Carcinoma Of Cervical Stump Research Articles

Advanced cervical stump cancer after laparoscopic subtotal hysterectomy: a case report of imaging, laparoscopic staging and treatment approach

BackgroundAdvanced cancer of the cervical stump, occurring years after a laparoscopic supracervical hysterectomy (LASH), is a rare but serious clinical condition. Many patients who undergo a LASH are unaware of this possible complication. Upon diagnosis of advanced cervical stump cancer, a holistic approach including imaging, laparoscopic surgery and multimodal oncological therapy is required.Case presentationA 58-year-old patient presented to our department with the suspicion of advanced cervical stump cancer eight years after LASH. She reported pelvic pain, irregular vaginal bleedings and irregular discharge. Gynaecological examination revealed a locally advanced tumor of the uterine cervix with suspicion of infiltration of the left parametria and bladder. After thorough diagnostic imaging and laparoscopic staging, the tumor stage was determined as FIGO IIIB and the patient was treated with combined radiochemotherapy. The patient presented with tumor recurrence 5 months after the completion of therapy and she is currently being treated with multichemotherapy and immunotherapy regimens as palliative treatment.ConclusionPatients should be made aware about the risk of cervical stump carcinoma after LASH and the necessity for regular screening. Cervical cancer after LASH is often diagnosed at advanced stages and the treatment requires an interdisciplinary approach.

Characteristics, complications, and outcomes of early-stage cervical stump carcinoma: laparoscopy versus laparotomy.

ObjectiveTo compare the characteristics, surgical complications, and overall survival between patients undergoing laparoscopy versus laparotomy for treatment of early-stage cervical stump carcinoma.MethodsPatients with International Federation of Gynecology and Obstetrics (FIGO, 2009) stage IA2 to IIA2 cervical stump carcinoma who underwent laparoscopy or laparotomy in the Obstetrics and Gynecology Hospital of Fudan University from January 2000 to June 2018 were retrospectively reviewed. All patients’ clinical characteristics, pathological features, complications, and follow-up data were retrieved.ResultsSeventy-two patients were included in the analysis; 58 underwent laparoscopy and 14 underwent laparotomy. With respect to surgical complications, laparoscopy was associated with a significantly lower complication rate, less blood loss, a shorter operative time, and a higher hospitalization fee than laparotomy. Survival was not significantly different between the laparoscopy and laparotomy groups.ConclusionsAlthough survival was not significantly different between the two surgical approaches, the rate of surgical complications was much lower in the laparoscopy than laparotomy group.

Analysis of the poor prognostic factors affecting 48 cases of cervical stump carcinoma

Objective To explore the poor prognostic factors of patients with cervical stump carcinoma, aiming to provide certain reference for the clinical diagnosis and treatment. Methods Clinical data of 48 patients with cervical stump carcinoma admitted to the Affiliated Tumor Hospital of Xinjiang Medical University from January 1, 2005 to December 1, 2016 were retrospectively analyzed. A total of 19 patients (40%) withⅠA-ⅡA stage cervical stump carcinoma were treated with surgery+ adjuvant therapy and 29 patients (60%) in ⅡB-Ⅳ stage received radiotherapy combined with chemotherapy. The median age of onset was 51 years old. Uterine fibroids were the main cause of subtotal hysterectomy. The average time interval from subtotal hysterectomy to definite diagnosis was 10.76 years. Results The 1-, 3-, 5-year survival rate was 98%, 83% and 74%, respectively. Univariate analysis demonstrated the time interval from subtotal hysterectomy (P=0.016), tumor diameter (P=0.016), clinical stage (P=0.036), histological grade (P=0.009), lymph node metastasis (P=0.044), parametrial invasion (P=0.046), myelosuppression (P=0.013) and radical surgery (P=0.019) were the poor prognostic factors of cervical stump carcinoma. Conclusions Poor prognosis of patients with cervical stump carcinoma is correlated with tumor diameter, clinical stage, histological grade, lymph node metastasis, parametrial invasion and myelosuppression. Histological grade is an independent risk factor. Key words: Cervical stump; Malignant neoplasm/radiochemotherapy; Prognosis

Retrospective analysis of surgery for cervical stump carcinoma at early stage.

Cervical stump cancer is a rare type of disease as total hysterectomies are performed infrequently. The purpose of this retrospective study was to assess the diagnosis, treatment, follow-up methods and complications of 10 patients with cervical stump carcinoma treated with surgery in Anhui Provincial Hospital affiliated to Anhui Medical University (Hefei, China). From January 2006 to October 2016 a total of 10 patients underwent surgery for carcinoma of the cervical stump. The pathological reports revealed 80% of cases were squamous cell carcinoma and 20% of cases were adenocarcinoma. The FIGO stage distribution was as follows: Carcinoma in situ (10%); IB1 (70%); IIA (20%). The patients received a transvaginal trachelectomy or a radical trachelectomy and pelvic lymphadenectomy (either laparoscopic or laparotomic abdominal); four of the patients were treated with adjuvant chemotherapy, and two with concurrent chemoradiotherapy. The parametrial and resection margin infiltration, lymph node metastasis and lymph vascular space invasion (LVSI) were negative in all patients, and the deep stromal invasion rate was 66.7% (6/9). No incidences of recurrence or mortality were recorded during the follow-up interval of 6-120 months. Compared with the four patients who received laparotomic abdominal surgery, significantly less blood loss was recorded for the five patients who underwent laparoscopic surgery (P<0.01). There was no significant difference observed in the surgery time (P>0.01) or in the hospital stay duration (P>0.01) for the patients treated with laparotomic abdominal surgery and laparoscopic surgery. One patient experienced bladder fistula due to bladder over-dilation, but recovered quickly after the catheter was reinserted. Surgery for cervical stump cancer at an early-stage is a viable and safer procedure, particularly the laparoscopic approach.

Estado actual del tratamiento del carcinoma cérvico uterino

Histerectomía total con resección de un tercio de la vagina y el parametrio, con o sin ooforectomía bilateral, se recomienda para el Estado "0" del carcinoma epidermoide de cuello uterino. En el Estado de que la medida terapéutica depende de la respuesta de sensibilización (SR) que indican si la cirugía o la radiación deben ser uso. lf cirugía está indicada, se debe realizar histerectomía total radical con disección de los ganglios. La radioterapia es el método de elección para el Estado II, excepto en thouse casos en los que hay un pobre "respuesta a la radiación" (RR). Histerectomía radical con disección de los ganglios debe ser el tratamiento en los casos quirúrgicos de este grupo. No tenemos ninguna duda de que la evaluación citológica mediante el "SR" y respuestas "RR" es una gran ayuda en la selección del tratamiento. En el Estado III y IV, la radiación es el método de elección. Si la recidiva se produce después de la radioterapia exenteración pélvica debe contemplarse. En el carcinoma de muñón cervical de la cirugía es el tratamiento de elección. En el embarazo el tratamiento es en relación con la viabilidad del feto, y el grado del desarrollo de tumor. En el carcinoma de fundus lo que indicaría wheather cirugía o radiación.

Carcinoma of the cervical stump. A case report and literature review.

Subtotal hysterectomy for benign uterine disease was a common surgical procedure in the past decades. Keeping in place the uterine cervix predisposes to late complications such as cervico-vaginal prolapse, chronic cervicitis or even malignant transformations of the cervical stump. We present the case of a 56 year old patient who was submitted to subtotal hysterectomy for a large uterine fibroma 4 years before and who presented vaginal bleeding and pelvic pain. She was diagnosed with cervical stump carcinoma and a radical resection including trachelectomy with pelvic and para-aortic lymph node dissection was performed. The histopathological studies revealed a well differentiated squamous cell cervical cancer.

Survival and Prognostic Factors in Patients with Carcinoma of Cervical Stump

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.

Carcinoma of the cervical stump--multicenter study

Cervix-sparing hysterectomy due to benign conditions remains controversial, especially when the presumed risk of cervical cancer in the retained cervical stump is concerned. On the other hand, supracervical hysterectomy is associated with shorter operative time, decreased blood loss and decreased intraoperative complications. Moreover, beneficial effects of retaining the cervix on the pelvic statics and female psychosexual functioning have been suggested, although not yet proven. The aim of the study was to determine the frequency and types of cervical cancers in the retained cervical stump after supracervical hysterectomy performed due to benign diseases of the uterine corpus in four academic settings. Retrospective review of medical records of 903 women who underwent treatment due to cervical carcinoma in four departments participating in the study: Centre 1- 2nd Department of Gynecology, Medical University Lublin (years: 2001- 2011); Centre 2- Department of Gynecology and Gynecologic Oncology, Military Institute of Medicine, Warsaw (years: 2002-2012); Centre 3- Katedra i Kliniki Poloźnictwa, Chorób Kobiecych i Ginekologii Onkologicznej II Wydziału Lekarskiego WUM, Warsaw (years: 2008-2013) and Centre 4- Department of Gynecologic Oncology, Poznań University of Medical Sciences, (years: 2000-2012). The occurrence rate of cervical stump carcinoma was reported in relation to patient age, time elapsed between supracervical hysterectomy and diagnosis stump cancer and histological type of cancer. Only 3 cases of cervical stump carcinoma (0.33%) were identified among the 903 investigated women. In all these cases, cervical stump cancers were diagnosed several years after supracervical hysterectomy. In one case the only treatment was radiotherapy in one case only trachelectomy was performed, whereas in one case surgery followed by radiotherapy was used. It should be remembered that subtotal hysterectomy carries a risk, albeit relatively low, of developing stump cancer. Therefore, patients should be informed that after such operation further cervical cancer screening is mandatory. Moreover subtotal hysterectomy should not be offered in populations at risk of developing cancer of the uterine cervix.

Study of the radiotherapy modality for patients with stage IIb-IIIb cervical stump cancer

To investigate the radiotherapy modality progress of stageIIb-IIIb cervical stump cancer. The clinical data of 13 patients with stageIIb-IIIb cervical stump cancer undergoing radiotherapy from January 2000 to April 2012 was reviewed. Before 2006, 8 patients received conventional external beam radiotherapy and brachytherapy.Since 2006, 5 patients received intensity-modulated radiotherapy (IMRT) and brachytherapy. The median survival was 12-139 months. The median overall survivals and disease free survivals in the conventional radiotherapy (CRT) group were 57 months and 50 months, 3 cases of them recurred during 8-19 months and died of tumor progression.While, the median overall survivals and disease free survival in the IMRT group both were 21 months and nobody recurred. In the CRT group, 7 patients suffered toxicities, including 5 patients grade I-II acute rectum reaction, 2 patients grade I bladder reaction; and 3 had grade I-III, late rectum reaction, 2 patients for grade II bladder late reaction.In the IMRT group, toxicities including 1 case grade I acute or late rectum reaction, and no bladder reaction. In our experience, the recommended IMRT and interstitial brachytherapy for the selected patients with advanced cervical stump carcinoma may be obtain better tumor dose distribution and more sparing of the organ at risk.

O270 Applicable precautions for prevention of cervical stump carcinoma: An Egyptian experience

O270 Applicable precautions for prevention of cervical stump carcinoma: An Egyptian experience

Laparoscopic radical trachelectomy or parametrectomy and pelvic and para-aortic lymphadenectomy for cervical or vaginal stump carcinoma: report of six cases

The aim of this study was to investigate the feasibility and safety of laparoscopic radical parametrectomy and pelvic and para-aortic lymphadenectomy after previous supracervical or extrafascial hysterectomy. This is a prospective study of six patients with vaginal or cervical stump carcinoma after previous supracervical or extrafascial hysterectomy. The technique of radical parametrectomy with pelvic and para-aortic lymphadenectomy as used for open surgical cases for years was performed laparoscopically. The average operating time was 180 min, the estimated average blood loss was 220 mL, and the duration of hospitalization was 11.8 days. There was no intraoperative or postoperative complication. Laparoscopic radical parametrectomy with pelvic and para-aortic lymphadenectomy for cervical or vaginal stump carcinoma can be successfully and safely accomplished.

Hysterectomy for benign gynaecological disease

Hysterectomy, the commonest major gynaecological operation, is the only definitive cure for dysfunctional uterine bleeding, rates highest in satisfaction scores compared with other treatments, and improves quality of life. Although research indicates that vaginal hysterectomy is safer and cheaper than total abdominal hysterectomy, the latter still accounts for 60–80% of all hysterectomies in the UK and the USA, and at least 95% of these are total rather than subtotal. Although recent research also shows that subtotal hysterectomy confers no advantages over the total procedure, with respect to pelvic organ function, subtotal hysterectomy is the quicker and safer operation, and the risk of cervical stump carcinoma in a woman who has previously had normal smears is negligible. Overall mortality rates from hysterectomy are 0.5–2 per 1000, and rates of visceral damage are 0.5–2%. Complications are most common in women treated for uterine fibroids, and overall rates decrease with increasing age of women. Cost-effective analysis shows hysterectomy to be an effective and cost-effective intervention across a variety of indications. Conservative alternatives to hysterectomy, including endometrial ablative techniques, the Mirena intrauterine system (IUS), and uterine artery embolization for fibroids, have not yet greatly reduced hysterectomy rates, which vary widely between regions, and within the same geographical area. A major challenge is to establish the reasons for this variation in rates.

Endometriotic cyst after subtotal abdominal hysterectomy mimicking carcinoma of the cervical stump

Endometriotic cyst after subtotal abdominal hysterectomy mimicking carcinoma of the cervical stump

Maternal and Perinatal Outcome of Massive Postpartum Hemorrage: A Review of 33 Cases

Postpartum hemorrhage is a significant contributor to maternal morbidity and mortality. We evaluated maternal and perinatal outcome of primary massive postpartum hemorrhage. In a restrospective case analysis of 33 women with intractable postpartum hemorrhage initially managed either by hysterectomy or a conservative approach in a tertiary referral center between January 1, 1991 to December 30, 1998, we reviewed the procedures used as a primary or secondary attempt to arrest the hemorrhage. Medical and surgical measures were successful in controlling hemorrhage in 21 (63.6%) of the 33 women. Hemorrhage was successfully arrested by conservative surgery in 13 cases, and by medical management in 8 cases. Emergency hysterectomy was performed in 12 cases (0.7 per 1000 deliveries) No maternal deaths occurred, but there were 2 early neonatal deaths (6.1 %). Atony of the uterus was the main cause of hemorrhage (n=15). Genital tract laceration was associated with a worse prognosis, but the time lapse between delivery and surgery appears to be the main prognostic factor. Uterine atony and morbid adherent placenta are major causes of massive obstetric hemorrhage. In our series, morbidity was high, but there was no mortality. Obstetricians should identify women at risk which is especially associated with a prior cesarean delivery, a current placenta previa and high parity. Early intervention and proper procedure could minimize the complications.

Cervical stump carcinoma following subtotal hysterectomy

(2002). Cervical stump carcinoma following subtotal hysterectomy. Journal of Obstetrics and Gynaecology: Vol. 22, No. 6, pp. 701-701.

Histologic subtype has minor importance for overall survival in patients with adenocarcinoma of the uterine cervix: a population-based study of prognostic factors in 505 patients with nonsquamous cell carcinomas of the cervix.

The incidence of adenocarcinoma of the uterine cervix is increasing. For better prognostic information, the authors studied all nonsquamous cell carcinomas (non-SCCs) in the Norwegian population over a total of 15 years. All non-SCCs from three 5-year periods (1966-1970, 1976-1980, and 1986-1990) were reviewed and classified according to the World Health Organization classification system, and histopathologic and clinical parameters were registered. Tissue blocks were available from all patients. Of 505 patients, 417 had tumors classified as adenocarcinoma, and 88 had tumors classified as other non-SCC. The mean ages were 53 years and 52 years for patients with adenocarcinoma and non-SCC, respectively. Sixty-two percent of the staged patients had clinical Stage I disease according to the classification system of the International Federation of Gynecology and Obstetrics (FIGO). In univariate analyses, histology, architectural and nuclear grade, extension to the vagina or corpus uteri, tumor length (> 20 mm) or tumor volume (> 3000 mm(3)), infiltration depth (in thirds of the cervical wall), thickness of the remaining wall (< 3 mm), vascular invasion, lymph node metastases, treatment, and patient age were significant variables in patients with FIGO Stage I disease. Variables with no significance in patients with Stage I disease were number of mitoses, state of resection margins, infiltration to ectocervix, tumor thickness, lymphoid reaction, earlier or concomitant cervical intraepithelial neoplasia, stump carcinoma, DNA ploidy or DNA index, or time period. Multivariate analyses of patients with FIGO Stage I disease identified small cell carcinoma, corpus infiltration, vascular invasion, and positive lymph nodes as independent prognostic factors. Small cell carcinoma was the only histologic subgroup of independent importance for prognosis in patients with non-SCC of the uterine cervix. No significant difference between major subtypes of adenocarcinoma favored a simplified classification. Extension to the corpus in patients with early-stage disease was of independent significance and should be acknowledged in planning treatment.

Outcome following subtotal hysterectomy

Approximately 20% of women in the United Kingdom have a hysterectomy by the age of 60 years for various reasons, usually a total hysterectomy. This modern hysterectomy was introduced in order to prevent the occurrence of cervical stump carcinoma. The incidence of cervical stump carcinoma is low and with the advent of Papanicolaou smears have been negligible. Many gynecologists and patients worldwide have questioned the routine removal of the benign cervix, as the argument for conserving the cervix is less disturbance to bladder, bowel and sexual function. This study was undertaken to review the long-term outcome after subtotal hysterectomy.

Cervical conservation: the future of hysterectomy?

Objective There has been much debate about the place of subtotal hysterectomy in gynaecological practice. With the more widespread introduction of the laparoscopic approach to cervical conservation, this issue has once again been brought into prime focus. We have reviewed the currently available literature in an attempt to present a balanced summary of the evidence encompassing both laparoscopic and conventional subtotal hysterectomy. Method Papers were identified using Current Contents (clinical medicine) and the Index Medicus (Medline). Various outcomes were examined, in particular cervical stump carcinoma, sexual function, urinary function, psychic health and operative complications. Conclusion The risk of carcinoma of the stump is very low and techniques to remove the transformation zone may all but eliminate this risk. There appears not to be any long‐term statistically significant difference between total and subtotal hysterectomy with respect to sexual function, urinary function or psychic health. Comparisons between different operative techniques are lacking; however operative complications involving the urinary tract and postoperative sepsis are less common with cervical conservation. With improvements in laparoscopic technique, this modality of surgery appears to be as safe as conventional surgery with particular benefits evident for the supracervical approach.

Sonographic and Histological Morphometry of the Uterine Cervix—An Assessment of Laparoscopic and Other lntrafascial Hysterectomy Techniques

New abdominal and vaginal hysterectomy techniques, such as classic intrafascial serrated edged macro-morcellator (SEMM) hysterectomy (CISH), by pelviscopy/laparoscopy or laparotomy, and intrafascial vaginal hysterectomy (IVH), are both essentially supravaginal techniques. It has been claimed that they give a prophylaxis against cervical stump carcinoma by coring out the cervix with the SEMM. We set out to answer two questions: 1) How can vaginosonography help to choose an adequate SEMM diameter so that the cervical mucosa and transformation zone are completely removed, and 2) How often do cervical glands remain after the coring out procedure? We were able to show a good correlation between sonographic and histological morphology by giant and serial sections. In 253 CISH operations, resection of both endocervix and transformation zone was complete in 92.9%. Dysplasias were always removed completely; only 18 cervical cores exhibited healthy glands (retention cysts) in the resection margin. Therefore, CISH procedures should be able to prevent most of the cervical stump carcinomata that follow traditional supravaginal hysterectomy, but only long-term follow-up will give the final proof.

Laparoscopic and Other Intrafascial Hysterectomy Techniques or Mucosal Ablation—A Choice for Maximum Organ Conservation

The operative methods of total uterine mucosal ablation (TUMA) as well as new abdominal and vaginal hysterectomy techniques are described. Classic intrafascial serrated edged macro-morcellator (SEMM) hysterectomy (CISH) by pelviscopy or laparotomy and intrafascial vaginal hysterectomy (IVH) are techniques that allow the nerve and the blood supply of the pelvic floor to remain intact, mainly because only the ascending branches of the uterine arteries are ligated. TUMA avoids the removal of the uterus altogether and is reserved for hypermenorrhea or menorrhagia without major enlargement of the uterus. Both CISH and IVH reduce the physical trauma of hysterectomy considerably and have the advantages of the supravaginal technique. Prophylaxis against cervical stump carcinoma is assured by coring out the cervix with the SEMM. In patients in whom both procedures are possible, IVH is preferred because it combines the minimal trauma and short operative time of vaginal hysterectomy. The decreased diameter of the cervix after coring out greatly simplifies this type of vaginal hysterectomy, the technique that has always been favored because of its short operative times and minimal trauma.