How little is known about cervical cancer in pregnancy?

Clinical analysis of twenty cases of cervical cancer associated with pregnancy

OBJECTIVES

The objectives are to investigate the therapeutic methods and prognosis of cervical cancer associated with pregnancy.

METHODS

Combined with a literature review, we analyzed the clinical characteristics, diagnosis and treating process, and prognosis of 20 cases of cervical cancer associated with pregnancy admitted in our hospital from 2000 to 2009.

RESULTS

Fifteen cases were treated with surgery, four cases with radiotherapy or synchronous chemoradiation, and one case with palliative systemic chemotherapy. Fourteen cases were disease-free survivals, five cases died of distant metastasis, and one case was lost to follow-up. Also, for survival, there were seven in eight cases of early pregnancy, two in four cases of mid-pregnancy, one in two cases of late pregnancy, four in six postpartum cases, and one in three cases of vaginal delivery.

CONCLUSIONS

There was a close relationship between clinical stage, diagnosis time, delivery method, and the prognosis of cervical cancer associated with pregnancy. For late pregnancy and postpartum cervical cancer surgery, preoperative and postoperative combination chemotherapy might improve the prognosis.

Cervical Carcinoma in Early Pregnancy - Successful Birth by Caesarean Section Followed by Radical Hysterectomy

A cervical carcinoma was diagnosed in a 32-year-old patient in the 17th week of her pregnancy. The histological confirmation revealed a well-differentiated squamous cell carcinoma. It was a clinical stage Ib1 tumour, without enlarged lymph nodes according to the image. After a staging MRI, intensive education of the patient and case discussion at the interdisciplinary tumour board as well as consultation with the neonatologist, it was agreed to prolong the pregnancy under close monitoring. The carcinoma was confined to the cervix in the further course of the pregnancy. The elective delivery was planned after 32 weeks of gestation. The primary Caesarean section followed by radical hysterectomy Piver II were carried out without complications. After regular postoperative progression of the mother, brachytherapy was performed at the appropriate time. The premature newborn was under neonatal care and exhibited good postnatal adaptation. Mother and child were discharged in good health.

Locally advanced cervical cancer: what is the standard of care?

PURPOSE OF REVIEW

Carcinoma of the cervix remains a significant health problem for women worldwide. Locally advanced cervical cancer (LACC) is a common presentation that has been extensively studied in the last three decades. This article reviews the standard of care and discusses current topics of clinical research.

RECENT FINDINGS

A multidisciplinary approach to the treatment of cervical cancer has led to marked improvement in outcome. Main advances are with neoadjuvant chemotherapy, chemoradiation, and preventive vaccination. Concurrent chemoradiation with a platinum-based agent is the recommended treatment for LACC. Palliation with platinum agent remains the standard of care for inoperable patients who have metastatic or recurrent disease.

SUMMARY

This is a review of published and ongoing studies testing multidisciplinary and medical management of LACC, with a focus on newer chemotherapeutic approaches. Optimal multidisciplinary treatment planning improves the outcome of each patient diagnosed with cervical cancer.

The Use of Cisplatin to Treat Advanced-Stage Cervical Cancer During Pregnancy Allows Fetal Development and Prevents Cancer Progression: Report of a Case and Review of the Literature

Background:

Cervical cancer is one of the most frequently encountered malignancies in pregnancy. For early-stage disease arising in late second/third trimester, treatment may be delayed until delivery. However, in advanced disease, data are lacking.

Case:

A 26-year-old woman presented at 21 weeks gestation with a stage IIB high-grade clear cell cervical carcinoma. At 25 + 1 weeks gestation, cisplatin 100 mg/m2 every 21 days was commenced. One month after cycle 3, a healthy infant was delivered. Thereafter, further cisplatin, intracavity cesium, and chemoradiation were administered. Findings from subsequent clinical examination and magnetic resonance imaging were normal. Fifteen months post treatment, both patient and baby remain well.

Conclusion:

Neoadjuvant cisplatin chemotherapy can be used in stage IIB cervical carcinoma during pregnancy to allow fetal development and prevent disease progression before delivery.

Lésions cervicales utérines pendant la grossesse : diagnostic et prise en charge

OBJECTIVES

To define a practical attitude for the management of pregnant women with cervical intraepithelial neoplasia (CIN) and cervical cancer.

MATERIALS AND METHODS

Review of the literature indexed in Medline.

RESULTS

The prevalence of the HPV infections is unchanged among pregnant women with infection by low risk viruses. The viral load increases at the time of the pregnancy, and decreases in the post-partum period. Cervical cytology is easily to perform with reliable results: among the 5% of pathological cervical smears, low grade lesions predominate. The high grade smears require colposcopic exploration, usefully completed by directed biopsies to rule out invasive lesions. Surveillance of high grade CIN is required during pregnancy with post-partum control; most regress. In France during the year 2000, 189 cancers of the uterine cervix were detected during 774.782 pregnancies. Clinical diagnosis is delayed by the non specific clinical signs and the histological aspects of the lesions which are identical with those observed in young woman. The intrinsic outcome of cancer is not modified by pregnancy, and the cesarean section is often preferred (vaginal delivery likely facilitates vascular dissemination). For fetal reasons, a therapeutic delay can be proposed for small sized lesions with a favourable histological subtype and no progression after 20 weeks of gestation.

CONCLUSION

Pregnancy offers the opportunity to perform cervical smears in women not regularly followed. A conservative attitude with a revaluation in postpartum can be proposed in the event of diagnosis of CIN during pregnancy. Pregnancy has little influence on invasive cervical cancers. Management decisions must be made on a case-by-case basis.