Carcinoma of the Cervix Complicated by Complete Procidentia: Radiation Therapy

Abstract

Carcinoma occurring in the exposed cervix of procidentia offers an unusual opportunity to observe the effects of radiation therapy in cervical cancer. Although treatment of this rare combination has been mainly surgical, radiation therapy can be used advantageously in conjunction with surgery, or to supplant surgery when the local or the general condition of the patient contraindicates operation. Literature Seventy-eight cases of procidentia with carcinoma of the cervix are reported in the papers and related bibliographies of Andrews (1, 2), Basden (3), Brady (4), Bulman (5), Guthrie and Bache (6), Percival (7), Scheffey (8), Strauss (9), and Todd (10). An accurate analysis of these cases is difficult because in many of the published protocols much pertinent information is lacking. Some interesting data, however, can be summarized. Carcinoma of the cervix is present in about 0.14 per cent of cases of procidentia (Judd and Graves, quoted by Strauss, and Kimbrough's discussion of the paper by Scheffey). The age variation in the reported cases is between twenty-five and eighty-six years. Although over 50 per cent of the patients presented themselves for medical examination after the age of sixty, the procidentia occurred before the fiftieth year in most of them. The extremes of duration were two days and forty years. The number of pregnancies in an individual case ranged from none to fourteen. The amount of prolapse varied from partial exposure of the cervix to complete exteriorization of the uterus; the largest presenting tumor measured 9 inches in diameter. Microscopically, the biopsy specimens revealed epidermoid carcinoma in all except one case, which proved to be sarcoma. Surgical procedures—mainly total vaginal hysterectomy, extirpation, and amputation—were the only form of treatment before the advent of radiation therapy. Forty-seven of the cases were reported after the discovery of roentgen rays and radium, and 11 of these received radiation therapy alone or in conjunction with surgery (Table I). Since, however, the reports appeared shortly after the completion of treatment, accurate survival or “cure” rates cannot be obtained for the different forms of treatment. It would seem advisable, however, to combine radiation therapy with surgery whenever possible, with the knowledge that “cure” of the carcinoma and decrease in the procidentia have occurred after irradiation alone in some instances. In view of the relatively small number of such cases in the literature, the following history is presented. The patient was an elderly woman who responded favorably to radiation, which was the only treatment given. Case Report E. O., an 81-year-old white female, was admitted to the Gynecology Service on Nov. 4, 1941.