Diagnosis and treatment of cervical cancer in pregnant women

Nitish Beharee, Zhujun Shi, Dongchen Wu, Jinhua Wang, Nitish Beharee, Zhujun Shi, Dongchen Wu, Jinhua Wang

Abstract

In recent years, the incidence of gynecological malignant tumors during pregnancy has increased, mainly due to the increased number of old age pregnancy. The most common gynecological malignant tumors in pregnancy are cervical cancer, accounting for 71.6%, followed by ovarian malignant tumors, accounting for 7.0%. The incidence of cervical cancer in pregnancy is itself not very high, and the symptoms are easily confused with other diseases in pregnancy. During pregnancy, gynecological examination is limited, and therefore, the rate of misdiagnosis is higher. The treatment of cervical cancer during pregnancy is related to many factors, such as tumor size, pathological type, period of gestation, lymph node involvement, and patients' willingness to maintain pregnancy. As a reason of these factors, it is difficult to determine the optimal treatment. This article reviews the research progress on the diagnosis and treatment principles of cervical cancer in pregnancy, in order to strike a balance between effective treatment of tumors and protection of fetal health, and avoid delays in treatment and preterm delivery.

Keywords: cervical cancer; chemotherapy; diagnosis; pregnancy; pregnancy with cervical cancer; tumor management; tumor staging.

Conflict of interest statement

None declared.

© 2019 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.

References

    1. Nguyen C, Montz FJ, Bristow RE. Management of stage I cervical cancer in pregnancy. Obstet Gynecol Surv. 2000;55:633.
    1. Creasman WT. Cancer and pregnancy. Ann N Y Acad Sci. 2001;943:281.
    1. Smith LH, Dalrymple JL, Leiserowitz GS, Danielsen B, Gilbert WM. Obstetrical deliveries associated with maternal malignancy in California, 1992 through 1997. Am J Obstet Gynecol. 2001;184:1504.
    1. Smith LH, Danielsen B, Allen ME, Cress R. Cancer associated with obstetric delivery: results of linkage with the California cancer registry. Am J Obstet Gynecol. 2003;189:1128.
    1. Demeter A, Sziller I, Csapó Z, et al. Outcome of pregnancies after cold‐knife conization of the uterine cervix during pregnancy. Eur J Gynaecol Oncol. 2002;23:207.
    1. Duggan B, Muderspach LI, Roman LD, et al. Cervical cancer in pregnancy: reporting on planned delay in therapy. Obstet Gynecol. 1993;82:598.
    1. Shiping Z, Lushan ZQ, et al. Progress in diagnosis and treatment of pregnancy complicated with cervical cancer. J Pract Med. 2018;25(4):400‐402.
    1. Meihao OG. The effect of pregnancy with cervical cancer on mother and child and the principle of diagnosis and treatment. Adv Modern Obstetr Gynecol. 2008;17(1):64‐66.
    1. Morice P, Uzan C, Gouy S, Verschraegen C, Haie‐Meder C. Gynaecological cancers in pregnancy. Lancet. 2012;379(9815):558‐569.
    1. Morimura Y, Fujimori K, Soeda S, et al. Cervical cytology during pregnancy: comparison with non‐pregnant women and management of pregnant women with abnormal cytology. Fukushima J Med Sci. 2002;48(1):27‐37.
    1. Li T, Wang J, Song F. Progress in the diagnosis and treatment of gynecological malignant tumors during pregnancy. Cancer Progression. 2018;16(13):1589‐1592, 1615.
    1. Jain AG, Higgins RV, Boyle MJ. Management of low‐grade squamous intraepithelial lesions during pregnancy. Am J Obstet Gynecol. 1997;177(2):298‐302.
    1. Schaefer K, Peters D, Aulmann S, Sohn C, Eichbaum M. Value and feasibility of LLETZ procedures for pregnant women with suspected high‐grade squamous intraepithelial lesions and microinvasive cervical cancer. Int J Gynaecol Obstet. 2012;118(2):141‐144.
    1. Lihui W, Yun Z, Xing X, et al. Expert consensus on the management of cervical cancer in pregnancy. Chinese J Obstetr Gynecol. 2018;19(2):190‐192.
    1. Siegler E, Lavie O, Amit A, Vaknin Z, Auslander R, Blumenfeld Z. Should the risk of invasive cancer in pregnancy and the safety of loop electrosurgical excision procedure during the first 15 weeks change our practice?. J Low Genit Tract Dis. 2017;21(4):299‐303.
    1. Robova H, Rob L, Pluta M, et al. Squamous intraepithelial lesion‐microinvasive carcinoma of the cervix during pregnancy. Eur J Gynaecol Oncol. 2005;26(6):611‐614.
    1. Amant F, Halaska MJ, Fumagalli M, et al. Gynecologic cancers in pregnancy: guidelines of a second international consensus meeting. Int J Gynecol Cancer. 2014;24(3):394‐403.
    1. Weinmann S, Naleway A, Swamy G, et al. Pregnancy outcomes after treatment for cervical cancer precursor lesions: an observational study. PLoS ONE. 2017;12(1):e0165276.
    1. Botha MH, Rajaram S, Karunaratne K. Cancer in pregnancy. Int J Gynecol Obstet. 2018;143:137‐142.
    1. Rob L, Skapa P, Robova H. Fertility‐sparing surgery in patients with cervical cancer. Lancet Oncol. 2011;12(2):192‐200.
    1. Căpîlna ME, Szabo B, Becsi J, Ioanid N, Moldovan B. Radical trachelectomy performed during pregnancy: a review of the literature. Int J Gynecol Cancer. 2016;26(4):758‐762.
    1. Peccatori FA, Azim HA, Orecchia R, et al. pregnancy and fertility: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow‐up. Ann Oncol. 2013;24(suppl 6):vi160‐vi170.
    1. Silva LB, Silva‐Filho AL, Traiman P, et al. Sentinel node mapping in a pregnant woman with cervical cancer: a case report. Int J Gynecol Cancer. 2006;16(3):1454‐1457.
    1. Jianhuan Z. Progress in the diagnosis and treatment of cervical cancer with pregnancy. China Pract Med. 2010;5(6):245‐246.
    1. Yukun L, Yinglin L, Shuning Z, et al. Clinical analysis of malignant tumors in pregnancy. Chinese J Clin Med Women Children. 2013;9(1):9‐14.
    1. Song YZ, Liu Y, Lin M, et al. Efficacy of neoadjuvant platinum‐based chemotherapy during the second and third trimester of pregnancy in women with cervical cancer: an updated systematic review and meta‐analysis. Drug Des DevelTher. 2019;13:79‐102.
    1. Calsteren KV, Verbesselt R, Devlieger R, et al. Transplacental transfer of paclitaxel, docetaxel, carboplatin, and trastuzumab in a baboon model. Int J Gynecol Cancer. 2010;20(9):1456‐1464.
    1. Köhler C, Oppelt P, Favero G, et al. How much platinum passes the placental barrier? analysis of platinum applications in 21 patients with cervical cancer during pregnancy. Am J ObstetGynecol. 2015;213(2):206.e1‐206.e5.
    1. Cardonick E, Iacobucci A. Use of chemotherapy during human pregnancy. Lancet Oncol. 2004;5(5):283‐291.
    1. Furukawa S, Hayashi S, Usuda K, Abe M, Hagio S, Ogawa I. Effect of cisplatin on rat placenta development. ExpToxicolPathol. 2013;65(1/2):211‐217.
    1. Kozuki N, Lee AC, Katz J, et al. Moderate to severe, but not mild, maternal anemia is associated with increased risk of small‐for‐gestational‐age outcomes. J Nutr. 2012;142(2):358‐362.
    1. Zagouri F, Sergentanis TN, Chrysikos D, Bartsch R. Platinum derivatives during pregnancy in cervical cancer: a systematic review and meta‐analysis. ObstetGynecol. 2013;121(2 Pt 1):337‐343.
    1. da Fonseca AJ, Dalla‐Benetta AC, Ferreira LP, et al. Neoadjuvant chemotherapy followed by radical surgery in pregnant patient with invasive cervical cancer: case report and literature review. Rev Bras GinecolObstet. 2011;33(1):43‐48.

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