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Le Guévelou J, Selleret L, Laas E, Lecuru F, Kissel M. Cervical Cancer Associated with Pregnancy: Current Challenges and Future Strategies. Cancers (Basel) 2024; 16:1341. [PMID: 38611019 PMCID: PMC11011172 DOI: 10.3390/cancers16071341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 03/25/2024] [Accepted: 03/27/2024] [Indexed: 04/14/2024] Open
Abstract
Cancer during pregnancy is defined as a tumor diagnosed in a pregnant woman or up to 1-year post-partum. While being a rare disease, cervical cancer is probably one of the most challenging medical conditions, with the dual stake of treating the cancer without compromising its chances for cure, while preserving the pregnancy and the health of the fetus and child. To date, guidelines for gynecological cancers are provided through international consensus meetings with expert panels, giving insights on both diagnosis, treatment, and obstetrical care. However, these expert guidelines do not discuss the various approaches than can be found within the literature, such as alternative staging modalities or innovative surgical approaches. Also, the obstetrical care of women diagnosed with cervical cancer during pregnancy requires specific considerations that are not provided within our current standard of care. This systematic review aims to fill the gap on current issues with regards to the management of cervical cancer during pregnancy and provide future directions within this evolving landscape.
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Affiliation(s)
- Jennifer Le Guévelou
- Faculty of Medicine, University of Geneva, 1205 Geneva, Switzerland
- Department of Radiation Oncology, Centre Eugène Marquis, 35000 Rennes, France
| | - Lise Selleret
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Sorbonne University, 75005 Paris, France
- Cancer Associé à La Grossesse (CALG), French CALG Network, 75005 Paris, France
| | - Enora Laas
- Breast, Gynecology and Reconstructive Surgery Unit, Institut Curie, 75005 Paris, France
| | - Fabrice Lecuru
- Breast, Gynecology and Reconstructive Surgery Unit, Institut Curie, 75005 Paris, France
- Université de Paris, 75006 Paris, France
| | - Manon Kissel
- Department of Radiation Oncology, Institut Curie, 75005 Paris, France
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Salvo G, Frumovitz M, Pareja R, Lee J, Ramirez PT. Simple trachelectomy with pelvic lymphadenectomy as a viable treatment option in pregnant patients with stage IB1 (≥2 cm) cervical cancer: Bridging the gap to fetal viability. Gynecol Oncol 2018; 150:50-55. [PMID: 29804639 DOI: 10.1016/j.ygyno.2018.05.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 05/08/2018] [Accepted: 05/10/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Cervical cancer is the most common gynecologic cancer in pregnancy. This study aims to evaluate simple trachelectomy and pelvic lymphadenectomy in patients with stage IB1 (≥2 cm) cervical cancer wishing to maintain their pregnancy. METHODS We included patients with stage IB1 (≥2 cm) cervical cancer who underwent simple trachelectomy and minimally invasive pelvic lymphadenectomy during pregnancy from January 2004 to August 2016. Data analysis included demographics, perioperative, obstetrics, and oncologic outcomes. RESULTS A total of 5 patients were included. Median age was 30 years (range; 26-38). Median gestational age (GA) at diagnosis was 12 weeks (range; 7-18) and at treatment intervention 16.5 weeks (range; 12-19). Histologic subtypes included: adenocarcinoma (3 patients) and squamous cell carcinoma (2 patients). Median tumor size by clinical exam was 27 mm (range; 20-40), grade 2 (range; 2-3) and depth of invasion 10 mm (range; 1.5-12). All patients underwent laparoscopic (1) or robotic (4) pelvic lymphadenectomy followed by vaginal simple trachelectomy. Median operative time was 193 min (range; 155-259), estimated blood loss 100 ml (range; 50-550) and length of stay 2 days (range; 1-3). There were no intraoperative or postoperative complications (<30 days). Median number of lymph nodes removed was 14 (range; 5-15). One patient had bilateral microscopic positive nodes. The median gestational age at delivery was 39 weeks (range; 28-40.6). After median follow-up of 75 months (range; 18-168), all patients are alive without disease. CONCLUSION Simple trachelectomy with pelvic lymph node dissection may be a safe option in pregnant patients with stage IB1 (>2 cm) cervical cancer wishing to maintain their pregnancy.
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Affiliation(s)
- Gloria Salvo
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States
| | - Michael Frumovitz
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States
| | - Rene Pareja
- Department of Gynecologic Oncology, Instituto Nacional de Cancerología (Bogotá-Colombia) and Clínica de Oncología Astorga, Medellín, Colombia
| | - Joseph Lee
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States
| | - Pedro T Ramirez
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States.
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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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Farthing A, Kyrgiou M. Authors' Reply re: Laparoscopic radical abdominal trachelectomy for the management of stage IB1 cervical cancer at 14 weeks gestation: case report and review of the literature. BJOG 2016; 123:646. [PMID: 26914902 DOI: 10.1111/1471-0528.13771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Alan Farthing
- West London Gynaecological Cancer Center, Imperial Healthcare NHS Trust, London, UK
| | - Maria Kyrgiou
- West London Gynaecological Cancer Center, Imperial Healthcare NHS Trust, London, UK.,Department of Surgery and Cancer, Imperial College London, London, UK
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Kyrgiou M, Horwell DH, Farthing A. Laparoscopic radical abdominal trachelectomy for the management of stage IB1 cervical cancer at 14 weeks' gestation: case report and review of the literature. BJOG 2015; 122:1138-43. [PMID: 25832461 DOI: 10.1111/1471-0528.13392] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/17/2014] [Indexed: 11/27/2022]
Affiliation(s)
- M Kyrgiou
- Department of Surgery & Cancer, Faculty of Medicine, Imperial College, London, UK.,West London Gynaecological Cancer Centre, Queen Charlotte's & Chelsea - Hammersmith Hospital, Imperial Healthcare NHS Trust, London, UK
| | | | - A Farthing
- Department of Surgery & Cancer, Faculty of Medicine, Imperial College, London, UK.,West London Gynaecological Cancer Centre, Queen Charlotte's & Chelsea - Hammersmith Hospital, Imperial Healthcare NHS Trust, London, UK
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Conservative treatment of uterine cervical adenocarcinoma in pregnancy. Case Rep Obstet Gynecol 2013; 2013:692017. [PMID: 24455354 PMCID: PMC3877580 DOI: 10.1155/2013/692017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Accepted: 11/24/2013] [Indexed: 11/20/2022] Open
Abstract
Cancer of the cervix is the most common malignancy diagnosed during pregnancy, with an incidence of 1–10 cases per 10,000 pregnancies. The desire of patients to maintain pregnancy and subsequent fertility is a difficult target to be achieved and should be widely studied, since it depends on the stage of disease, gestational age at diagnosis, and the woman's desire to maintain pregnancy. We describe in this report the case of a pregnant woman with invasive cervical adenocarcinoma in stage IB1 (FIGO) initially treated with neoadjuvant chemotherapy, followed by radical surgery and cesarean section in the same surgical procedure.
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Kolomainen D, Bradley R, Larsen-Disney P, Shepherd J. Radical vaginal trachelectomy at 16 weeks' gestation: A case report. GYNECOLOGIC ONCOLOGY CASE REPORTS 2013; 5:28-30. [PMID: 24371689 PMCID: PMC3862222 DOI: 10.1016/j.gynor.2013.03.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/03/2013] [Accepted: 03/04/2013] [Indexed: 11/18/2022]
Abstract
•A young woman diagnosed with early-stage cervical cancer whilst pregnant is a clinical dilemma.•The maternal risks need to be balanced against the risks to the foetus.•Radical vaginal trachelectomy has a potential role as treatment with a favourable outcome for mother and baby.
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Affiliation(s)
- D.F. Kolomainen
- Department of Gynaecological Oncology, The Royal Marsden NHS Foundation Trust, London, UK
| | - R.J. Bradley
- Department of Gynaecological Oncology, Royal Sussex County Hospital, Brighton, UK
| | - P. Larsen-Disney
- Department of Gynaecological Oncology, Royal Sussex County Hospital, Brighton, UK
| | - J.H. Shepherd
- Department of Gynaecological Oncology, The Royal Marsden NHS Foundation Trust, London, UK
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Bravo E, Parry S, Alonso C, Rojas S. Radical vaginal trachelectomy and laparoscopic pelvic lymphadenectomy in IB1 cervical cancer during pregnancy. GYNECOLOGIC ONCOLOGY CASE REPORTS 2012; 2:78-9. [PMID: 24371625 DOI: 10.1016/j.gynor.2012.04.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2012] [Accepted: 04/03/2012] [Indexed: 10/28/2022]
Abstract
► We expose an novel surgical technique in pregnant women with cervical cancer. ► We preserve the pregnancy in this case. ► After 40 months of monitoring both patient and her child are healthy.
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Affiliation(s)
- Erasmo Bravo
- Oncologic Gynecology Unit, Van Buren Hospital, Valparaíso, Chile ; Oncologic Gynecology Unit, Gustavo Fricke Hospital, Viña del Mar, Chile ; Department of Gynecology and Obstetrics, University of Valparaíso, School of Medicine, Valparaíso, Chile
| | - Santiago Parry
- Oncologic Gynecology Unit, Van Buren Hospital, Valparaíso, Chile ; Oncologic Gynecology Unit, Gustavo Fricke Hospital, Viña del Mar, Chile
| | - Catalina Alonso
- Oncologic Gynecology Unit, Gustavo Fricke Hospital, Viña del Mar, Chile ; Department of Gynecology and Obstetrics, University of Valparaíso, School of Medicine, Valparaíso, Chile
| | - Sergio Rojas
- Oncologic Gynecology Unit, Van Buren Hospital, Valparaíso, Chile ; Oncologic Gynecology Unit, Gustavo Fricke Hospital, Viña del Mar, Chile ; Department of Gynecology and Obstetrics, University of Valparaíso, School of Medicine, Valparaíso, Chile
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Amant F, Brepoels L, Halaska MJ, Gziri MM, Van Calsteren K. Gynaecologic cancer complicating pregnancy: An overview. Best Pract Res Clin Obstet Gynaecol 2010; 24:61-79. [DOI: 10.1016/j.bpobgyn.2009.08.001] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2009] [Accepted: 08/05/2009] [Indexed: 11/26/2022]
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The management of women with abnormal cervical cytology in pregnancy. Best Pract Res Clin Obstet Gynaecol 2009; 24:51-60. [PMID: 19805007 DOI: 10.1016/j.bpobgyn.2009.07.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2009] [Accepted: 07/29/2009] [Indexed: 11/29/2022]
Abstract
The management of women with abnormal cytology in pregnancy represents both a diagnostic and a therapeutic challenge for colposcopists. The emphasis should be on diagnosis and confirmation of cervical precancer (Cervical intraepithelial neoplasia (CIN) or Adenocarcinoma in situ (AIS), thus excluding invasive cancer). Following an initial assessment, careful follow-up is essential. This must include colposcopy and take into account the physiological changes of the cervix during pregnancy and the puerperium. The management of women with invasive cancer diagnosed during pregnancy depends on the gestation at diagnosis and requires careful assessment and multidisciplinary planning.
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Gurney EP, Blank SV. Postpartum radical trachelectomy for IB1 squamous cell carcinoma of the cervix diagnosed in pregnancy. Am J Obstet Gynecol 2009; 201:e8-e10. [PMID: 19695559 DOI: 10.1016/j.ajog.2009.06.072] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2009] [Revised: 05/22/2009] [Accepted: 06/22/2009] [Indexed: 11/25/2022]
Abstract
Standard management of stage IB1 cervical cancer in pregnancy is radical hysterectomy with fetus in situ if diagnosis precedes viability, or cesarean radical hysterectomy. Postpartum abdominal radical trachelectomy was performed as an alternative, fertility-preserving surgery in a 30-year-old nulliparous woman diagnosed with stage IB1 cervical at 21 weeks' gestation.
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Van De Nieuwenhof HP, Van Ham MA, Lotgering FK, Massuger LF. First case of vaginal radical trachelectomy in a pregnant patient. Int J Gynecol Cancer 2008; 18:1381-5. [DOI: 10.1111/j.1525-1438.2008.01193.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Women who present with cervical carcinoma during pregnancy pose for us a clinical problem. In general, three treatment options exist: (i) radical hysterectomy with termination of pregnancy, (ii) a planned delay, or (iii) chemotherapy until lung maturation has occurred, both followed by a radical hysterectomy. Vaginal radical trachelectomy is an alternative approach to preserve the pregnancy. We report on a woman with a stage IBI cervical carcinoma, diagnosed at 16 weeks of gestation treated with vaginal radical trachelectomy. At a gestational age of 36 weeks, a cesarean section was performed, followed by radical hysterectomy. Follow-up of 9 months is uneventful for both the mother and the child. The vaginal radical trachelectomy is a new approach in the treatment of cervical carcinoma during pregnancy.
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Ungár L, Smith JR, Pálfalvi L, Del Priore G. Abdominal Radical Trachelectomy During Pregnancy to Preserve Pregnancy and Fertility. Obstet Gynecol 2006; 108:811-4. [PMID: 17018513 DOI: 10.1097/01.aog.0000216015.15415.5f] [Citation(s) in RCA: 80] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND For 10,000-40,000 women each year, cervical cancer complicates pregnancy. Current therapy usually terminates the pregnancy and results in the loss of future fertility. Abdominal radical trachelectomy is a fertility-preserving alternative to radical hysterectomy for young women with cervical cancer. CASES We report five pregnancies complicated by cervical cancer treated by abdominal radical trachelectomy with preservation of the concurrent pregnancy and the birth of two healthy term infants. CONCLUSION Pregnancy complicated by concurrent cervical cancer can be managed with abdominal radical trachelectomy during pregnancy while preserving future fertility.
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Affiliation(s)
- László Ungár
- Department of Gynaecologic Oncology, St Stephen Hospital, Budapest, Hungary
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Monleón J, Goberna L, Monleón F. Cáncer y gestación. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2006. [DOI: 10.1016/s0210-573x(06)74091-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Zoundi-Ouango O, Morcel K, Classe JM, Burtin F, Audrain O, Levêque J. Lésions cervicales utérines pendant la grossesse : diagnostic et prise en charge. ACTA ACUST UNITED AC 2006; 35:227-36. [PMID: 16645555 DOI: 10.1016/s0368-2315(06)78306-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
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.
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Affiliation(s)
- O Zoundi-Ouango
- Département d'Obstétrique Gynécologie et Médecine de la Reproduction, CHU de Rennes, Hôpital Sud, 16, boulevard de Bulgarie, BP 90347, 35203 Rennes Cedex 2
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Abstract
This article reviews the key concepts regarding the counseling and management of cervical dysplasia and invasive cervical cancer diagnosed during pregnancy. Emphasis is placed on balancing the maternal and fetal well-being in collaboration with appropriate multidisciplinary teams. Information regarding appropriate diagnosis strategies and the impact of delay in treatment, subsequent prognosis, and treatment algorithms are discussed. Novel fertility-sparing techniques for cervical cancer and their impact on complications of future pregnancies are also discussed.
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Affiliation(s)
- Carolyn Y Muller
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of New Mexico Health Sciences Center, 1 University of New Mexico, MSC 10 5580, Albuquerque, NM 87131, USA.
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