Incidence occult cancer during benign gyn surgery low but not insignificant
A study recently published in Obstetrics and Gynecology has found that while incidence of occult gynecological cancer in women who undergo hysterectomy or myomectomy for benign indications is low, it is still prevalent, especially in women older than age 55. The study looked at occurrence of uterine, cervical and ovarian cancers.
The research was a secondary analysis of data from the 2014-2015 American College of Surgeons National Surgical Quality Improvement Program. The authors identified adult women undergoing hysterectomies (24,076) and myomectomies (2,368) without evidence of existing cancer at the beginning of surgery. The primary outcome was pathology-confirmed malignancy in the corpus uteri, cervix uteri, and ovary.
Malignancy of the corpus uteri was found in 1.44% (95% CI 1.29—1.59%) of the women undergoing hysterectomy. However, the rate varied greatly depending on surgical route. In patients who underwent laparoscopic supracervical hysterectomy, the rate was 0.23% (95% CI 0.06—0.58%) and for total laparoscopic or laparoscopic-assisted vaginal hysterectomy, the rate was 1.89% (95% CI, 1.65—2.14%).
The study also found that older women were significantly more likely to have preoperatively undetected malignancy of the corpus uteri (adjusted odds ratio 6.46, 95% CI, 4.96—8.41 for women age ≥ 55 vs age 40-54). Of the women who underwent abdominal hysterectomy, 9.72% aged ≥ 55 were diagnosed with corpus uteri cancer; women aged 40 to 54 had a diagnosis rate of only 1.06%. A majority of the occult corpus uteri and ovarian cancers tended to be found in the early stages; 80% of corpus uteri cancer and 60.9% of the ovarian malignancies were stage I-IC neoplasms. Among women with occult cervix uteri cancer, 44.1% and 40.7% had cancers of stage I-IB2 and cancers of stage NOS, respectively.
Of the women who underwent hysterectomy for benign conditions, 0.60% (95% CI, 0.50—0.70%) were found to have malignancy of the cervix uteri, and 0.19% (95% CI 0.14—0.25%) were found to have ovarian cancer. In patients undergoing myomectomy, 0.21% (95% CI, 0.03—0.40%) were found to have malignancy of the corpus uteri with no occult cervical or ovarian cancer identified.
The authors believe that the findings from their study indicate that power morcellation may have potential use in select patient groups. Since occult cancer of the corpus uteri was not found in patients undergoing laparoscopic myomectomy, the benefits of minimally invasive procedures enabled by power morcellation, along with careful screening, may outweigh the risk of occult malignancy in these patients. One of the noted strengths of this study was exclusion of surgeries performed by gynecologic oncologists, which helped eliminate the likelihood that a patient had a complex or high-risk surgery that may have indicated a greater chance of having a malignancy. A noted limitation was the lack of data on surgical indications. In addition, because cervical and ovarian tissue was not always included in the pathology assessment at time of hysterectomy or myomectomy, prevalence of occult cervical and ovarian cancers may have been underestimated in the analysis. The authors believe that given the results of their study, it is critical to continue developing gynecologic cancer screening techniques.