To the Editor: A 77-year-old woman with a past history of five pregnancies, five births, and cardiac arrhythmias with atrial fibrillation was admitted through the gynecology clinic with a chief complaint of postmenopausal vaginal bleeding for 1 month. She had not ever undergone a Papanicolaou test. On physical examination, the gynecologist found complete prolapse of her uterus and a large mass (~6 × 6 cm) arising from the posterior uterine cervix and extending to the posterior vagina. The cervical mass was biopsied, and pathology revealed squamous cell carcinoma. She had anemia (hemoglobin 9.2 g/dL). Magnetic resonance imaging (MRI) of the pelvis (Figure 1A, B) and magnetic resonance urography (MRU) of the abdomen (Figure 1C) revealed a large lobular mass at the posterior cervix of the completely prolapsed uterus, cystorectocele, mild right hydroureteronephrosis, and moderate chronic left obstructive uropathy with moderate left hydroureteronephrosis. A regional lymphadenopathy was also noted at the left side of the pelvis. The clinical staging statuses of the cervical cancer were International Federation of Gynaecology and Obstetrics Stage IIB and cT2bN1M0 (T, primary tumor; N, regional lymph node; M, metastasis). She underwent total excision of the cervical cancer. The final pathological diagnosis was condylomatous squamous cell carcinoma of the uterine cervix with pathological staging status pT1b2. Postoperative tomoradiotherapy (intensity-modulated radiation therapy) was then undertaken with a delivery dose of 6,000 cGy in 30 fractions to the pelvis. In follow-up, the gynecologist managed her uterine prolapse using a pessary. Pelvic organ prolapse (POP), the descent of one or more female pelvic organs or compartments, mainly including the urinary bladder, uterus, and vagina, occurs more commonly in older women than younger.1-4 Development of POP is multifactorial as the result of failure of the support maintained by interaction of the levator ani muscles (pelvic floor muscles), the vagina, and the connective tissues and stretching injury of the pudendal nerve causing loss of the normal muscle tone of levator ani during vaginal delivery.1, 4 Vaginal childbirth, older age, higher body mass index, menopause, and low socioeconomic status are the generally accepted risk factors for POP.1, 2, 4 Other risk or predisposing factors include ethnicity (e.g., Hispanic), high intra-abdominal pressure (chronic cough, chronic lung disease, straining with chronic constipation, repeated heavy lifting), obstetric history (current pregnancy, previous prolonged labor, instrumental delivery, episiotomy, increased parity, birth weight), and previous surgery (hysterectomy, previous prolapse surgery).2, 4 Baden-Walker (Grades 0–4) and pelvic organ prolapse quantification (Stages 0–IV) are the two main systems for staging the severity of POP.2, 4 The former is a simple clinical method, whereas the latter is a complicated quantitative method that is highly reliable and involves several measurements.4, 5 Some studies have shown a linear association between uterine prolapse and age and a positive association between cystocele and rectocele and age up to sixth decade and then negative association with older age.3 The coincidence of uterine prolapse and cervical cancer is uncommon and usually happens in underdeveloped countries and in older women, although uterine prolapse and cervical cancer are not rare.6-8 The assumption that displacement of the uterine cervix from the natural environment of the vagina may decrease the neoplastic process of viral infection explains the lower risk of cervical cancer in uterine prolapse,6, 7 although the continual injury of the cervical epithelium may cause neoplasm.7 MRI along with MRU is a necessary noninvasive, nonionizing technique in evaluation of uterine prolapse associated with cervical cancer. Radiographic assessment is unnecessary for simple POP.2 The best treatment for cervical cancer associated with complete uterine prolapse has not been determined. The standard curative principle of cervical cancer, including radical surgery plus adjuvant radiotherapy or radical radiotherapy for early stages and chemoradiotherapy for locally advanced cancers is probably applicable to cervical cancer associated with uterine prolapse,6, 7 but urethral obstruction and silent upper urinary tract obstruction often complicate genital prolapse.9 MRI with multiplanar images is useful for preoperative evaluation of the pelvic regional lymph nodes for tumor staging and silent upper urinary tract obstruction level for treatment planning of POP to avoid surgical complications.9 Uterine prolapse is usually associated with cystocele and rectocele. Tomoradiotherapy is better than conventional radiotherapy in lowering radiation toxicity at the urinary bladder and the rectum.10 The options of treatment for symptomatic POP include observation, pessary, and surgery.2, 4 Pessary use should be considered before surgery in symptomatic women.4 The surgical strategies for POP include reconstructive and obliterative techniques.2 Conflict of Interest: None. Author Contributions: Concept and design: Wing-Keung Cheung and Szu-Fen Huang. Acquisition of participants and data: Wing-Keung Cheung, Min-Po Ho. Analysis and interpretation of data: Wing-Keung Cheung, Min-Po Ho, Ming-Chow Wei, Pei-Wei Shueng, Szu-Fen Huang. Preparation of manuscript: Wing-Keung Cheung. Critical review and approval: All authors. Sponsor's Role: None.