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Early Invasive Cervical Cancer During Pregnancy: Different Therapeutic Options to Preserve Fertility
  1. Domenico Ferriaoli, MD*,
  2. Annie Buenerd, MD,
  3. Pierangelo Marchiolè, MD,
  4. Sergio Constantini, MD*,
  5. Pier Luigi Venturini, MD, PhD* and
  6. Patrice Mathevet, MD, PhD§
  1. *Department of Obstetrics and Gynaecology, San Martino Hospital and University of Genoa, Genoa, Italy;
  2. Laboratory of Anatomy and Cyto-Pathology, Groupement Hospitalier Est, Bron, France;
  3. Department of Gynecology and Obstetrics, Villa Scassi Hospital, Genoa, Italy;
  4. §Department of Gynecology, Femme-Mère-Enfant Hospital,Bron, France; and
  5. Claude Bernard Lyon I University, Lyon, France.
  1. Address correspondence and reprint requests to Patrice Mathevet, MD, PhD, Department of Gynecology, Femme Mère Enfant Hospital, 59 Blvd Pinel, 69677 Bron Cedex, France. E-mail: patrice.mathevet@chu-lyon.fr.

Abstract

Introduction Cervical cancer is the second most common cancer diagnosed during pregnancy. Conservative management is possible, and different options should be discussed with patients. The main decision parameters are stage of disease, lymph node status, trimester of pregnancy and wishes of the patient. We reviewed our experience on cases of early-stage cervical cancer discovered during pregnancy and treated with different options of fertility-sparing management.

Materials and Methods Between 1990 and 2010, 5 patients with early-stage cervical cancer diagnosed during pregnancy were referred to our department for fertility-sparing treatment. The mean age at diagnosis was 28.6 years (range, 26–30 years). The stages of the tumors according to the International Federation of Gynecology and Obstetrics were IA2 in 2 women and IB1 in 3 women. The histological type was squamous carcinoma in 3 cases and adenocarcinoma in 2 cases. All patients willing to preserve their fertility were treated with vaginal radical trachelectomy (VRT) and pelvic lymph nodes dissection (PLN-D).

Results Three procedures were performed in the first trimester: 1 patient was treated with medical abortion and then VRT and PLN-D, 2 patients were submitted to VRT and PLN-D during the first trimester, and 1 patient’s case was complicated by spontaneous abortion. One patient was observed during the second trimester (20 weeks of gestation) and treated with VRT and PLN-D during pregnancy. Because this patient had pelvic lymph nodes positive for cancer, a cesarean delivery (CD) with radical hysterectomy and para-aortic lymph nodes dissection was performed followed by chemoradiotherapy. The last patient was evaluated during the third trimester of her pregnancy. Treatment included CD followed by VRT and PLN-D, which was delayed, to allow fetal maturity.

Conclusions Diagnosis of cervical cancer can occur during pregnancy. Different options of fertility-sparing treatment can be discussed on the basis of several factors: tumor stage, gestational age, and the patient’s desire regarding fertility and pregnancy sparing.

  • Early invasive cervical cancer
  • Pregnancy and cancer
  • Fertility-sparing treatment
  • Radical trachelectomy

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Footnotes

  • The authors declare that there are no conflicts of interest.

  • In memoriam of Daniel Dargent.

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