Endometrial Cancer Evaluation After Le Fort Colpocleisis

Abstract

Background:

Le Fort colpocleisis is a highly effective surgery for pelvic organ prolapse. One consequence of the surgery is difficulty accessing the endometrial cavity. Endometrial cancer risk increases with age and can occur in patients with colpocleisis. Two cases of endometrial cancer after colpocleisis are discussed.

Cases and Results:

Case 1: A 76-year-old woman presented with vaginal bleeding 4 years after colpocleisis. Endometrial sampling could not be obtained despite attempts. Imaging showed thickened endometrium and an endometrial mass. She underwent modified radical laparoscopic hysterectomy with bilateral salpingo-oophorectomy, with pathology consistent with endometrial adenocarcinoma, and subsequent pelvic radiation. She had no evidence of disease on follow-up. Case 2: A 66-year-old woman presented with abdominal pain, bloating, decreased appetite, and weight loss 2 years after colpocleisis. Tumor markers and imaging were concerning for carcinomatosis. As endometrial sampling was not feasible, she underwent peritoneal biopsy that revealed high-grade serous carcinoma. She was treated with neoadjuvant chemotherapy followed by interval debulking surgery. Her disease progressed on multiple lines of chemotherapy and she expired from her disease 2.5 years after diagnosis.

Conclusion:

After Le Fort colpocleisis, access to the endometrium is limited; however, patients continue to be at risk for malignancy. Careful evaluation of risk factors for postmenopausal bleeding and endometrial cancer should be performed when selecting patients for colpocleisis. Vaginal bleeding after colpocleisis should be worked up with a high suspicion for endometrial malignancy using physical examination, endometrial sampling if feasible, laboratory studies, and imaging.