Introduction/Background*Intestinal type cervical cancer is exceptionally rare and this a a c ase of 54 year presented with abnormal bleeding. The cancer is not normally picked up by the cervical screeing system. This is the story of multidisciplinary approach to managing such a case.
Methodology The case presented with abnormal bleeding with normal cervical screening history. She particularly complained of continuous mucus profuse per vaginal discharge. The ultrasound indicated fluid in the endometrium.The cervix looked abnormal and biopsies were taken. The histology indicated intestinal type adenocarcinoma. Her Ca19-9 was exceptionally high more than 2000iu, however CT scan did not indicate any pancreas or intestinal malignancy. The imaging including CT PET and MRI also indicated cervical tumor and one 7.5mm left external iliac lymph node giving her stage 2B. The immunochemistry was positive for caudal tyoe homeobox2 (CDX20, Ca19-9, CEA, CK7, CK20 and it was negative for p16, p53 and estrogen. The histology demonstrated atypical signet ring and it was shown on the cervical, endometrial and vaginal biopsies.
Result(s)*The case was managed through multidisciplinary approach and recommended chemoradiation. She recieved brachy therapy and carboplatin and achieved radiological and clinical response. Subsequent follow up indocated some residual upper vaginal focus of tumor. She was offered sugery and she had radical hystrectomy and lymphadenopathy followed by full recovery. Two years follow indicated no recurrence clinically and radiologically.
Conclusion*This case posed diagnostic and management dilemmas whether it is purely a cancer of the cervix or still representing an intestinal primary. The cancer is not HPV related so it can slip through the net of cervical screening and the main distinguished clinical feature was profuse mucus vaginal discahrge which greatly reduced after radiotherapy. The combination of neoadjuvant chemotherapy follwed by surgery was successful in this case. These enteric type cervical cancer represent a rare heterogenous group of cancers with variable presenations and prognosis.
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