Uterine Prolapse Complicated by Vaginal Cancer: A Case Report and Literature Review

Abstract

Primary vaginal cancer is not common, representing 1-2% of all female genital malignancies. We present a case of a third-degree uterine prolapse complicated by an isolated primary vaginal cancer and its surgical treatment. The cervix was clinically normal, but on the nearby prolapsed vaginal wall, a large exogenous hard lesion had developed. A biopsy of the lesion revealed a squamous carcinoma. The patient was asymptomatic and had no recurrence during the last 4 years of follow-up after surgical treatment with radiotherapy. The surgical treatment with or without radiotherapy is the optimum treatment for uterine prolapse with early-stage vaginal squamous cell carcinoma, although the majority of vaginal malignancies are treated with radiotherapy. We recommend always performing a biopsy prior to surgery in prolapse-induced ulceration.

Primary Vulvo-Vaginal Cancers: Trends in Incidence and Mortality in Poland (1999-2012)

“…However, proven risk factors of vaginal cancer are as follows: low socioeconomic status, abnormal cervical smear, chronic vaginitis, HPV infection and exposure to radiation (especially if it occurs before 45 years of age). Pelvic organ prolapse as a result of changes in vaginal biomedical properties can also increase the risk of vaginal cancer [9,10]. Pessaries, the second most common treatment chosen by women with pelvic organ prolapse, can be responsible for chronic vaginitis, a proven risk factor of vaginal cancer [11].…”

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

“…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].…”

“…There are no clear treatment recommendations in combined POP and primary vaginal cancer. When the early stage primary vaginal cancer is combined with POP, surgery becomes the first option instead of RT to cure primary disease and also to restore the anatomy [4,5,6,7,8,11,12,13]. Interstitial BT is another treatment option for medically inoperable patients with early-stage disease [19].…”

“…Vaginal trauma, chronic irritation, and inflammation of the vaginal mucosa can cause primary vaginal cancer in patients with POP [3]. However, a combination of POP and primary vaginal or cervical cancer is an extremely rare entity [4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19].…”

Vaginal cancer in patient presenting with advanced pelvic organ prolapse: case report and literature review

“…4,5 A comprehensive review of the available English language literature reveals only 7 case reports and 1 case series (6 patients) of primary vaginal cancer associated with pelvic organ prolapse (Table 1). 4,[6][7][8][9][10][11][12] Conversely, finding an erosion of the vaginal mucosa in a postmenopausal woman in the setting of treatment for pelvic organ prolapse is not uncommon. This finding may be present with or without the use of a vaginal pessary and warrants very close monitoring.…”