Cervical Cancer in Pregnancy

3 Cases, 3 Different Approaches

Filipa Ribeiro, MD; Lúcia Correia, MD; Tereza Paula, MD; Isabel Santana, MD; Luís Vieira Pinto, MD; Jorge Borrego, MD; Ana Francisca Jorge, MD

Disclosures

J Low Genit Tract Dis. 2013;17(1):66-70. 

In This Article

Abstract and Introduction

Abstract

Objective. Cervical cancer is one of the most common malignancies in pregnancy and one percent of women diagnosed with cervical cancer are pregnant or postpartum at the time of the diagnosis. We discuss how pregnancy will affect the management of cancer, and cancer will affect the management of the pregnancy.

Material and Methods. Three case reports.

Results. We report three cases, with three different approaches of pregnant patient with cervical carcinoma stage IB1, diagnosed below-20 weeks gestation. In two cases, the patients decided to continue the pregnancy.

Conclusions. Cervical cancer in pregnancy is a clinical challenge. Once the diagnosis, the stage and the extent of invasive cervical cancer have been established, a multidisciplinary approach is required. Decisions regarding timing of treatment and delivery require careful considerations, as well as the trimester in which the diagnosis is made. Delaying definitive treatment to improve fetal outcome, may carry an additional risk of tumor progression, although a delay in definitive treatment is regarded as feasible. Delayed treatment is safe in patients with small sized, early stage disease, if there is no evidence of disease progression. Neoadjuvant chemotherapy during pregnancy is still controversial. Cesarean delivery followed by radical hysterectomy is recommended. The effect of cervical cancer on pregnancy outcome is still not clear.

Introduction

Uterine cervical cancer is the third most common malignant disease in Portuguese women, with an estimated incidence of 12.2 in 100,000 women and mortality of 3.6 in 100,000 in 2008.[1]

Despite the decreasing numbers due to the increasing availability of screening test, it is the second most common malignancy if adjusted to child-bearing age (incidence of 4.5 in 100,00 with 378 deaths in 2008) in women in Portugal. Of the women diagnosed with cervical cancer, 1% to 3% are pregnant or in the postpartum period at the time of the diagnosis.[2,3] Approximately one half of these cases are diagnosed prenatally.[4] Cervical cancer is one of the most common malignancies in pregnancy, with an estimated incidence of 1 to 10 in 10,000 pregnancies.[5]

Given the critical role that the cervix plays in the continuation of a successful term pregnancy and the vulnerability of the fetus to common cancer treatment modalities, cervical cancer in pregnancy is a clinical challenge. The unique ethical considerations and the rarity of the disease make large, randomized, controlled trials far more difficult, if not impossible, to perform. As a result, there is a noticeable absence of such data to recommend definitive treatment guidelines.

Pregnancy will affect the management of cancer, and cancer will affect the management of the pregnancy. However, stage by stage, the course of the disease and prognosis of cervical cancer in pregnant patients are similar to those of nonpregnant patients.[6,7]

The diagnosis of cancer will be devastating for the woman, her partner, her family, and her care providers. A multidisciplinary team approach is required to address issues such as termination versus continuation of pregnancy, delay of definitive treatment, form of therapy during pregnancy, as well as timing and route of delivery.

We report 3 cases, with 3 different approaches, of pregnant patients with cervical carcinoma with stage IB1 according to the International Federation of Gynecology and Obstetrics (FIGO),[8] diagnosed at less than 20 weeks of gestation.

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