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Winarno AS, Fehm TN, Hampl M. Vulvar cancer during pregnancy and/or breastfeeding: a report of five cases from a single center study at the University Hospital of Düsseldorf. BMC Pregnancy Childbirth 2022; 22:207. [PMID: 35291960 PMCID: PMC8922737 DOI: 10.1186/s12884-022-04448-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 02/02/2022] [Indexed: 11/10/2022] Open
Abstract
Background The incidence of vulvar cancer (VC) in pregnancy is unknown due to its rarity; between 1955 and 2014 only 36 case reports were reported worldwide. Underreporting may also be a contributing factor to the unknown incidence of VC in pregnancy. The aim of this study was to analyze the diagnosis, treatment and outcome of vulvar cancer cases diagnosed during pregnancy and/or breastfeeding. Case presentation Patient 1 was diagnosed at 18 weeks’ gestation (WG) with Grade 2 VC (pT1a, pN0, 0/4 sentinel lymph nodes biopsy (SLNB) involved) and was treated by having the tumor resected (R0). She is currently recurrence-free at 4 years post-diagnosis. Patient 2 was diagnosed at 7 WG with Grade 2 VC (pT1b, pN1a, 1/17 SLNB, R0) and was treated during the first trimester and during the second trimester with SLNB. She is currently recurrence-free at 5 years post-diagnosis. Patient 3 was diagnosed at 30 WG with Grade 2 VC (pT1b, pN0, 0/5 SLNB, R0). She subsequently experienced a number of local recurrences postpartum that were managed by resection and is currently recurrence-free at 3 years post-diagnosis. Patient 4 was diagnosed a VL later, at 14 months during breastfeeding, that was diagnosed as Grade 3 VC (pT1b, pN1a, 1/14 SLNB, R0). The patient is currently recurrence-free at 9 years post-diagnosis. Patient 5 was not diagnosed during pregnancy, but was diagnosed with G3 VC (pT2, pN2c, 2/17 SLNB, R0) 8 months postpartum. The patient due to the extent of tumor involvement and lymph node metastasis, underwent chemoradiation therapy post-surgery. Despite adjuvant therapy, the patient progressed and developed bone metastases. Analysis of the tumour tissue revealed increased expression of PD-L1 (programmed cell death protein 1) indicating that the patient may have benefited from treatment with nivolumab to block the PD-L1 interaction; unfortunately the patient passed away at 24 months post-diagnosis before immunotherapy treatment could commence. Conclusion Surgical resection and simultaneous SLNB in VC cases are considered safe during pregnancy, with comparable outcomes to non-pregnant women. Prompt diagnostic workup and treatment should never be delayed during pregnancy as delayed diagnosis could lead to tumour progression with fatal consequences.
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Affiliation(s)
- Andreas Suhartoyo Winarno
- Department of Obstetrics and Gynecology, The Heinrich Heine University Hospital of Duesseldorf, Moorenstraße 5, 40225, Duesseldorf, Nordrhein-Westfalen, Germany.
| | - Tanja Natascha Fehm
- Department of Obstetrics and Gynecology, The Heinrich Heine University Hospital of Duesseldorf, Moorenstraße 5, 40225, Duesseldorf, Nordrhein-Westfalen, Germany
| | - Monika Hampl
- Department of Obstetrics and Gynecology, The Heinrich Heine University Hospital of Duesseldorf, Moorenstraße 5, 40225, Duesseldorf, Nordrhein-Westfalen, Germany
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Gaunt E, Pounds R, Yap J. Vulval cancer in pregnancy: Two case reports. Case Rep Womens Health 2022; 33:e00374. [PMID: 34993054 PMCID: PMC8713052 DOI: 10.1016/j.crwh.2021.e00374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 12/03/2021] [Accepted: 12/06/2021] [Indexed: 11/27/2022] Open
Abstract
Vulval cancer is rare in women of reproductive age. We report two cases of vulval squamous cell carcinoma (VSCC) in pregnancy. They presented with a solitary labial mass, at 20 and 21 weeks of gestation, diagnosed as stage 1B VSCC based on clinical examination and cross-sectional imaging. In the first case, the patient underwent close clinical surveillance whilst pregnant and had an elective caesarean section at 39 weeks of gestation. Two months post-partum she underwent a radical anterior vulvectomy and bilateral groin sentinel lymph node biopsy. In the second case, the patient underwent an anterior vulvectomy at 33 weeks of gestation followed by a vaginal delivery at 37 weeks of gestation. Six weeks post-natally she had bilateral groin sentinel lymph node biopsies. We conclude that surgical resection is safe during pregnancy under spinal anaesthesia but it can be deferred until the post-partum period if the cancer presents at early stage. Vulval cancer is rare in pregnancy and management is tailored according to gestation age. Surgical resection of a local tumour for symptom control is feasible antenatally and the decision should be made on a case-by-case basis with antenatal surveillance of the tumour. Staging surgery for inguinal lymphatics should be deferred until the post-natal period if there is no suspicion of clinical or radiology metastasis. Sentinel inguinal lymph node biopsy is absolutely contraindicated during the antenatal period due to risks of radiation exposure of the foetus. Vaginal birth is possible after vulvectomy and reconstructive surgery may be considered in the future.
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Affiliation(s)
- Ellen Gaunt
- Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, England, United Kingdom
| | - Rachel Pounds
- University of Birmingham, Birmingham, England, United Kingdom
| | - Jason Yap
- Institute of Genomic Cancer Sciences, College of Dental and Medical School, University of Birmingham, Birmingham, England, , United Kingdom
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Palicelli A, Giaccherini L, Zanelli M, Bonasoni MP, Gelli MC, Bisagni A, Zanetti E, De Marco L, Torricelli F, Manzotti G, Gugnoni M, D’Ippolito G, Falbo AI, Sileo FG, Aguzzoli L, Mastrofilippo V, Bonacini M, De Giorgi F, Ricci S, Bernardelli G, Ardighieri L, Zizzo M, De Leo A, Santandrea G, de Biase D, Ragazzi M, Dalla Dea G, Veggiani C, Carpenito L, Sanguedolce F, Asaturova A, Boldorini R, Disanto MG, Goia M, Wong RWC, Singh N, Mandato VD. How Can We Treat Vulvar Carcinoma in Pregnancy? A Systematic Review of the Literature. Cancers (Basel) 2021; 13:836. [PMID: 33671249 PMCID: PMC7921964 DOI: 10.3390/cancers13040836] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 02/06/2021] [Accepted: 02/11/2021] [Indexed: 02/05/2023] Open
Abstract
According to our systematic literature review (PRISMA guidelines), only 37 vulvar squamous cell carcinomas (VSCCs) were diagnosed during pregnancy (age range: 17-41 years). The tumor size range was 0.3-15 cm. The treatment was performed after (14/37, 38%), before (10/37, 27%), or before-and-after delivery (11/37, 30%). We found that 21/37 (57%) cases were stage I, 2 II (5%), 11 III (30%), and 3 IVB (8%). HPV-related features (condylomas/warts; HPV infection; high-grade squamous intraepithelial lesion) were reported in 11/37 (30%) cases. We also found that 9/37 (24%) patients had inflammatory conditions (lichen sclerosus/planus, psoriasis, chronic dermatitis). The time-to-recurrence/progression (12/37, 32%) ranged from 0 to 36 (mean 9) months. Eight women died of disease (22%) 2.5-48 months after diagnosis, 2 (5%) were alive with disease, and 23 (62%) were disease-free at the end of follow-up. Pregnant patients must be followed-up. Even if they are small, newly arising vulvar lesions should be biopsied, especially in women with risk factors (HPV, dermatosis, etc.). The treatment of VSCCs diagnosed in late third trimester might be delayed until postpartum. Elective cesarean section may prevent vulvar wound dehiscence. In the few reported cases, pregnancy/fetal outcomes seemed to not be affected by invasive treatments during pregnancy. However, clinicians must be careful; larger cohorts should define the best treatment. Definite guidelines are lacking, so a multidisciplinary approach and discussion with patients are mandatory.
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Affiliation(s)
- Andrea Palicelli
- Pathology Unit, Azienda USL-IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy; (M.Z.); (M.P.B.); (M.C.G.); (A.B.); (E.Z.); (L.D.M.); (F.D.G.); (S.R.); (G.B.); (G.S.); (M.R.)
| | - Lucia Giaccherini
- Radiation Oncology Unit, Azienda USL-IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy;
| | - Magda Zanelli
- Pathology Unit, Azienda USL-IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy; (M.Z.); (M.P.B.); (M.C.G.); (A.B.); (E.Z.); (L.D.M.); (F.D.G.); (S.R.); (G.B.); (G.S.); (M.R.)
| | - Maria Paola Bonasoni
- Pathology Unit, Azienda USL-IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy; (M.Z.); (M.P.B.); (M.C.G.); (A.B.); (E.Z.); (L.D.M.); (F.D.G.); (S.R.); (G.B.); (G.S.); (M.R.)
| | - Maria Carolina Gelli
- Pathology Unit, Azienda USL-IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy; (M.Z.); (M.P.B.); (M.C.G.); (A.B.); (E.Z.); (L.D.M.); (F.D.G.); (S.R.); (G.B.); (G.S.); (M.R.)
| | - Alessandra Bisagni
- Pathology Unit, Azienda USL-IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy; (M.Z.); (M.P.B.); (M.C.G.); (A.B.); (E.Z.); (L.D.M.); (F.D.G.); (S.R.); (G.B.); (G.S.); (M.R.)
| | - Eleonora Zanetti
- Pathology Unit, Azienda USL-IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy; (M.Z.); (M.P.B.); (M.C.G.); (A.B.); (E.Z.); (L.D.M.); (F.D.G.); (S.R.); (G.B.); (G.S.); (M.R.)
| | - Loredana De Marco
- Pathology Unit, Azienda USL-IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy; (M.Z.); (M.P.B.); (M.C.G.); (A.B.); (E.Z.); (L.D.M.); (F.D.G.); (S.R.); (G.B.); (G.S.); (M.R.)
| | - Federica Torricelli
- Laboratory of Translational Research, Azienda USL-IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy; (F.T.); (G.M.); (M.G.)
| | - Gloria Manzotti
- Laboratory of Translational Research, Azienda USL-IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy; (F.T.); (G.M.); (M.G.)
| | - Mila Gugnoni
- Laboratory of Translational Research, Azienda USL-IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy; (F.T.); (G.M.); (M.G.)
| | - Giovanni D’Ippolito
- Unit of Obstetrics and Gynaecology, Azienda USL-IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy; (G.D.); (A.I.F.); (F.G.S.); (V.D.M.)
| | - Angela Immacolata Falbo
- Unit of Obstetrics and Gynaecology, Azienda USL-IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy; (G.D.); (A.I.F.); (F.G.S.); (V.D.M.)
| | - Filomena Giulia Sileo
- Unit of Obstetrics and Gynaecology, Azienda USL-IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy; (G.D.); (A.I.F.); (F.G.S.); (V.D.M.)
| | - Lorenzo Aguzzoli
- Unit of Surgical Gynecol Oncology, Azienda USL-IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy; (L.A.); (V.M.)
| | - Valentina Mastrofilippo
- Unit of Surgical Gynecol Oncology, Azienda USL-IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy; (L.A.); (V.M.)
| | - Martina Bonacini
- Clinical Immunology, Allergy and Advanced Biotechnologies Unit, Azienda USL-IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy;
| | - Federica De Giorgi
- Pathology Unit, Azienda USL-IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy; (M.Z.); (M.P.B.); (M.C.G.); (A.B.); (E.Z.); (L.D.M.); (F.D.G.); (S.R.); (G.B.); (G.S.); (M.R.)
| | - Stefano Ricci
- Pathology Unit, Azienda USL-IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy; (M.Z.); (M.P.B.); (M.C.G.); (A.B.); (E.Z.); (L.D.M.); (F.D.G.); (S.R.); (G.B.); (G.S.); (M.R.)
| | - Giuditta Bernardelli
- Pathology Unit, Azienda USL-IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy; (M.Z.); (M.P.B.); (M.C.G.); (A.B.); (E.Z.); (L.D.M.); (F.D.G.); (S.R.); (G.B.); (G.S.); (M.R.)
| | - Laura Ardighieri
- Pathology Unit, ASST Spedali Civili di Brescia, 25123 Brescia, Italy;
| | - Maurizio Zizzo
- Surgical Oncology Unit, Azienda USL-IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy;
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, 41121 Modena, Italy
| | - Antonio De Leo
- Molecular Diagnostic Unit, Azienda USL Bologna, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, 40138 Bologna, Italy;
| | - Giacomo Santandrea
- Pathology Unit, Azienda USL-IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy; (M.Z.); (M.P.B.); (M.C.G.); (A.B.); (E.Z.); (L.D.M.); (F.D.G.); (S.R.); (G.B.); (G.S.); (M.R.)
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, 41121 Modena, Italy
| | - Dario de Biase
- Pharmacology and Biotechnology Department (FaBiT), University of Bologna, 40138 Bologna, Italy;
| | - Moira Ragazzi
- Pathology Unit, Azienda USL-IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy; (M.Z.); (M.P.B.); (M.C.G.); (A.B.); (E.Z.); (L.D.M.); (F.D.G.); (S.R.); (G.B.); (G.S.); (M.R.)
| | - Giulia Dalla Dea
- Department of Health Science, University of Eastern Piedmont, 28100 Novara, Italy; (G.D.D.); (R.B.)
- Pathology Unit, Maggiore Della Carità Hospital, 28100 Novara, Italy;
| | - Claudia Veggiani
- Pathology Unit, Maggiore Della Carità Hospital, 28100 Novara, Italy;
| | - Laura Carpenito
- School of Pathology, University of Milan, 20122 Milan, Italy;
| | - Francesca Sanguedolce
- Pathology Unit, Azienda Ospedaliero-Universitaria-Ospedali Riuniti di Foggia, 71122 Foggia, Italy;
| | - Aleksandra Asaturova
- 1st Pathology Department, FSBI “National Medical Research Center for Obstetrics, Gynecology and Perinatology Named After Academician V.I. Kulakov”, Ministry of Healthcare of the Russian Federation, 117997 Moscow, Russia;
| | - Renzo Boldorini
- Department of Health Science, University of Eastern Piedmont, 28100 Novara, Italy; (G.D.D.); (R.B.)
- Pathology Unit, Maggiore Della Carità Hospital, 28100 Novara, Italy;
| | | | - Margherita Goia
- Unit of Pathology, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, 10126 Turin, Italy;
| | - Richard Wing-Cheuk Wong
- Department of Clinical Pathology, Pamela Youde Nethersole Eastern Hospital, Hong Kong, China;
| | - Naveena Singh
- Department of Cellular Pathology, Barts Health NHS Trust, The Royal London Hospital, Whitechapel, London E1 1BB, UK;
| | - Vincenzo Dario Mandato
- Unit of Obstetrics and Gynaecology, Azienda USL-IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy; (G.D.); (A.I.F.); (F.G.S.); (V.D.M.)
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Winarno AS, Mondal A, Martignoni FC, Fehm TN, Hampl M. The potential risk of contralateral non-sentinel groin node metastasis in women with early primary vulvar cancer following unilateral sentinel node metastasis: a single center evaluation in University Hospital of Düsseldorf. BMC WOMENS HEALTH 2021; 21:23. [PMID: 33435958 PMCID: PMC7802357 DOI: 10.1186/s12905-020-01165-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 12/29/2020] [Indexed: 12/16/2022]
Abstract
Background Since the introduction of sentinel node biopsy (SLNB) in unifocal vulvar cancer (diameter of < 4 cm) and unsuspicious groin lymph nodes, the morbidity rate of patients has significantly decreased globally. In contrast to SLNB, bilateral inguinofemoral lymphadenectomy (IFL) has been associated with increased risk of common morbidities. Current guidelines (NCCN, ESGO, RCOG, and German) recommend that in cases of unilaterally positive sentinel lymph node (SLN), bilateral IFL should be performed. However, two recent publications by Woelber et al. and Nica et al. contradict the current guideline, since a significant rate of positive non sentinel lymph nodes in IFL contralaterally was not observed [Woelber et al. 0% (p = 0/28) and Nica et al. 5.3% (p = 1/19)].
Methods A retrospective single-center analysis conducted in the University Hospital of Dusseldorf, evaluating vulvar cancer patients treated with SLNB from 2002 to 2018. Results 22.2% of women (n = 4/18) were found to have contralateral IFL groin metastasis after an initial diagnosis of unilateral SLN metastasis. The depth of tumor infiltrating cells correlated significantly and positively with the rate of incidence of groin metastasis (p = 0.0038). Conclusion Current guideline for bilateral IFL should remain as the standard management. Therefore, this depth may be taken into account as an indication for bilateral IFL. The management of VC and SLNB should be performed in a high volume center with an experienced team in marking SLN and performing the adequate surgical procedure. Well conducted counseling of the patients outlining advantages but also potential oncological risks of this technique especially concerning rate of groin recurrence is critical.
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Affiliation(s)
- Andreas Suhartoyo Winarno
- Department of Obstetrics and Gynecology, University Hospital of Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany. .,Department of Obstetrics and Gynecology, Franziskus Hospital Bielefeld, Kiskerstraße 26, 33615, Bielefeld, Nordrhein-Westfalen, Germany.
| | - Anne Mondal
- Women's Clinic on Schwanenmarkt, Düsseldorf, Germany
| | - Franca Christina Martignoni
- Department of Obstetrics and Gynecology, University Hospital of Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany
| | - Tanja Natascha Fehm
- Department of Obstetrics and Gynecology, University Hospital of Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany
| | - Monika Hampl
- Department of Obstetrics and Gynecology, University Hospital of Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany
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Capriglione S, Manzano A, Gulino FA, Lopez S. Management of gynecological cancer in pregnant patients. ACTA ACUST UNITED AC 2018; 71:133-145. [PMID: 30318875 DOI: 10.23736/s0026-4784.18.04324-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Cancer during pregnancy is a rare but challenging condition. More women delay childbearing and consequently the incidence of cancer during pregnancy is constantly increasing. EVIDENCE ACQUISITION An extensive electronic search was performed in PubMed and Scopus. Only studies written after 1985 were considered eligible for this review. Abstracts, conference papers, book chapters, animal studies, commentaries as well as editorials articles were excluded from this review. EVIDENCE SYNTHESIS Cancer treatment during pregnancy is possible, but both maternal and fetal conditions need to be preserved. Randomized clinical trials are not feasible and current evidence are mainly based on case-series, small case reports and expert opinion. Cervical and ovarian cancers are the most common gynecological cancers diagnosed during pregnancy. Surgery and chemotherapy after the first trimester seem to be relatively safe for the newborn. Platinum-based chemotherapy administered during the 2nd-3rd trimester showed comparable adverse effects in newborns to those in the general population. Babies exposed to antenatal chemotherapy might be more likely to develop small for gestational age and NICU admission, than babies not exposed. CONCLUSIONS Management of pregnant women with cancer should be performed in specialized cancer centers and all cases should be discussed with a multidisciplinary approach. In the present review, we discuss the current recommendations for the management of pregnancies complicated by cancer and neonatal outcomes.
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Affiliation(s)
- Stella Capriglione
- Department of Obstetrics and Gynecology, Institute for Social Security, Borgo Maggiore, San Marino
| | - Aranzazu Manzano
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, CT, USA
| | | | - Salvatore Lopez
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, CT, USA - .,Department of Experimental and Clinical Medicine, Magna Græcia University, Catanzaro, Italy
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Iavazzo C, Minis EE, Gkegkes ID. Current management of gynecologic cancer in pregnancy. J Turk Ger Gynecol Assoc 2018; 19:104-110. [PMID: 29699959 PMCID: PMC5994818 DOI: 10.4274/jtgga.2018.0044] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Cancer during pregnancy is a particularly challenging complication. The incidence has increased in recent years due to childbearing at advanced maternal ages due to career choices and/or the development of reproductive technology. Approximately two thirds of cancer cases during pregnancy comprise invasive cervical cancers and breast cancer. Cancer during gestation is characterized by a need for specialized treatment due to major changes in the hormonal profile (estrogen-progesterone), metabolism (enhancement of anabolism), hemodynamic changes (hyperdynamic circulation), immunologic changes (cell-mediated and humoral immunity), and increased angiogenesis (increased blood flow towards the uterus). Moreover, the management of such patients is based on the trimester of pregnancy, type and stage of cancer, and informed consent of the mother based on her wishes. The optimal treatment of cancer during pregnancy remains elusive because there are limited data from retrospective studies with small samples. As a result, it is crucial that data regarding survival of the women and long-term follow-up of the children from different cancer centers and registries are shared. This need is dictated by the fact that the incidence of cancer during pregnancy will continue to rise as child-bearing age continues to increase.
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Affiliation(s)
- Christos Iavazzo
- Department of Gynecological Oncology, Metaxa Cancer Hospital, Piraeus, Greece
| | | | - Ioannis D Gkegkes
- Department of Surgery, General Hospital of Attica “KAT”, Athens, Greece
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Abstract
The management of melanoma during pregnancy is challenging as maternal benefits and fetal risks need to be balanced. Here, we present an overview of the incidence, the demographic and clinical characteristics and the treatment modalities used. After analysis of obstetric, fetal and maternal outcome, recommendations for clinical practice are provided. From the 'International Network on Cancer, Infertility and Pregnancy' database, pregnant patients with melanoma were identified and analysed. Sixty pregnancies were eligible for analysis. Fifty percent of the patients presented with advanced melanoma during pregnancy (14 stage III and 16 stage IV), and 27% were diagnosed with recurrent melanoma. Surgery was the main therapeutic strategy during pregnancy. Only four patients with advanced melanoma were treated during pregnancy with systemic therapy (n=1) or radiotherapy (n=3). Premature delivery was observed in 18% of the ongoing pregnancies, all which were induced and 78% of which involved patients with advanced melanoma. Thirty-nine percent of the patients died within 5 years; all had been diagnosed with stage III or IV disease during pregnancy. Melanoma can present in a more advanced stage during pregnancy. New systemic therapies may be beneficial for patients with metastatic melanoma but may not be pregnancy compatible. In these patients, preterm induction of labour need to be discussed, despite the short-term and long-term negative effects on the child.
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Axillary staging for breast cancer during pregnancy: feasibility and safety of sentinel lymph node biopsy. Breast Cancer Res Treat 2017; 168:551-557. [DOI: 10.1007/s10549-017-4611-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Accepted: 12/06/2017] [Indexed: 10/18/2022]
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Halaska MJ, Rob L, Robova H, Cerny M. Treatment of gynecological cancers diagnosed during pregnancy. Future Oncol 2016; 12:2265-75. [DOI: 10.2217/fon-2016-0271] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Because of a notable increase in age at delivery, the incidence of malignancy diagnosed during pregnancy has substantially increased. This review aims to summarize the literature and expert knowledge on gynecologic cancers diagnosed in pregnancy regarding epidemiology, examination and staging procedures, description of treatment modalities and management of gynecological malignancies with special interest in cervical and ovarian cancer. Thorough attention is paid to the surgery and chemotherapy administration for early-stage cervical cancer diagnosed during pregnancy.
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Affiliation(s)
- Michael J Halaska
- Department of Obstetrics & Gynecology, 2nd Medical Faculty, Charles University in Prague, Prague, Czech Republic
| | - Lukas Rob
- Department of Obstetrics & Gynecology, 2nd Medical Faculty, Charles University in Prague, Prague, Czech Republic
| | - Helena Robova
- Department of Obstetrics & Gynecology, 2nd Medical Faculty, Charles University in Prague, Prague, Czech Republic
| | - Milos Cerny
- Department of Obstetrics & Gynecology, 2nd Medical Faculty, Charles University in Prague, Prague, Czech Republic
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Difficulties with diagnosis of malignancies in pregnancy. Best Pract Res Clin Obstet Gynaecol 2016; 33:19-32. [DOI: 10.1016/j.bpobgyn.2015.10.005] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Accepted: 10/09/2015] [Indexed: 11/22/2022]
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Soo-Hoo S, Luesley D. Vulval and vaginal cancer in pregnancy. Best Pract Res Clin Obstet Gynaecol 2016; 33:73-8. [DOI: 10.1016/j.bpobgyn.2015.10.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Accepted: 10/09/2015] [Indexed: 10/22/2022]
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Abstract
The diagnosis of a gynecological malignancy during pregnancy is rare but not uncommon. Cancer treatment during pregnancy is possible, but both maternal and fetal interests need to be respected. Different treatment plans may be justifiable and multidisciplinary treatment is advised. Clinical trials are virtually impossible, and current evidence is mainly based on small case series and expert opinion. Individualization of treatment is necessary and based on tumor type, stage, and gestational age at time of diagnosis. Termination of pregnancy is not necessary in most cases. Surgery and chemotherapy (second trimester and onwards) are possible types of treatment during pregnancy. Radiotherapy of the pelvic area is not compatible with an ongoing pregnancy. This article discusses the current recommendations for the management of gynecological malignancies (cervical, ovarian, and vulvar cancers) during pregnancy.
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Matsuo K, Whitman SA, Blake EA, Conturie CL, Ciccone MA, Jung CE, Takiuchi T, Nishimura M. Feto-maternal outcome of pregnancy complicated by vulvar cancer: a systematic review of literature. Eur J Obstet Gynecol Reprod Biol 2014; 179:216-23. [DOI: 10.1016/j.ejogrb.2014.04.017] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2013] [Revised: 03/26/2014] [Accepted: 04/08/2014] [Indexed: 01/07/2023]
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