CERVICAL-CANCER COMPLICATED BY PREGNANCY - EPISIOTOMY SITE RECURRENCES FOLLOWING VAGINAL DELIVERY

Objective: To determine the optimal diagnostic and therapeutic modalit ies relevant to episiotomy site recurrence of cervical cancer after va ginal delivery. Methods: Records from the past 30 years were reviewed to identify patients treated at the Mayo Clinic with episiotomy site r ecurrence of cervical cancer complicated by pregnancy with vaginal del ivery. Results: Four patients with episiotomy site recurrence of squam ous cell carcinoma of the cervix were treated primarily at the Mayo Cl inic. These cervical cancers were originally diagnosed at delivery or in the immediate postpartum period and were treated by radical hystere ctomy. Episiotomy site recurrences were detected less than 12 weeks af ter surgery in three patients and at 2 years in one patient. Three pat ients have died of recurrent cancer and one is disease-free at 1 year. Conclusions: Careful screening and examination of cervical abnormalit ies during pregnancy is required. The primary cancer was not diagnosed until delivery or postpartum in all patients who developed episiotomy site recurrences. If vaginal delivery is elected in a patient with ce rvical cancer, perineal inspection becomes critical. Including other c ases reported in the literature, six of nine with stage IB disease wer e diagnosed with episiotomy site recurrence within 12 weeks of primary therapy. Consideration should be given to colposcopy of the episiotom y site or random biopsy in these women preoperatively to rule out occu lt implantation, and this site warrants careful postoperative surveill ance.