Endometrial Cancer Occurring 27 Years after Radiation Therapy for Cervical Carcinoma
Mayumi Kobayashi *
Division of Gynecology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, 104-0045, Tokyo, Japan.
Shun-ichi Ikeda
Division of Gynecology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, 104-0045, Tokyo, Japan.
Mitsuya Ishikawa
Division of Gynecology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, 104-0045, Tokyo, Japan.
Hiroshi Yoshida
Department of Pathology and Clinical Laboratories, Pathology Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, 104-0045, Tokyo, Japan.
Reiko Watanabe
Department of Pathology and Clinical Laboratories, Pathology Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, 104-0045, Tokyo, Japan.
Tomoyasu Kato
Division of Gynecology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, 104-0045, Tokyo, Japan.
*Author to whom correspondence should be addressed.
Abstract
Aims: Endometrial cancer usually occurs after perimenopause and is associated with obesity, diabetes, hypertension, nulliparity, and anovulatory menstrual cycles. Abnormal vaginal bleeding is an early symptom of endometrial carcinoma. We describe our experience with a patient who had endometrial cancer that developed 27 years after radiation therapy for cervical carcinoma, without vaginal bleeding.
Presentation of Case: The patient was a 45-year-old woman with stage IIIB uterine cervical cancer who received radiation therapy. She presented with lower abdominal pain 27 years after treatment. Both transvaginal ultrasonography and magnetic resonance imaging showed a tumor within the uterus. Endometrial biopsy revealed endometrial adenocarcinoma. After placement of a double-J stent, abdominal total hysterectomy and bilateral salpingo-oophorectomy were performed.
Discussion and Conclusion: Our experience shows that endometrial carcinoma can develop 27 years after radiation therapy for cervical cancer. Moreover, patients who have endometrial cancer after radiation therapy might have no abnormal bleeding despite the presence of gross tumor because radiotherapy leads to stenosis and occlusion of the vagina and cervical canal. We should be aware that endometrial adenocarcinoma has an atypical course after radiation therapy; long-term observation is thus essential.
Keywords: Endometrial cancer, radiation therapy, uterine cervical cancer.