Salvage therapy in acute life-threatening vaginal bleeding of cervical cancer: Hypogastric artery embolization

Abstract

Cervical cancer is the second leading cause of death among women in the world [1]. Eighty percent of these deaths occur in developing countries with low socioeconomic status [2]. It is the ninth most common cancer among females in Turkey, with an incidence rate of 4.76 per 1000 [3], and it is a well-known fact that the most frequent cause of mortality in terminal-stage cervical cancer cases is bleeding and uremia. Vaginal bleeding usually progresses very rapidly and may result in death within a few hours either by secondary anemia and its complications or by hemorrhagic shock. Although ligation of the hypogastric artery is a standard procedure with proven efficacy in controlling massive bleeding in cervical carcinoma, in recent years, embolization has become a significant therapeutic option for the management of intractable hemorrhage in gynecologic malignancies because of its low mortality and morbidity rates [4]. In this report, we present a case of terminal-stage cervical cancer associated with massive vaginal bleeding, and we describe the beneficial effects of hypogastric artery embolization in the management of such bleeding. One year ago, a 56-year-old patient was admitted to our hospital with pelvic pain and spotting vaginal bleeding. The first gynecologic examination showed an exophytic tumor of the cervix measuring approximately 5 cm in diameter. Pathological examination of a cervical biopsy confirmed Grade 3 squamous cell carcinoma. On further evaluation, the tumor was found to extend to the pelvic wall and involve the bladder and rectum. FIGO (The International Federation of Gynecology and Obstetrics) staging of the tumor was Stage IVA. Cisplatin-based chemotherapy and external radiotherapy combined with brachytherapy was started immediately after diagnosis. There was no remarkable vaginal