Cervical Cancer

The World Health Organization reports cervical cancer as the second largest cause of female cancer mortality worldwide with 288,000 deaths yearly. Roughly 510,000 cases of cervical cancer are reported each year with approximately 80% of these from developing countries. Human papilloma virus is a cause of cervical cancer with prevalence of approximately 630 million infections in the world.

Invasive cervical cancer is a well-known cause of both ureteral obstruction and invasion into the bladder. Although cervical cancer is clinically staged, the presence of hydronephrosis on imaging due to tumor fulfils one of two criteria for the diagnosis of Stage IIIB cervical cancer in the International Federation of Gynecology and Obstetrics staging system. The proximity of the distal third of the ureter to the upper vagina and lower uterine cervix make this area susceptible to the direct invasive nature of advanced cervical cancer. The predominant route of spread is from the cervix into the vaginal mucosa, into the uterine myometrium, into the paracervical lymphatics, and then into the pelvic nodes. This is followed by extension into the adjacent structures, wall of the pelvis, bladder, or rectum with possible resulting vesicovaginal or rectovaginal fistula. Most patients will ultimately die from bilateral ureteral obstruction and subsequent sepsis.

Treatment of cervical cancer with radiation or surgery has a high incidence of urologic complications. In 2001, Fujikawa reported on 271 patients who were treated with external beam therapy and intracavitary brachytherapy for cervical cancer. Eight percent had urologic complications requiring surgical intervention, while 13% had complications of the rectum or intestine (26). Spontaneous rupture of the bladder has also been reported by the same group.

Radical hysterectomy is used for early stage treatment of cervical cancer. This involves resection of the parametrial tissues including the uterosacral ligaments, portions of the cardinal ligaments, and upper third of the vagina. Radical hysterectomy has been associated with changes in bladder compliance and bladder capacity (27). This often results from direct injury to the sensory and motor nerve supply to the bladder. It is not uncommon for individuals to have voiding dysfunction for over a month after surgery often requiring intermittent self-catheterization or continuous bladder drainage.

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