Challenges in Diagnosis and Treatment of a Cervical Carcinom
Cervical squamous cell carcinoma and pelvic organ prolapse (POP) are individually considered common events in women of advanced age. However, the concurrence of complete uterine procidentia and cervical cancer is scarcely encountered, mainly in elderly women from low-income countries. The exact incidence of uterine cervical cancer associated with uterine prolapse is unknown. The reported prevalence (0.14-1%) is primarily based on sporadic case reports. In most of these cases, however, the pathophysiologic association of these entities was discussed, mainly focusing on modes of treatment. An 81-year-old postmenopausal woman presented to the outpatient department with an ulcerated irreducible uterine procidentia. The prolapse was reduced under general anesthesia and a biopsy of the lesions confirmed a cervical squamous cell carcinoma. Pretreatment clinical staging revealed a 16 cm enlarged uterus and mild to moderate unilateral hydroureteronephrosis, secondary to periureteric infiltration, clinical-stage IIIB. The patient was disqualified from surgery, and palliative chemotherapy plus radiotherapy was recommended. The patient's general condition has rapidly deteriorated, and three months after the diagnosis, the patient passed away. Therapeutic management of cervical cancer associated with uterovaginal prolapse is not well established. Hence, this article presents the clinical concerns that arise in such rare and neglected cases.