy and Cervical Pathology, and American Society for Clinical Pathology Screening Guidelines for the Prevention and Early Detection of Cervical Cancer

“…125 Thus, even if women with hysterectomy were at an increased risk of vaginal cancer, there is no proven method to effectively intervene before vaginal cancer develops.…”