Surveillance for Recurrent Cancers and Vaginal Epithelial Lesions in Patients With Invasive Cervical Cancer After Hysterectomy

Abstract

Our results indicate that women with cervical cancer are at an increased risk of VAIN besides recurrence, and women with cervical SCC are more prone to high-grade VAIN/recurrence, especially within the first two years after hysterectomy. The significantly increased detection rate of VAINs/recurrence in the hrHPV-positive group suggests vaginal cytology and HPV cotesting might be the preferred method for surveillance in these women.

Risk of vaginal cancer among hysterectomised women with cervical intraepithelial neoplasia: a population‐based national cohort study

“…Previous studies show conflicting results regarding the risk of vaginal cancer if a woman has CIN. [3][4][5]14,15,[24][25][26][27][28][29] Also, smaller studies analysing vaginal cancer risk as an effect of time after diagnosis of CIN show conflicting results. 2,4,10,14 Women with CIN3 history run a higher risk of vaginal, vulvar and anal cancer, confirming that the HPV infection is a connecting link between these cancer types.…”

Clinical presentation, treatment and outcome of vaginal intraepithelial neoplasia

“…The risk is especially high after hysterectomy because of high-grade CIN or cervical cancer. Li et al showed a 15 % rate of VAIN in 147 patients treated for invasive cervical carcinoma [13]. The risk was 54.5 % (6/11) in patients with HR-HPV detection compared with 16.7 % (6/36) in HR-HPV negative women.…”

Should we search for high-risk HPV in vaginal vault Pap smear after hysterectomy due to CIN2+?

“…Every year about 13,000 women are diagnosed with cervical cancer, half of them being diagnosed with Stage I disease [1]. Recently, the algorithm for the diagnosis of cervical cancer has changed, mostly due to the introduction of co-testing with both cytology and high-risk HPV (hrHPV) in women over 30 years of age [2]. This has been recommended by all major cervical cancer screening societies throughout the globe, as well as the Portuguese Society for cervical cancer screening [3][4][5][6][7].…”

“…This has been recommended by all major cervical cancer screening societies throughout the globe, as well as the Portuguese Society for cervical cancer screening [3][4][5][6][7]. The appropriate treatment for women with early stage cervical cancer consists of total or radical hysterectomy with pelvic lymphadenectomy and radiation, providing these patients with a five-year survival rate that exceeds 90% [2]. The scar left on the vaginal vault after hysterectomy is a site with increased risk for vaginal cancer, and therefore the Society for Gynecologic Oncology (SGO) and the American College of Obstetricians and Gynecologists (ACOG) recommend physical examination and annual cytologic surveillance for 20 years after hysterectomy for cervical intraepithelial neoplasia grade 2+ (CIN2+) [8,9].…”

“…This was based on data collected from long-term follow-up studies in this population of women, which showed an elevated rate of invasive disease when compared with the general population until at least 20 years after treatment [5]. This surveillance can also be important in the early diagnosis of local recurrences, present in 10% to 20% of cases, and which respond to salvage treatments with potential cure [2].…”