Management of invasive cervical cancer in pregnancy: clinical analysis of 13 cases / 中华妇产科杂志

ABSTRACT

Objective To analyze the clinical characteristics and assess the outcome of treatment for cervical cancer during pregnancy.Methods A cohort of 13 patients with cervical cancer diagnosed during pregnancy from January 2001 to September 2011 in Peking Union Medical College Hospital (PUMCH) was retrospectively studied.Clinical information,gestational age at diagnosis,treatment options and maternal and child outcomes were collected and analyzed.Results Thirteen patients out of 2030 cases of invasive cervical cancer were diagnosed during pregnancy with an incidence of 0.64％ (13/2030).The Mean gestational age at diagnosis of 13 patients is 21+6 weeks.Two cases were diagnosed during the first trimester,8 cases at second trimester and 3 cases at third trimester respectively.Vaginal bleeding during the pregnancy was main clinical manifestation presented in 8 patients and all thirteen cases were diagnosed by biopsy with pathological types of squamous cell carcinoma in 10 cases.The International Federation of Gynecology and Obstetrics (FIGO) stage was Ⅰ in eleven cases and stage Ⅱ in two cases.Six patients of them received treatment promptly after diagnosis.The other 7 patients had delayed treatment with mean diagnosis-treatment interval time of 65 days due to fertility reasons,who ended pregnancy by cesarean section at mean gestational age of 34+6 weeks,two of them received chemotherapy with cisplatin + fiuorouracil (PF)or cisplatin respectively before the end of the pregnancy,while the one with PF chemotherapy experienced neonatal death.The rest 6 neonatal outcomes were good.As follow-up of 13 cases11 cases in stage Ⅰ received surgical treatment,and two of which had recurrence respectively,15 months and 7 months post surgery,and one case had died.One case of Stage Ⅱ patients died and one had recurrence after 53 months after radiotherapy.The recurrence rate in 13 cases was 3/13 and the mortality rate was 2/13.Conclusions Most cases of cervical cancer diagnosed during pregnancy were in early FIGO stage.For those patients diagnosed in late pregnancy with strong fertility demand,considering delayed treatment according to FIGO stage of the disease and fetus maturity is appropriate.Chemotherapy during pregnancy may cause neonatal complications.