Management of precancerous lesions prior to conception and during pregnancy: a narrative review of the literature

Abstract

Special considerations aiming at preserving reproductive function have to be implemented when treating young patients with precancerous lesions of the lower genital tract. These high-grade lesions may progress into invasive cancer if left untreated. Currently, there are limited data on the impact of vulvar and vaginal precancerous lesions on fertility and its management during pregnancy. However, management and outcomes for cervical lesions have been extensively reported. The main approach for vulvar and vaginal lesions are maintaining anatomical function and cosmetics; whereas, treatment options for cervical precancerous lesions range from observation, cryotherapy or the more aggressive conisation. Gestational age is the most important factor in determining expectant management or surgical intervention. This narrative review draws attention to the relevant aspects of precancerous lesions of the lower genital tract, the potential effects and management prior to conception and during pregnancy.

Current management of gynecologic cancer in pregnancy

“…Warts and intraepithelial lesions of the squamous epithelium (SIL) tend to increase in size during pregnancy. In most cases, no treatment is recommended unless the lesions are symptomatic ( 11 ). These lesions regress following delivery.…”

Methodische Entwicklung von evidenzbasierten Leitlinien am Beispiel der S3-Leitlinie „Diagnostik, Therapie und Nachsorge der Patientin mit Zervixkarzinom“

“…CIN-Läsionen (inklusive hochgradige Läsionen) werden daher -trotz eines geringen Progressionsrisikos -in der Schwangerschaft zumeist kolposkopisch kontrolliert und nach der Geburt reevaluiert und ggf. therapiert [193][194][195]204]. Während der Schwangerschaft ist das empfohlene Kontrollintervall alle 8-12 Wochen.…”

Prevalência e conduta terapêutica de lesões pré-malignas de colo uterino em gestantes atendidas em hospital público do Rio Grande do Sul

“…Já as lesões de alto grau se não forem tratadas podem se tornar com o passar do tempo cancerosas, exigindo um tratamento mais agressivo e intenso. Dessa forma, devemos dar importância a um diagnóstico precoce, pois a maioria das pacientes são assintomáticas e não procuram orientação médica até que observem alguma alteração física em seu corpo 6 .…”