Abstract
Purpose: To evaluate patients with carcinoma of cervical stump (CCS) and analyse different clinico-pathologic factors affect prognosis. Patients and Methods: This study was carried out through review of clinical records of patients. Recorded data included information on age, tumor stage, presenting symptoms, size of tumor, histopathology, grade, type, cause of subtotal hysterectomy (STH), treatment and follow-up results. Staging according to International Federation of Gynecology and Obstetrics (FIGO) staging system was done through: PHYSICAL examination, pelvic examination under anaesthesia, chest X-ray, magnetic resonance imaging (MRI) of the abdomen and pelvis, cystoscopy, rectosigmoidoscopy and intravenous pyelography. Prognostic factors as age, size of tumor, stage, lymph node (LN) involvement, pathological type, grade and type of CCS either true or coincidental were analysed through multivariate analysis. Results: 62% of patients are above 50 years with stage II in 48.7%. Squamous cell carcinoma was more common but 54% are of GIII. 89% were true CCS. Positive lymph nodes were reported in 27%. The predominant reason for STH was abnormal bleeding (73%). In about 95% of cases, women seeked medical attention because of symptoms and the most common presenting symptom was bleeding (54%). According to the stage and performance status of patients, treatment consisted of radiotherapy either external or interstitial, chemotherapy and chemoradiotherapy. Through multivariate analysis, the following was found to have adverse impact on survival: Coincidental type (P = 0.04), high grade (P = 0.03), advanced stage (P = 0.01), larger tumor size (P = 0.02), lymph node involvement (P = 0.029) and older age (P = 0.035). While pathological type was not (P = 0.52). After median follow-up of 52 months; 5-year overall survival was 65%. Conclusion: CCS has a low morbidity. Adverse survival outcomes can be anticipated in those patients with: high grade lesions, advanced stages, large tumor size, coincidental type, older age and positive lymph node involvement.
Highlights
Sparing the cervix at time of hysterectomy which called subtotal hysterectomy (STH) was carried out in the past in order to reduce surgical complications as blood loss, vaginal vault prolapse, enterocele, ureteral injuries and vaginal cuff abscess [1]
The aim of this study is to retrospectively review patients with cervical stump (CCS) as regard age, clinical stage, histopathology, treatment and survival, to determine clinico-pathologic factors which are prognostic for patients with CCS
According to the stage and performance status of patients, treatment consisted of radiotherapy either external or interstitial, chemotherapy and chemoradiotherapy
Summary
Sparing the cervix at time of hysterectomy which called subtotal hysterectomy (STH) was carried out in the past in order to reduce surgical complications as blood loss, vaginal vault prolapse, enterocele, ureteral injuries and vaginal cuff abscess [1]. It was suggested that the retaining cervix reduce the adverse effect on psychosexual behavior of the patients. The retaining cervix carries the risk of developing cervical stump symptoms as vaginal bleeding, pelvic pain and cervical malignancy. Carcinoma of cervical stump (CCS) has been divided into: 1) Coincidental cases, when detected within 2 years after hysterectomy suggesting presence of pre-existing disease that not recognized at time of surgery; 2) True cases, when detected later than 2 years and considered to arise de novo [1]. The aim of this study is to retrospectively review patients with CCS as regard age, clinical stage, histopathology, treatment and survival, to determine clinico-pathologic factors which are prognostic for patients with CCS
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