The Incidence of Vaginal Fistulae in Patients with Carcinoma of the Cervix

Abstract

In dealing with such a fatal disease as carcinoma, radical measures are considered justifiable if the procedures selected give the patient the best chance of a cure or a reasonable chance of benefit, even though some unfortunate sequelae may result. This is equally true in surgery and in irradiation therapy. In carcinoma of the uterine cervix, which makes up 20 to 30 per cent (1) of all carcinoma in women, vaginal fistula is one of the unfortunate sequelae. The discomfort of the afflicted patient tends to distort the individual physician9s impression of the frequency of occurrence. Rulle (2) has pointed out that neither the incidence of vesicovaginal fistula nor the time of appearance is entirely dependent upon the dosage of radium used. Behney (3) found the incidence less in treated than in untreated patients, but used only women with advanced disease for the comparison. The wide variation in the figures of various authors, from Beckmann9s 6 per cent (7) to Williams9 38 per cent (6), suggests that the type of therapy plays a part. The question has been asked, “How frequently do vaginal fistulae occur at Memorial Hospital following irradiation therapy for carcinoma of the cervix?” This report is an attempt to answer that question. It is based on a study of the records of 2,852 patients, proved by biopsy to have carcinoma of the cervix, who have been treated by irradiation at Memorial Hospital from 1916 to 1932, inclusive. All patients included have been carefully observed, through a thorough follow-up system, until death, or, if living, are still under frequent observation. A group of 96 cases considered too advanced to benefit by irradiation when they first appeared at Memorial Hospital, and which therefore received no irradiation, has been used for comparison.