Retrospective Analysis Of39Cases Of Cervical Stump Cancer Following Subtotal Hysterectomy

Background: Hysterectomy is the most commonly and the most basicperformed gynecologic operation for benign gynecologic diseases. Accordingto the extent of surgery, it is included total hysterectomy(referred to as) andsubtotal hysterectomy (referred to as SH). For the pros and cons of thesetwo procedures,there has been widespread controversy. TH that involvesremoving the body of the uterus and the cervix can be achieved by avoidingcervical stump cancer purposes. But the postoperative impact on women suchas pelvic floor dysfunction, ovarian failure and the decline of sexualsatisfaction has been getting attention in recent years. The biggest concernissue following SH is the risk of developing cancer on the cervical stump.Objective: To retrospectively analyze39cases of cervical stump cancerclinical data, investigate the incidence of cervical stump cancer, clinicalfeatures, pathological features、treatment、 causes and regulate medicalbehavior to prevent stump cancer from happening.Methods: A total of39patients who underwent subtotal hysterectomyfor benign disease were referred to the second hospital of Jilin university fortreatment of a histologically verified carcinoma of the cervical stump fromJanuary2007to November2013. Access to their clinical data in detail wereretrospectively analyzed. Results:1. In this study, the time interval between subtotal hysterectomy and thediagnosis of the neoplasm varied from15days to27years (median=7.5years).13cases (33.33%) is in less than two years,,26cases (66.67%) morethan2years. The age of patients ia from29to68years old, with an averageage of50.5years. Over the same period，736cases of cervical cancer weretreated, of which thirty-nine (3.85%) were in the cervical stump.2. In this study, five cases (12.82%) of the patients got married under theage of20,31cases (79.49%) between20-25years of age,2cases (5.13%)between25-30years of age, one case (2.56%) was unmarried,but hadsexual contact history. One case of all patients had no history of pregnancy,the remaining38patients had a history of pregnancy (97.44%). Most patientshad multiple pregnancy and prolific situation.3. The reasons for performing the subtotal hysterectomy: uterine fibroidsranks first, followed by endometriosis, dysfunctional uterine bleeding,endometrial atypical hyperplasia and so on.4. This study shows that the main symptoms of cervical stump canceris contact bleeding, irregular vaginal bleeding, vaginal discharge, othersymptoms such as abdominal pain and abdominal distension, etc.3cases hadno clinically symptoms and the cervical stump were smooth duringgynecological examination, accounting for7.69percent.5Among39stump cancer cases33were squamous cell carcinoma,3cases adenocarcinoma,3cases adeno-squamous carcinoma. Accordingto the International Obstetrics Union (FIGO2003) revised clinical stagingcriteria, three cases were classified as stage IA,12cases IB,12cases IIA,7cases IIB,1cases stage III, five cases is can not determine the originalstaging. Conclusion:1. The age distribution of cervical stump cancer patients is unimodal,the peak age is40to49years old. Squamous cell carcinoma is still the mostcommon histopathological type of cervical stump cancer, accounting for84.62%. The main clinical symptom of cervical stump cancer is contactbleeding, irregular vaginal bleeding and vaginal discharge. treatment ofcervical stump cancer is consistent with the general principles of cervicalcancer, giving priority to surgery and radiotherapy. But there are still itsparticularity, because pelvic organ anatomical relations have changed afterSH, cervical stump may adhere to the surrounding tissue,such as bowel,bladder and so on, increasing the difficulty of re-operation, as well asaffecting the chemotherapy and radiotherapy treatment effect because of theimpact of cervical stump blocking blood flow on ideal dose distribution.Either surgery or radiation therapy must be carefully treated individually.2. The reasons for the occurrence of cervical stump cancer are mainlypoor medical condition, non-standard diagnosis and treatments of physicianand lack of patients’ understanding to the disease.3. The prevention of cervical stump cancer is that should strictly controlindications for hysterectomy,routine gynecological examination and cervicalcytology virological testing should be carried out to exclude cervical lesionsbefore SH, which can effectively reduce the incidence of cervical cancer,especially hidden stump cancer. Remaining cervix should be checkedregularly,promptly found and treated.