Clinical Evaluation and Treatment of Unexpected Invasive Cervical Cancer Found at Simple Hysterectomy

Yoon, Jae Hee; Lee, Seon Kyung

Abstract

OBJECTIVE
The objective of this study was to analyze the clinical aspects, the problems in diagnstic process, proper complimentary treatment of invasive cervical cancer found after simple hysterectomy.
METHODS
From February 1990 till December 2003, of the 2013 patients who underwent simple hysterectomy at Departments of Obstetrics and Gynecology, College of Medicine, Kyung Hee University, 4 cases who were able to be followed up with the pathological diagnosis of invasive cervical cancer, were picked. One patient transferred to KHMC of a recurrence at the vaginal stump after vaginal hysterectomy performed at a nearby clinic was chosen. The archives of the 5 patients were analyzed.
RESULTS
Of the 5 cases, 2 were treated with whole-pelvis external radiation for 6 weeks. The follow-up periods after radiotherapy were after 5 months and 48 months, and they are both disease-free and are in satisfactory health conditions. The patients who underwent simple hysterectomy and received re-operations, one case after one month, and the other after 2 months in case 2 and 3, showed negative results in the biopsy and the follow-up periods after the operation were 12 months and 42 months, maintaining healthy conditions. The patient in case 5 who received pelvic exenteration after additional staging operations and 7 cycles of chemotherapy done after whole-pelvis external radiation/intracavitary radiotherapy for 6 weeks after simple hysterectomy, showed negative biopsy results and is currently being followed up at the outpatient clinic.
CONCLUSION
To prevent for invasive cervical cancer diagnosed pathologically after simple hysterectomy, a variety of complimentary tests should be performed and thorough step-by-step pre-operative exams should be emphasized as in the well-established diagnostic guidelines. Invasive lesions as more than post-operative stage Ia2 found after simple hysterectomy need much more aggressive supportive treatment. But between pelvic irradiation and secondary radical re-operation, which treatment is advisable is not yet concluded. Therefore, the treatment should be chosen case-by-case according to the patient's condition.