Introduction/Background Cervical cancer is the most common cancer diagnosed in pregnancy with an estimated incidence between 2–4/100000 pregnancies. Squamous cell variant accounts for 80% of the cases. According to the literature approximately 30% of women diagnosed with cervical cancer are in the reproductive age, whereas 3% of cervical cancers are diagnosed during pregnancy. At the time of the diagnosis around 70% of cervical cancers are staged as FIGO stage I-IIA.
Methodology We present the case of a 31-year old caucasian female patient with vaginal bleeding in the 15th gestational week (G3 P2). Vaginal and ultrasound examinations showed an intact pregnancy an exophytic tumour of the posterior cervical lip. The initial biopsy showed only a HSIL of the cervix. A cold knife cone biopsy was performed with diagnosis of a 5,9x4,9x3,2 cm squamous cell cervical cancer (HPV positive, G3). The termination of pregnancy, laparoscopic pelvic lymphadenectomy and chemoradiotherapy were offered and performed on the patient. The surgical-pathological staging was pT1b2, pN0, M0, G3, L1, V1, Pn0, R1. Unfortunately the planned brachytherapy after EBRT was not possible, instead we performed an external boost radiotherapy.
The patient was diagnosed with local recurrence eleven months after ending the radiotherapy. A salvage radical hysterectomy C2 (Querleu-Morrow) with iliac and paraaortic node dissection was performed with a surgical-pathological stage: rpT2a1, pN0, M0, G3, L1, V0, Pn0, R0. We decided for a postoperative treatment with six cycles of carboplatin-paclitaxel chemotherapy.
Results The follow-up controlls up to 15 months after surgery showed no signs of cancer recurrence.
Conclusion The case illustrates the complexity of the topic, the difficult decisions needed to be made by the physicians and the pregnant patient. Multidisciplinary approach in cervical cancer and pregnancy is strongly recommended. The radical hysterectomy for local recurrent cervical cancer after radiotherapy seems to be a feasible treatment.
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