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

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.