Missed diagnosis of pelvic organ prolapse complicated with cervical cancer: a retrospective case series of five patients and review of literature

Background: Pelvic organ prolapse (POP) combined with cervical cancer is a complex and challenging condition, to date only few cases have been reported worldwide. The preoperative missed diagnosis poses a significant risk to the diagnosis and treatment of patients. There is a need of studies investigating this condition to improve its management and avoid its consequences. The aim of this study was to present unusual cases of missed diagnosis of POP complicated with cervical cancer and review literature on diagnostic challenges, consequences of delayed detection, and the need for improved detection and management approaches in such cases. Methods: A retrospective case series study was conducted between June 2020 and June 2024, focusing on Chinese women with a missed diagnosis of POP complicated with cervical cancer. The study extensively reviewed and analyzed the underlying causes, clinical manifestations, treatment options, and eventual outcomes in these complex cases. Results: This study involved five Chinese women with a missed diagnosis of POP complicated with cervical cancer. The median age was 75 years. Two patients had negative results in preoperative cervical smear and human papillomavirus (HPV) test, while the other three patients had positive cervical smear tests showing low-grade squamous intraepithelial lesion (LSIL) and high-grade squamous intraepithelial lesion (HSIL), respectively, and positive HPV tests. Nonetheless, the pathological examination identified cervical cancer after surgery. Surgical interventions included vaginal hysterectomies, colpocleisis, perineorrhaphies and other procedures. The median operation time was 93 minutes, and median blood loss was 50 mL. Complete prolapse resolution was achieved in all patients, with no instances of cervical cancer or POP recurrence over the median 11-month follow-up period. Adjuvant chemotherapy was not required in any case. Conclusions: The coexistence of POP and cervical cancer poses a diagnostic challenge, as the symptoms of POP can mask the signs of cervical cancer. Clinicians should maintain a high index of suspicion for cervical cancer in patients with POP and consider appropriate diagnostic measures, such as pelvic examinations, biopsies and imaging studies. Early detection and timely treatment are crucial for improving outcomes in these patients. A multidisciplinary approach involving gynecologists, oncologists, and pelvic floor specialists is essential for optimal management. Further research is needed to develop standardized guidelines for the management of cervical cancer in the presence of POP.