Cervical neoplasia in pregnancy. Part 2: current treatment of invasive disease

Hunter, Mark; Tewari, Krishnansu S.; Monk, Bradley J.

doi:10.1016/j.ajog.2007.12.011

Cited by 64 publications

(48 citation statements)

References 62 publications

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“…The follow-up result showed that the patient was tumor-free and the baby was in good health, indicating that patients with stage IIA cervical cancer can continue pregnancy and postpone therapy for six weeks with satisfactory outcomes. Indeed, 70% of cervical cancers associated with pregnancy cases are diagnosed at tumor clinical stage I (Lee et al, 1981;Takushi et al, 2002;Hunter et al, 2008). Reports investigating postponed therapy for patients with stage II or more advanced tumor remain limited.…”

Section: Discussionmentioning

confidence: 99%

“…Retrospective studies with small patient numbers showed that only 5% (4/76) of pregnant patients died of cervical cancer after postponing therapy for an average of 16 weeks, indicating the satisfactory safety profile of postponed therapy, especially for early-stage tumor (Lee et al, 1981;Takushi et al, 2002;Hunter et al, 2008). Postponed therapy for stage IB1 cancer patients did not promote tumor recurrence in cases with no pelvic lymph node metastasis visible by laparoscopy (Nisker and Shubat, 1983;Greer et al, 1989;Alouini et al, 2008;Lee et al, 2008).…”

Section: Introductionmentioning

confidence: 99%

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Treatment and prognosis of cervical cancer associated with pregnancy: analysis of 20 cases from a Chinese tumor institution

Zhang

Yong-liang

Yang

2015

J. Zhejiang Univ. Sci. B

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Abstract:This study was designed to investigate the therapeutic approaches and prognosis for cervical cancer associated with pregnancy. Clinical information, therapeutic strategies, and follow-up results of 20 patients with cervical cancer associated with pregnancy from Jan. 2000 to June 2009 in the Zhejiang Cancer Hospital were retrospectively analyzed. The International Federation of Gynecology and Obstetrics (FIGO) stages were: in situ (n=1), stage IA1 (n=1), stage IB1 (n=5), stage IB2 (n=1), stage IIA (n=8), stage IIB (n=3), and stage IIIB (n=1). Eight patients were in the first trimester of pregnancy, four in the second, two in the third, and six at postpartum when diagnosed. The therapeutic strategies were either single or combined modalities, including surgery, radiotherapy, and chemotherapy. Fourteen patients survived, five patients died (four of remote metastasis and one of uremia), and one patient was lost to follow-up. One newborn from a patient at stage IIA carcinoma in the third trimester with postponed therapy six weeks after diagnosis survived. Retarded fetal growth was observed in one patient receiving neoadjuvant chemotherapy and cesarean section. Out of the six postpartum patients, three underwent cesarean section and survived, whereas only one out of the three who underwent vaginal delivery survived. The remaining two died of remote metastasis. Therefore, personalized treatment is necessary for cervical cancer associated with pregnancy. Cervical cancer patients in the third trimester of pregnancy can continue the pregnancy for a short period of time. There may be potential risk for the fetus by chemotherapy during pregnancy. Cesarean section is the preferred mode of delivery for pregnant cervical cancer patients.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Treatment and prognosis of cervical cancer associated with pregnancy: analysis of 20 cases from a Chinese tumor institution

Zhang

Yong-liang

Yang

2015

J. Zhejiang Univ. Sci. B

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“…70% of cervical cancers during pregnancy are diagnosed at stage I [3]. The most common symptom is vaginal bleeding, as well as vaginal discharge.…”

Section: Discussonmentioning

confidence: 99%

Cesarean Delivery with Bilateral Ovarian Transposition for Locally Advanced Cervical Cancer

Alanbay¹,

Öztürk²,

Ulubay³

et al. 2016

Ann Clin Anal Med

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ÖzetBiz vakamızda özellikle 3. trimestırda lokal ileri evre serviks kanserinin, sezeryan ile doğum esnasında ovaryan transpozisyon uygulama yöntemi hakkında tartışma-yı amaçladık. Hastamız 26 yaşında gebeliğinin 29 haftasında olup 9 gündür amnios sızıntısı devam etmektedir. Steril spekulum incelemesi sırasında geniş servikal lezyon saptandı. Servikal Biyopsi sonucu invaziv servikal kanser olarak rapor edildi. Manyetik rezonans görüntülemede şüpheli sağ parametriyal katılımı ile nodal tutulumu olmayan (MRG) 55X 63X 68 mm servikal lezyon, tutulum gösterilmiş-tir. Non-reaktif fetal durum ve şüpheli koryoamnionit ön tanısı ile elektif sezeryan planlandı. Otuzuncu gebelik haftasında elektif sezeryan ve bilateral ovaryan transpozisyon uygulandı. Pelvik radyasyon, eksternal brakiterapi ileri evre serviks kanseri için standart tedavi olarak uygulandı. Genç kadınlarda gebeliğin 3. trimestı-rında fetal matürite sağlandığında sezeryan uygulamasına ilave ovaryan transpozisyon uygulanması önerilmelidir. Anahtar KelimelerServikal Kanser; Ovaryan Transpozisyon; Gebelik AbstractWe aimed to discuss about management of pregnancy with locally advanced cervical cancer, especially at the third trimester with ovarian transposition concomittant with cesarean delivery.A 26 year old patient who was at the 29th week of gestation had amniotic leakage for 9 days. During the sterile speculum examination, a large cervical lesion was detected.The cervical biopsy revealed invasive squamous cervical cancer. An magnetic resonance imaging(MRI) showed 55X63X-68mm cervical lesion with suspicious right parametrial involvement, and no nodal involvement.An elective cesarean delivery decision was taken due to non-reassuring fetal status and suspicious chorioamnionitis.At 30th week of gestation, an elective cesarean delivery with bilateral ovarian transposition was performed.Pelvic radiation, including external beam and brachytherapy, has been the standard treatment of advanced cervical cancer.During the third trimester, fetal maturity is awaited and a caesarean section followed by standard treatment is proposed and the ovaries can be preserved with ovarian transposition in young women.

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“…The rarity of the situation makes large trials or randomized studies impossible, and guidelines up to now are based on small case series and expert opinion. Several clinical practice guidelines [Amant et al 2010;Hunter et al 2008;Morice et al 2009] as well as a Lancet series paper have been published [Morice et al 2012] in an attempt to reach a consensus on treatment options during pregnancy.…”

Section: Introductionmentioning

confidence: 99%

Cervical cancer in pregnant women: treat, wait or interrupt? Assessment of current clinical guidelines, innovations and controversies

et al. 2013

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Cervical neoplasia in pregnancy. Part 2: current treatment of invasive disease

Cited by 64 publications

References 62 publications

Treatment and prognosis of cervical cancer associated with pregnancy: analysis of 20 cases from a Chinese tumor institution

Treatment and prognosis of cervical cancer associated with pregnancy: analysis of 20 cases from a Chinese tumor institution

Cesarean Delivery with Bilateral Ovarian Transposition for Locally Advanced Cervical Cancer

Cervical cancer in pregnant women: treat, wait or interrupt? Assessment of current clinical guidelines, innovations and controversies

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