Aims: Breast cancer treatment may result in long-term upper limb morbidity: reduced range of motion of the shoulder, muscle weakness of the arm and hand, lymph edema, pain and numbness. Relationship of this late morbidity with activities of daily life (ADL) and quality of life (QOL) is infrequently described and the strength of this relationship is not clear. Methods: A systematic review was performed to evaluate the results of studies, analyzing late morbidity of breast cancer treatment in relationship with ADL and/or QOL. A literature search over the last 20 years (1980±2000) was performed in the databases MEDLINE, EMBASE, PSYCHLIT and CANCERLIT. Methodological quality of selected articles was assessed and additional, aspects of treatment related late morbidity and the relationship to ADL and/or QOL were summarized. Results: From the 1642 yielded articles 15 fulfilled our primary selection criteria. Only six articles could be selected due to the inappropriate methodological quality. There was high variation in prevalence of pain (12±51%), impairments in range of motion (2±51%), edema (6±43%) and decreased muscle strength (17±33%). Four articles reported significant relationships between late morbidity of the upper limb and perceived disabilities in ADL/QOL. The strength of these relationships was rather low. Conclusions: Few studies investigated the relationship between late morbidity of the upper limb after treatment of early breast cancer and ADL/QOL. Significant relationship between late morbidity and restrictions of daily activities and poorer QOL was reported, however, the strength of this relationship was rather low.

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Despite the available effective screening techniques, cervical cancer is the most common genital malignancy in Romania. In patients with isolated pelvic recurrence after radiotherapy, exenteration represents the only chance for curative treatment. We present the case of a 45-year-old patient with a massive pelvic tumour causing intensive, poorly controlled vaginal bleeding, bilateral hydronephrosis and chronic renal failure. She underwent total infralevatorian exenteration with vulvectomy. Postoperative recovery was uneventful, and she presented a good evolution in the two months following surgery. We consider pelvic exenteration as the last treatment option to cure irradiated pelvic tumour recurrences. CASE REPORTWe present the case of a 45-year-old patient who was diagnosed with stage IIB squamous cervical carcinoma, complaining of atypical vaginal bleeding. She was referred to chemo-radiotherapy with curative intent. After five years she relapsed, complaining of lower abdominal pain and vaginal bleeding. Transrectal ultrasound (Figure 1) and magnetic resonance scan revealed a tumor of 8 × 4 cm, invading the parametrium bilaterally, the urinary bladder, the rectum, vagina, distal urethra, and the right internal iliac vessels. No distant metastases were described. The patient developed bilateral hydronephrosis with a nonfunctional right kidney. In September 2016, the patient had been admitted for intensive vaginal bleeding in order to attempt hemostasis and for blood transfusions.