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Keywords:

  • adenocarcinoma;
  • cervical cancer;
  • human papillomavirus

Paper Presentation

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  2. Paper Presentation

Background

Worldwide efforts to reduce cervical cancer have been successful with the development and implementation of the cervical cancer/human papillomavirus vaccine. Success has been noted throughout the United States in the reduction in squamous cell cervical cancers, those that account for approximately 75% to 80% of all cervical cancers. However, the rate of adenocarcinoma has risen, notably in young women of reproductive age.

Case

M.L. is a 24-year-old female who telephoned her obstetrician complaining of break through bleeding on her oral contraceptive pill. While many healthcare providers typically reassure their patients, this provider brought the patient in for an exam. On exam, the physician discovered a small mass protruding from the internal os of her cervix. Surprised by this finding, the physician took a small biopsy and noted that the patient had always had all normal cervical cytology screenings. The healthcare provider was suspicious as it did not appear to be a cervical polyp. Pathology returned adenocarcinoma. The patient was immediately referred to the gynecologic oncology practice. Upon arrival, a full pelvic exam was performed, and the patient was sent for a chest, abdomen, and pelvic CT scan and scheduled for a radical hysterectomy. The CT scan revealed a sizable tumor around her cervix with measureable nodes along the iliac chain. She underwent surgery, recovered, and began a traditional course of chemotherapy for cervical cancer: Paclitaxel and Carboplatin every 21 days for six courses. Premedication was given with each course and patient was sent home with antiemetic therapy. The patient did well, completed chemotherapy, and was sent for complete pelvic radiation as she had residual lymph nodes. Two weeks into the radiation, she telephoned the office with severe abdominal pain. The nurse practitioner triaged the patient, examined her, and she was admitted for dehydration and a CT scan. The CT scan revealed severe lymph node invasion with pelvic seeding. Radiation was stopped and the patient was placed on palliation second line chemotherapy of Topotecan for comfort care. Hospice was consulted.

Conclusion

Adenocarcinoma is a particularly challenging cancer to treat. If not caught early, the disease can spread sporadically in the abdominal and pelvic cavity. Typical treatment options for microinvasive disease are large conization procedures with conservative follow-up or hysterectomy. Invasive adenocarcinoma as presented above has high rates of morbidity and mortality.