Cervical Tumors After Hysterectomy: A Patient's Journey

Cervical tumor found after hysterectomy and oophorectomy?

Hello Dr.
Tsao, my mother underwent a right total mastectomy for ductal carcinoma in situ in the first half of 2014 and has been on Tamoxifen for two years since then.
In the second half of 2014, she had a hysterectomy and oophorectomy due to enlarging uterine fibroids and excessive menstrual bleeding.
During a follow-up transvaginal ultrasound, a 3.6 cm tumor was found on the cervix.
The doctor determined that since the uterus and ovaries had been removed, the tumor would gradually shrink, so only monitoring was needed (subsequent follow-ups showed not only normal results but also signs of shrinkage).
In 2015, she was diagnosed with hyperthyroidism (tremors) and has been on Carbimazole and Propranolol 10 mg since then.
Recently (July 2016), the original physician was unavailable, and a different doctor performed a follow-up transvaginal ultrasound, revealing that the tumor had increased in size to 3.8 cm.
I apologize for the questions, but I would like to know how a cervical tumor could be discovered after the hysterectomy and oophorectomy, and why it has increased in size during follow-up? Is any treatment necessary? Thank you, Dr.
Tsao.

Niming, 50~59 year old female. Ask Date: 2016/08/08

Dr. Cao Guotao reply Obstetrics and Gynecology

Hello, if a hysterectomy is performed, the cervix should also be removed.
I don't understand why there is a 3.6 cm tumor in the cervix.
You may want to consult your physician about this.
As for the difference between 3.6 cm and 3.8 cm, it is negligible and within the margin of error; monitoring should suffice.
Wishing you good health.

Reply Date: 2016/08/08

More Info

The situation you describe regarding your mother's health journey is complex and requires careful consideration of various factors. After undergoing a hysterectomy, including the removal of the uterus and ovaries, the presence of a cervical tumor can be concerning. It is important to understand the nature of the tumor, its growth pattern, and the implications for treatment.

Firstly, the development of a cervical tumor after a hysterectomy is not typical, as the cervix is usually removed during this procedure. However, if the cervix was not completely excised or if there was residual cervical tissue, it is possible for a tumor to develop in that area. The tumor's growth from 3.6 cm to 3.8 cm, despite previous assessments indicating it was shrinking, raises questions about its nature and the accuracy of the imaging studies performed.

There are several potential explanations for the tumor's growth:
1. Residual Disease: If any cervical tissue remained after the hysterectomy, it could potentially develop into a tumor, especially if there were pre-existing dysplastic changes or cancerous cells.

2. Misinterpretation of Imaging: Variability in imaging techniques or interpretations can lead to discrepancies in tumor size assessments. Different ultrasound operators may have varying levels of experience, which can affect the accuracy of measurements.

3. Biological Behavior of the Tumor: Some tumors can exhibit unpredictable growth patterns. Factors such as hormonal influences, especially in the context of your mother's history with breast cancer and ongoing tamoxifen therapy, could potentially impact tumor behavior.

Given these considerations, it is crucial to follow up with a healthcare provider who specializes in gynecologic oncology. Here are some steps that may be recommended:
1. Further Evaluation: A biopsy may be necessary to determine the histological type of the tumor. This will help ascertain whether it is benign, malignant, or a recurrence of a previous cancer.

2. Imaging Studies: Additional imaging, such as MRI or CT scans, may be warranted to assess the tumor's characteristics and to check for any signs of metastasis or involvement of surrounding tissues.

3. Multidisciplinary Approach: Involving a team of specialists, including gynecologists, oncologists, and radiologists, can provide a comprehensive evaluation and treatment plan tailored to your mother's specific situation.

4. Treatment Options: Depending on the biopsy results and the tumor's characteristics, treatment options may include surgical intervention, radiation therapy, or chemotherapy. The decision will depend on factors such as the tumor's stage, grade, and your mother's overall health.

5. Regular Monitoring: Continuous follow-up is essential to monitor the tumor's behavior and response to any treatments initiated.

In summary, the appearance of a cervical tumor after a hysterectomy is a significant concern that necessitates thorough investigation. It is essential to work closely with healthcare professionals to determine the best course of action. Your mother's history of breast cancer and current medications should also be taken into account when developing a treatment plan. Open communication with her healthcare team will be vital in navigating this challenging situation.

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