Hernández Juárez, Roberto¹; Ríos Reina, José Luis²; Alvarado Estrada, Eliel Anastasio³; Arias Renteria, Marcel⁴

Language: English/Spanish [Versión en español]
References: 5
Page: 153-156
PDF size: 2364.69 Kb.

ABSTRACT

Cervical cancer (CC) remains one of the leading causes of morbidity and mortality worldwide. In advanced stages, transvaginal bleeding is a serious complication that affects both the quality of life and the prognosis. This case report presents a 39-year-old patient with stage IV A squamous cell carcinoma of the cervix, who experienced severe transvaginal bleeding, anemia, and hypovolemic shock. Uterine artery embolization (UAE) was successfully performed to control the bleeding. While the results were positive, further clinical research and controlled studies are needed to establish protocols and assess the applicability of UAE in advanced CC patients.

INTRODUCTION

One of the main complications of cervical cancer is bleeding, which affects up to 70% of cases with an advanced diagnosis and is the immediate cause of death in 6% of them.^1-3 In this context, uterine artery embolization (UAE) has emerged as an effective option to control pelvic hemorrhages, especially when surgical options are limited.

This work shows the effectiveness of UAE as a minimally invasive strategy that improves the quality of life of patients, positioning itself as a valuable tool in the palliative management of advanced cervical carcinoma.^3-5

CASE PRESENTATION

A 39-year-old female patient, with no relevant personal or family history, diagnosed with squamous cell cervical carcinoma six months ago; presents with signs of hemorrhagic shock. On targeted physical examination, an ulcerated 7 cm tumor is identified in the cervix with vaginal invasion and active bleeding. Laboratory and imaging studies show: hemoglobin (Hb) 5.9 and a tumor arising from the cervix with infiltration into the bladder, stage IV A (Figure 1). Given the limited therapeutic options, a uterine artery embolization is performed (Figures 2 and 3), which was successful in controlling the bleeding.

Under intravenous general anesthesia and guided by fluoroscopy, the right common femoral artery is punctured using the Seldinger technique. The left internal iliac artery is catheterized with a 5 Fr Cobra hydrophilic catheter and a 2.8 Fr microcatheter, identifying a tortuous uterine artery with increased vascularity and areas of active bleeding. Embolization is performed using 300-500 micron embospheres and a 2 mm × 4 cm coil in the trunk of the left uterine artery (Figure 2).

On the right side, the procedure is repeated with a 5 Fr Simmons catheter, using 300-500 and 500-700 micron embospheres due to increased vascularity in the uterine fundus. A 3 mm × 8 cm coil is placed in the trunk of the uterine artery, and complete embolization is confirmed, as well as the preservation of pelvic vascularity (Figure 3).

DISCUSSION

Uterine artery embolization (UAE) has proven to be effective in treating hemorrhages in patients with endometrial cancer or pelvic metastatic tumors, although evidence regarding its use in cervical carcinoma is still limited. Some studies suggest that this technique could be useful in controlling bleeding, but there are no established protocols or sufficient evidence to generalize its use in these cases.^1-5

This report highlights the effectiveness of UAE in controlling persistent hemorrhage, supporting its utility as a minimally invasive alternative in a palliative setting when surgical options are limited. However, more studies with larger sample sizes and prolonged follow-ups are needed to evaluate the benefits and risks of this technique.

CONCLUSIONS

UAE is an effective therapeutic option in the management of bleeding in patients with advanced cervical carcinoma. Its use should be considered within a multidisciplinary approach and remains a relevant area for future research.

REFERENCES

1. Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A et al. GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021; 71 (3): 209–249. doi: 10.3322/caac.21660.

2. Bhatla N, Aoki D, Sharma DN, Sankaranarayanan R. Cancer of the cervix uteri: 2021 update. Int J Gynecol Obstet. 2021; 155 (Suppl 1): 28-44. doi: 10.1002/ijgo.13865

3. Munteanu O, Secara D, Neamtu MN, Baros A, Dimitriade A, Dorobat B et al. Our experience in using the endovascular therapy in the management of hemorrhages in obstetrics and gynecology. Diagnostics (Basel). 2022; 12 (6): 1436. doi: 10.3390/diagnostics12061436.

4. Dariushnia SR, Nikolic B, Stokes LS, Spies JB, Society of Interventional Radiology Standards of Practice Committee. Quality improvement guidelines for uterine artery embolization for symptomatic leiomyomata. J Vasc Interv Radiol. 2014; 25 (11): 1737-1747. doi: 10.1016/j.jvir.2014.08.029.

5. Lipman J. Uterine artery embolization in the office-based lab. Tech Vasc Interv Radiol. 2024; 27(1). doi: 10.1016/j.tvir.2024.100954

AFFILIATIONS

¹ Médico residente de tercer año. Departamento de Radiología e Imagen. Facultad Mexicana de Medicina. Universidad la Salle. Hospital Angeles León. León, Guanajuato, México. ORCID: 0009-0005-2475-3159

² Radiólogo intervencionista. Jefe de departamento y profesor titular de la especialidad en radiología e imagen del Hospital Angeles Mocel. Ciudad de México, México. ORCID: 0009-0001-9932-1044

³ Médico residente de segundo año. Departamento de Radiología e Imagen. Facultad Mexicana de Medicina. Universidad la Salle. Hospital Angeles Mocel. Ciudad de México, México. ORCID: 0009-0008-0957-4867

⁴ Departamento de Anestesiología, Centro Médico Nacional Siglo XXI. Facultad de Medicina de la Universidad de Guadalajara. Guadalajara, Jalisco, México. ORCID: 0009-0005-2234-9645

If you wish to consult the supplementary data for this article, please contact editorial.actamedica@saludangeles.mx

CORRESPONDENCE

Dr. Roberto Hernández Juárez. Correo electrónico: Dr.robertto2021@gmail.com

Received: 2025-03-21. Accepted: 2025-04-04.