Case of a locally advanced carcinoma cervix presenting with protrusio acetabuli: pre-screening era presentation rarely seen in modern times

Cervical cancer is the third most commonly diagnosed cancer, and the fourth leading cause of cancer deaths in women worldwide. In 2008, there were an estimated 529 000 new cases of cervical cancer, and 275 000 cervical cancer-related deaths. 1 Cancer of the cervix has been the most common cancer in women in India for the past two decades. 2 The lungs, para-aortic lymph nodes and supraclavicular nodes are the most common sites of distant metastases. Bone metastases are not commonly seen, usually only in 0.8-23% of cases, and then mostly in the dorsal or lumbar vertebrae. 3,4 Skeletal deposits were estimated to occur in less than 1% of patients in postmortem reports of large series of cases, such as those compiled by MacCormack. 5 Matsuyama, Tsukamoto, Imachi and Nakano reported rates as high as 4-6.5%. 6 Large fungating or invasive lesions are rarely seen since the advent of the routine use of screening procedures for cervical cancer in the Western world. However, such lesions are still commonly observed in developing countries. We describe a case of locally advanced cervical cancer, which had spread laterally to involve the left pelvic side wall, causing erosion and destruction of the left acetabulum and femoral head.