Uterine prolapse complicated by endometrial cancer

An infrequent clinical dilemma arises when a patient with uterine prolapse that is best treated vaginally is discovered to have coexisting endometrial cancer. Often the underlying cancer is only discovered intraoperatively or postoperatively. We have reviewed our experience in this situation in an effort to evaluate efficacy of treatment, strategies to avoid late postoperative discovery of cancer, and general guidelines for optimal treatment.

At the Mayo Clinic from 1950 to 1993, 54 patients with coexisting endometrial carcinoma underwent vaginal hysterectomy with repairs for uterine prolapse.

We have retrospectively reviewed these cases for relevant data and survival analysis. Complete follow-up is available for 53 patients, and there were four recurrences. In 19 patients bilateral oophorectomy was not performed for multiple reasons, and one of these patients had a recurrence. Twenty-five percent of all patients had disease confined to the endometrium, and 80% overall had low-grade lesions with superficial or no myometrial invasion. Of the four recurrences, three would have been considered low risk of extrauterine spread, and it is doubtful that an abdominal approach would have yielded additional useful information. No patient required reoperation for recurrent pelvic relaxation.

We believe that for certain selected patients vaginal surgery for uterine prolapse is adequate treatment in the presence of endometrial cancer. We discuss the selection strategies, exclusion criteria, and general guidelines to optimize care for these challenging patients.