Cervical Cancer Relapse After Total Hysterectomy: Case Report

Introduction Successful treatment of locally recurrent cervical cancer after pelvic exenteration surgery. Case Presentation A cervical biopsy of a 34-year-old woman revealed a diagnosis of squamous cell carcinoma, G2. MRI scan results indicated stage T2a N1 carcinoma. The patient underwent a total laparoscopic radical hysterectomy with lymphadenectomy. The risk of relapse assessment indicated adjuvant chemotherapy and radiotherapy. 5 months following the completion of the treatment, the patient began experiencing heavy yellow vaginal discharge and general malaise. A palpable solid mass was found in the right side of the vaginal stump. The findings from ultrasound examination demonstrated heterogenous mass with central necrosis infiltrating the right vaginal wall adjacent to the urinary bladder. The proximal rectum and distal sigmoid colon were also involved. A pelvic MRI scan confirmed cancer recurrence, and a biopsy of the vaginal mass identified squamous cell carcinoma, G3. A full-body PET-CT scan detected a 4.8 x 4.4 cm metabolically active local cervical cancer relapse without evidence of metastasis. A laparotomy and total pelvic exenteration were performed, including vaginectomy, bilateral adnexectomy, low anterior resection of the rectum and cystectomy, followed by the creation of an enterocolostomy and urostomy. Pathological examination of the mass confirmed stage T3b carcinoma with complete histologic margins. Discussion Cervical cancer is the 4th most commonly diagnosed cancer among women [1]. In Europe it accounts approximately 2,5% of all newly diagnosed oncological diseases a year [2]. The five-year survival rates are varying remarkably depending on the country and ranging from 54% to 80% [3]. Cervical cancer recurrences mostly appear in two-years time post-treatment. However, the overall survival rates after cervical carcinoma relapse are low with only 50,5% of the patients surviving more than two-years [4]. Conclusions Ongoing monitoring and intervention strategies are of vital importance for cervical cancer patients, particularly during early years following the treatment completion.