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Le Guévelou J, Selleret L, Laas E, Lecuru F, Kissel M. Cervical Cancer Associated with Pregnancy: Current Challenges and Future Strategies. Cancers (Basel) 2024; 16:1341. [PMID: 38611019 PMCID: PMC11011172 DOI: 10.3390/cancers16071341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 03/25/2024] [Accepted: 03/27/2024] [Indexed: 04/14/2024] Open
Abstract
Cancer during pregnancy is defined as a tumor diagnosed in a pregnant woman or up to 1-year post-partum. While being a rare disease, cervical cancer is probably one of the most challenging medical conditions, with the dual stake of treating the cancer without compromising its chances for cure, while preserving the pregnancy and the health of the fetus and child. To date, guidelines for gynecological cancers are provided through international consensus meetings with expert panels, giving insights on both diagnosis, treatment, and obstetrical care. However, these expert guidelines do not discuss the various approaches than can be found within the literature, such as alternative staging modalities or innovative surgical approaches. Also, the obstetrical care of women diagnosed with cervical cancer during pregnancy requires specific considerations that are not provided within our current standard of care. This systematic review aims to fill the gap on current issues with regards to the management of cervical cancer during pregnancy and provide future directions within this evolving landscape.
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Affiliation(s)
- Jennifer Le Guévelou
- Faculty of Medicine, University of Geneva, 1205 Geneva, Switzerland
- Department of Radiation Oncology, Centre Eugène Marquis, 35000 Rennes, France
| | - Lise Selleret
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Sorbonne University, 75005 Paris, France
- Cancer Associé à La Grossesse (CALG), French CALG Network, 75005 Paris, France
| | - Enora Laas
- Breast, Gynecology and Reconstructive Surgery Unit, Institut Curie, 75005 Paris, France
| | - Fabrice Lecuru
- Breast, Gynecology and Reconstructive Surgery Unit, Institut Curie, 75005 Paris, France
- Université de Paris, 75006 Paris, France
| | - Manon Kissel
- Department of Radiation Oncology, Institut Curie, 75005 Paris, France
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2
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He Z, Xie C, Qi X, Hu Z, He Y. The effect of preserving pregnancy in cervical cancer diagnosed during pregnancy: a retrospective study. BMC Womens Health 2022; 22:314. [PMID: 35879712 PMCID: PMC9317436 DOI: 10.1186/s12905-022-01885-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 07/15/2022] [Indexed: 12/24/2022] Open
Abstract
Objective Cervical cancer diagnosed during pregnancy is a rare event, and data regarding efficacy of cancer treatment during pregnancy is limited. This study aimed to assess the safety of continuation of the pregnancy for mother and fetus when concomitantly diagnosed with cervical cancer. Methods This study retrospectively analyzed all cervical cancer patients diagnosed while pregnant or immediately postpartum, inclusive from Jan 2010 to June 2019 at our institute. Patient clinical details and follow-up were obtained from hospital records. Results The study comprised 40 patients with clinical cancer stages of IA1 (1/40, 2.5%); IB1 (15/40, 37.5%); IB2 (10/40, 25%); IIA (12/40, 30%); and IIB (2/40, 5%). There were 38 patients diagnosed during pregnancy, and 2 diagnosed in the postpartum period. Of the 38 patients, 17 were diagnosed in the first trimester, 13 in the second trimester, and 8 in the third trimester. 10 of 38 patients (26.3%) continued their pregnancy after learning of their diagnosis; 7 (70%) in the third trimester and 3 (30%) in the second trimester. The mean time from diagnosis to surgery in the patients who continued their pregnancy was 52.7 days, which was statistically significantly greater than the termination of pregnancy group (52.7 vs. 16.3 days, P < 0.01). Notably, there was no survival difference between the 2 groups (100% vs. 90.91%, P = 0.54), and none of the pregnant women who ultimately died had delayed treatment due to pregnancy. Similarly, the surgical estimated blood loss and operative duration comparison in the 2 groups were not significantly different. Conclusions In the present study, the gestational age of pregnancy at the time of initial diagnosis of cervical cancer was an important determinant in the disease management. Continuation of the pregnancy when diagnosed with cervical cancer may not affect the oncologic outcome of the mother nor increase either surgical or obstetric complications. Additionally, the use of neoadjuvant chemotherapy did not threaten the health of the fetus. These results may be useful in counseling patients facing the diagnosis of cervical cancer during pregnancy.
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3
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Nagasawa S, Kasahara M, Aoki Y, Kusunoki S, Sugimori Y, Matsuoka S, Ogura K, Ogishima D. Successful pregnancy with stage IB2 uterine cervical cancer: A case report. Cancer Rep (Hoboken) 2021; 5:e1542. [PMID: 34528406 PMCID: PMC9327669 DOI: 10.1002/cnr2.1542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 07/11/2021] [Accepted: 08/14/2021] [Indexed: 11/18/2022] Open
Abstract
Background Although cervical cancer is one of the most common malignancies in pregnancy, its management mainly follows the guidelines for nonpregnant disease state. Within the limited time, patients, and healthcare workers must make difficult decisions to either delay treatment until documented fetal maturity or start immediate treatment based on the disease stage. Case The patient was a 37‐year‐old woman: gravida 1, para 0. Her cervical cytology revealed a high‐grade squamous intraepithelial lesion at 8 weeks' gestation. Moreover, invasive squamous cell carcinoma was suspected based on the findings of uterine cervix biopsy. Cervical conization was performed at 11 weeks' gestation, confirming a histopathological diagnosis of squamous cell carcinoma, pT1b2. Cervical cytology findings continued to be negative for intraepithelial lesion or malignancy from 2 weeks after conization until 2 weeks before a cesarean section. In addition, we performed abdominal pelvic lymphadenectomy at 16 weeks' gestation to determine whether the patient could continue her pregnancy. No lymph node metastasis or local recurrence was observed. Finally, a cesarean section and modified radical hysterectomy were performed at 35 weeks' gestation. There was no carcinoma invasion or metastasis. A baby girl weighing 2056 g was delivered with 1‐ and 5‐min Apgar scores of 8 and 9, respectively. Five years postoperatively, there was no evidence of cancer recurrence. Conclusion Management of cervical cancer during pregnancy by using a combination strategy of deep conization and pelvic lymphadenectomy could be an effective strategy for carefully and safely assessing risks of recurrence and metastasis.
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Affiliation(s)
- Saya Nagasawa
- Department of Obstetrics and Gynecology, Juntendo University Nerima Hospital, Nerima-ku, Tokyo, Japan
| | - Makiko Kasahara
- Department of Obstetrics and Gynecology, Juntendo University Nerima Hospital, Nerima-ku, Tokyo, Japan
| | - Yuji Aoki
- Department of Diagnostic Pathology, Juntendo University Nerima Hospital, Nerima-ku, Tokyo, Japan
| | - Soshi Kusunoki
- Department of Obstetrics and Gynecology, Juntendo University Nerima Hospital, Nerima-ku, Tokyo, Japan
| | - Yayoi Sugimori
- Department of Obstetrics and Gynecology, Juntendo University Nerima Hospital, Nerima-ku, Tokyo, Japan
| | - Shozo Matsuoka
- Department of Obstetrics and Gynecology, Juntendo University Nerima Hospital, Nerima-ku, Tokyo, Japan
| | - Kanako Ogura
- Department of Diagnostic Pathology, Juntendo University Nerima Hospital, Nerima-ku, Tokyo, Japan
| | - Daiki Ogishima
- Department of Obstetrics and Gynecology, Juntendo University Nerima Hospital, Nerima-ku, Tokyo, Japan
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Rodolakis A, Thomakos N, Sotiropoulou M, Kypriotis K, Valsamidis D, Bourgioti C, Moulopoulou LE, Vlachos G, Loutradis D. Abdominal Radical Trachelectomy for Early-Stage Cervical Cancer During Pregnancy: A Provocative Surgical Approach. Overview of the Literature and a Single-Institute Experience. Int J Gynecol Cancer 2019; 28:1743-1750. [PMID: 30376483 DOI: 10.1097/igc.0000000000001357] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE Treatment of pregnancy complication due to malignancy of the cervix constitutes a great clinical challenge between optimal maternal therapy and fetal viability. Radical trachelectomy in early-stage cervical cancer during pregnancy instead of radical hysterectomy presents an alternative approach that can offer a satisfactory outcome for the mother and fetus. MATERIALS AND METHODS-RESULTS A literature search of articles in English has been performed. Until now, 28 women with cervical cancer, including 2 who were managed and treated in our institute, who underwent a radical trachelectomy during pregnancy have been reported. We overviewed a total of 13 abdominal trachelectomies, 13 vaginal trachelectomies, and 2 laparoscopic trachelectomies. CONCLUSIONS Radical trachelectomy can widen the therapeutic approach of early-stage cervical cancer in pregnant women who wish to preserve their pregnancy, providing a possibility of receiving the proper treatment with no delay.
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Affiliation(s)
- Alexandros Rodolakis
- 1st Obstetric and Gynaecological Department of "Alexandra" Hospital of National and Kapodistrian University of Athens
| | - Nikolaos Thomakos
- 1st Obstetric and Gynaecological Department of "Alexandra" Hospital of National and Kapodistrian University of Athens
| | | | - Konstantinos Kypriotis
- 1st Obstetric and Gynaecological Department of "Alexandra" Hospital of National and Kapodistrian University of Athens
| | | | - Charis Bourgioti
- Department of Radiology "Aretaieion" Hospital of National and Kapodistrian University of Athens, Athens, Greece
| | - Lia Evangelia Moulopoulou
- Department of Radiology "Aretaieion" Hospital of National and Kapodistrian University of Athens, Athens, Greece
| | - Georgios Vlachos
- 1st Obstetric and Gynaecological Department of "Alexandra" Hospital of National and Kapodistrian University of Athens
| | - Dimitrios Loutradis
- 1st Obstetric and Gynaecological Department of "Alexandra" Hospital of National and Kapodistrian University of Athens
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5
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Ma J, Yu L, Xu F, Yi H, Wei W, Wu P, Wu S, Li H, Ye H, Wang W, Xing H, Fan L. Treatment and clinical outcomes of cervical cancer during pregnancy. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:241. [PMID: 31317011 DOI: 10.21037/atm.2019.04.76] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background This study aims to investigate clinicopathological factors associated with survival rate and treatment of patients with cervical cancer during pregnancy (CCP). Methods A total of 92 patients diagnosed CCP were retrospectively reviewed. One patient was from Nanfang Hospital of Southern Medical University, 5 patients were from Tongji Hospital, and 86 patients were from case reports in the PubMed database from 1961 to 2019. Patients and tumor characteristics were evaluated. Kaplan-Meier and Cox regression methods were used to analyze the 5-year disease-specific survival (DSS). Results Most patients (73 cases) were stage I according to the 2018 International Federation of Gynecology and Obstetrics (FIGO) standards. Twelve patients (13.04%) terminated pregnancy once diagnosed. These patients were diagnosed at the mean gestational age (GA) of 11±3 weeks, during early pregnancy. For the rest of the patients (80 cases) who continued pregnancy, the mean GA was 35±2 weeks at delivery. There was a significant difference in survival whether the treatment was performed once diagnosed or not. The 5-year DSS was 75% in adenocarcinoma (AC), 68.5% in squamous cell carcinoma (SCC), and 43.7% in the rare subtype. Among the 38 patients who underwent neoadjuvant chemotherapy (NACT), one patient suffered from spontaneous abortion, and one baby experienced acute myeloid leukemia (AML) ex-FAB (French-American-British)-M7 subtype and received bone marrow transplantation. Other delivered newborns showed no abnormality or malformation. Cox multi-factorial analysis demonstrated that tumor size (2 cm) was an independent overall survival predictor for CCP patients (P<0.05). Conclusions Tumor size was an independent prognostic factor of survival in CCP patients. Pregnancy has adverse effects on the prognosis of cervical cancer. Personalized treatment is a priority for CCP patients.
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Affiliation(s)
- Jing Ma
- Department of Gynecology and Obstetrics, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 511436, China.,Department of Obstetrics and Gynecology, People's Hospital of Three Gorges University, Yichang 443000, China
| | - Lan Yu
- Department of Gynecology and Obstetrics, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 511436, China
| | - Fan Xu
- Department of Obstetrics and Gynecology, Nanchong Central Hospital, North Sichuan Medical University, Nanchong 637000, China
| | - Hongyan Yi
- Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Wenfei Wei
- Department of Gynecology and Obstetrics, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 511436, China
| | - Peng Wu
- Cancer Biology Research Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430000, China
| | - Sha Wu
- Department of Immunology, School of Basic Medical Sciences, Southern Medical University, Guangdong Provincial Key Laboratory of Proteomics, Guangzhou 510515, China
| | - Hua Li
- Department of Obstetrics and Gynecology, People's Hospital of Three Gorges University, Yichang 443000, China
| | - Hong Ye
- Department of Obstetrics and Gynecology, People's Hospital of Three Gorges University, Yichang 443000, China
| | - Wei Wang
- Department of Gynecology and Obstetrics, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 511436, China
| | - Hui Xing
- Department of Gynecology and Obstetrics, Xiangyang Hospital, Xiangyang 441000, China
| | - Liangsheng Fan
- Department of Gynecology and Obstetrics, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 511436, China
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6
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Halaska MJ, Rob L, Robova H, Cerny M. Treatment of gynecological cancers diagnosed during pregnancy. Future Oncol 2016; 12:2265-75. [DOI: 10.2217/fon-2016-0271] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Because of a notable increase in age at delivery, the incidence of malignancy diagnosed during pregnancy has substantially increased. This review aims to summarize the literature and expert knowledge on gynecologic cancers diagnosed in pregnancy regarding epidemiology, examination and staging procedures, description of treatment modalities and management of gynecological malignancies with special interest in cervical and ovarian cancer. Thorough attention is paid to the surgery and chemotherapy administration for early-stage cervical cancer diagnosed during pregnancy.
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Affiliation(s)
- Michael J Halaska
- Department of Obstetrics & Gynecology, 2nd Medical Faculty, Charles University in Prague, Prague, Czech Republic
| | - Lukas Rob
- Department of Obstetrics & Gynecology, 2nd Medical Faculty, Charles University in Prague, Prague, Czech Republic
| | - Helena Robova
- Department of Obstetrics & Gynecology, 2nd Medical Faculty, Charles University in Prague, Prague, Czech Republic
| | - Milos Cerny
- Department of Obstetrics & Gynecology, 2nd Medical Faculty, Charles University in Prague, Prague, Czech Republic
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7
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Radical Trachelectomy Performed During Pregnancy: A Review of the Literature. Int J Gynecol Cancer 2016; 26:758-62. [DOI: 10.1097/igc.0000000000000655] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
ObjectiveCervical cancer is one of the most frequent malignant diseases diagnosed during pregnancy. Abdominal or vaginal radical trachelectomies are fertility-preserving alternatives to radical hysterectomy for young women with early-stage cervical cancer that can be performed during ongoing pregnancy.MethodsA literature review of articles on this subject was conducted through a Medline search for articles published in English or French.ResultsAt this moment, 21 cervical cancer patients, including ours (4 stage IA2, 16 IB1, and 1 IB2) who underwent radical trachelectomy during pregnancy have been reported. Of these, 10 were performed by vaginal route and 11 were abdominal radical trachelectomies.ConclusionsRadical trachelectomy could be offered as an option for pregnant patients with early invasive cervical cancer. It may help women avoid the triple losses of a desired pregnancy, fertility, and motherhood.
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8
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Gungorduk K, Sahbaz A, Ozdemir A, Gokcu M, Sancı M, Köse MF. Management of cervical cancer during pregnancy. J OBSTET GYNAECOL 2015; 36:366-71. [PMID: 26467977 DOI: 10.3109/01443615.2015.1065235] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Cervical cancer (CC) is the most common gynaecological cancer during pregnancy. The rarity of the disease and lack of randomised control studies have prevented the establishment of treatment guidelines. The management of CC mainly follows the guidelines for the non-pregnant disease state, expert opinions and limited case reports. Although the management of CC diagnosed during pregnancy appears to be a significant dilemma for the patients and specialists, the prognosis of CC is not influenced by pregnancy. The treatment decision should be made collaboratively with a multidisciplinary team consisting of an obstetrician, gynaecologist, oncologist and paediatrician. The concerns of the patient should be taken into account.
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Affiliation(s)
- K Gungorduk
- a Department of Gynecologic Oncology , Tepecik Education and Research Hospital , Izmir , Turkey
| | - A Sahbaz
- b Department of Obstetrics and Gynecology , Bulent Ecevit University School of Medicine , Zonguldak , Turkey
| | - A Ozdemir
- a Department of Gynecologic Oncology , Tepecik Education and Research Hospital , Izmir , Turkey
| | - M Gokcu
- a Department of Gynecologic Oncology , Tepecik Education and Research Hospital , Izmir , Turkey
| | - M Sancı
- a Department of Gynecologic Oncology , Tepecik Education and Research Hospital , Izmir , Turkey
| | - M F Köse
- c Department of Gynecologic Oncology , Medipol University School of Medicine , İstanbul , Turkey
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9
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Kyrgiou M, Horwell DH, Farthing A. Laparoscopic radical abdominal trachelectomy for the management of stage IB1 cervical cancer at 14 weeks' gestation: case report and review of the literature. BJOG 2015; 122:1138-43. [PMID: 25832461 DOI: 10.1111/1471-0528.13392] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/17/2014] [Indexed: 11/27/2022]
Affiliation(s)
- M Kyrgiou
- Department of Surgery & Cancer, Faculty of Medicine, Imperial College, London, UK.,West London Gynaecological Cancer Centre, Queen Charlotte's & Chelsea - Hammersmith Hospital, Imperial Healthcare NHS Trust, London, UK
| | | | - A Farthing
- Department of Surgery & Cancer, Faculty of Medicine, Imperial College, London, UK.,West London Gynaecological Cancer Centre, Queen Charlotte's & Chelsea - Hammersmith Hospital, Imperial Healthcare NHS Trust, London, UK
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10
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Saso S, Sawyer R, O'Neill NM, Tzafetas M, Sayasneh A, Hassan Hamed A, Elliott F, Thum MY, Ghaem-Maghami S, Lee MJ, Smith JR, Del Priore G. Trachelectomy during pregnancy: What has experience taught us? J Obstet Gynaecol Res 2014; 41:640-5. [PMID: 25420436 DOI: 10.1111/jog.12594] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Accepted: 08/12/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Srdjan Saso
- Division of Surgery and Cancer; Institute of Reproductive and Developmental Biology; Imperial College London, Hammersmith Hospital Campus; London UK
| | - Renata Sawyer
- Division of Maternal Fetal Medicine; Cancer Treatment Centers of America, Southeastern Branch, Newnan; Georgia USA
| | - Nicole M. O'Neill
- Division of Gynecologic Oncology; Cancer Treatment Centers of America, Southeastern Branch, Newnan; Georgia USA
| | - Menelaos Tzafetas
- Division of Surgery and Cancer; Institute of Reproductive and Developmental Biology; Imperial College London, Hammersmith Hospital Campus; London UK
| | - Ahmed Sayasneh
- Division of Surgery and Cancer; Institute of Reproductive and Developmental Biology; Imperial College London, Hammersmith Hospital Campus; London UK
| | - Ali Hassan Hamed
- Division of Gynecologic Oncology; Cancer Treatment Centers of America, Southeastern Branch, Newnan; Georgia USA
| | - Freya Elliott
- Division of Surgery and Cancer; Institute of Reproductive and Developmental Biology; Imperial College London, Hammersmith Hospital Campus; London UK
| | | | - Sadaf Ghaem-Maghami
- West London Gynaecological Cancer Centre; Queen Charlotte's Hospital; Hammersmith Hospital Campus; Imperial College London, Hammersmith Hospital Campus; London UK
| | - Men-Jean Lee
- Division of Maternal Fetal Medicine; Cancer Treatment Centers of America, Southeastern Branch, Newnan; Georgia USA
| | - J. Richard Smith
- West London Gynaecological Cancer Centre; Queen Charlotte's Hospital; Hammersmith Hospital Campus; Imperial College London, Hammersmith Hospital Campus; London UK
| | - Giuseppe Del Priore
- Department of Gynaecologic Oncology; Cancer Treatment Centers of America, Southeastern Branch, Newnan; Georgia USA
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Rodriguez-Wallberg KA, Oktay K. Fertility preservation during cancer treatment: clinical guidelines. Cancer Manag Res 2014; 6:105-17. [PMID: 24623991 PMCID: PMC3949560 DOI: 10.2147/cmar.s32380] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
The majority of children, adolescents, and young adults diagnosed with cancer today will become long-term survivors. The threat to fertility that cancer treatments pose to young patients cannot be prevented in many cases, and thus research into methods for fertility preservation is developing, aiming at offering cancer patients the ability to have biologically related children in the future. This paper discusses the current status of fertility preservation methods when infertility risks are related to surgical oncologic treatments, radiation therapy, or chemotherapy. Several scientific groups and societies have developed consensus documents and guidelines for fertility preservation. Decisions about fertility and imminent potentially gonadotoxic therapies must be made rapidly. Timely and complete information on the impact of cancer treatment on fertility and fertility preservation options should be presented to all patients when a cancer treatment is planned.
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Affiliation(s)
- Kenny A Rodriguez-Wallberg
- Karolinska Institutet, Department of Clinical Science, Intervention and Technology, Division of Obstetrics and Gynecology, Sweden
- Reproductive Medicine, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Kutluk Oktay
- Innovation Institute for Fertility Preservation, Rye and New York
- Department of Obstetrics and Gynecology, New York Medical College, Valhalla, NY, USA
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12
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Abstract
Cervical cancer is the most commonly diagnosed malignancy during pregnancy with an incidence of 1.5 to 12 per 100,000 pregnancies. In the United States between 2% and 7% of all pregnant women will have an abnormal Pap test. The management of these abnormal results during pregnancy can present a challenge to the practitioner. This article reviews recently published guidelines and current evidence for evaluation and management of abnormal cervical cytology and cervical cancer in pregnancy.
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Affiliation(s)
- Jody Stonehocker
- Division of Gynecology, Department of Obstetrics and Gynecology, University of New Mexico, 1 University of New Mexico, Albuquerque, NM 87131-0001, USA.
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13
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Yousefi Z, Kazemianfar Z, Kadghodayan S, Hasanzade M, Kalantari M, Mottaghi M. Less radical surgery for patient with early-stage cervical cancer. IRANIAN RED CRESCENT MEDICAL JOURNAL 2014; 15:617-9. [PMID: 24396586 PMCID: PMC3871754 DOI: 10.5812/ircmj.5057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2012] [Revised: 01/20/2013] [Accepted: 01/28/2013] [Indexed: 11/21/2022]
Abstract
Introduction Surgery in cervical cancer should be used with intention of cure. Radical abdominal trachelectomy is a feasible operation for selected patients with stage Iα-1β cervical cancer which fertility can be preserved. Case Report A 30-years-old woman with squamous cell cervical cancer stage (1 A II) diagnosed at September 2011 expressed a wish for fertility-sparing treatment. Radical abdominal hysterectomy and pelvic and para-aortic lymphadenectomy were performed which showed no evidence of lymphatic metastasis. Subsequently, at last follow-up (5 months post-surgery), good oncologic outcomes were found after this procedure. This was the first case of fertility-sparing radical trachelectomy procedures performed at our institution. Conclusions Trachelectomy represents a valuable conservative surgical approach for early stage invasive cervical cancer.
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Affiliation(s)
- Zohreh Yousefi
- Department of Obstetrics and Gynecology, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, IR Iran
- Corresponding author: Zohreh Yousefi, Department of Obstetrics and Gynecology, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, IR Iran, Tel.: +98-5118417493, Fax: +98-5118409612, E-mail:
| | - Zahra Kazemianfar
- Department of Obstetrics and Gynecology, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, IR Iran
| | - Sima Kadghodayan
- Department of Obstetrics and Gynecology, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, IR Iran
| | - Malieheh Hasanzade
- Department of Obstetrics and Gynecology, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, IR Iran
| | - Mahmoudreza Kalantari
- Department of Pathology, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, IR Iran
| | - Mansoureh Mottaghi
- Department of Obstetrics and Gynecology, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, IR Iran
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15
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Kolomainen D, Bradley R, Larsen-Disney P, Shepherd J. Radical vaginal trachelectomy at 16 weeks' gestation: A case report. GYNECOLOGIC ONCOLOGY CASE REPORTS 2013; 5:28-30. [PMID: 24371689 PMCID: PMC3862222 DOI: 10.1016/j.gynor.2013.03.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/03/2013] [Accepted: 03/04/2013] [Indexed: 11/18/2022]
Abstract
•A young woman diagnosed with early-stage cervical cancer whilst pregnant is a clinical dilemma.•The maternal risks need to be balanced against the risks to the foetus.•Radical vaginal trachelectomy has a potential role as treatment with a favourable outcome for mother and baby.
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Affiliation(s)
- D.F. Kolomainen
- Department of Gynaecological Oncology, The Royal Marsden NHS Foundation Trust, London, UK
| | - R.J. Bradley
- Department of Gynaecological Oncology, Royal Sussex County Hospital, Brighton, UK
| | - P. Larsen-Disney
- Department of Gynaecological Oncology, Royal Sussex County Hospital, Brighton, UK
| | - J.H. Shepherd
- Department of Gynaecological Oncology, The Royal Marsden NHS Foundation Trust, London, UK
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16
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Neoadjuvant Chemotherapy Followed by Cesarean Radical Hysterectomy in a Triplet Pregnancy Complicated by Clear Cell Carcinoma of the Cervix: A Case Presentation and Literature Review. Int J Gynecol Cancer 2012; 22:1198-202. [DOI: 10.1097/igc.0b013e31825e0d5a] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
ObjectiveTo report a triplet pregnancy complicated by clear cell cervical carcinoma that was managed using neoadjuvant chemotherapy followed by caesarean radical hysterectomy.Patient HistoryA 26-year-old woman had a diagnosis of cervical clear cell carcinoma, which was International Federation of Gynecology and Obstetrics stage IB1, at 18 weeks of gestation during a triplet pregnancy. Owing to the patient’s strong desire for full-term pregnancy, 3 cycles of neoadjuvant chemotherapy was administered after magnetic resonance imaging evaluation of the tumor. The patient underwent cesarean delivery and radical hysterectomy at gestational week 32. The hysterectomy specimen revealed stage IB1 clear cell adenocarcinoma of the cervix. The neonates and the mother did not have any complications related to the treatment during 36 months of follow-up.ConclusionTo the best of our knowledge, this is the first report of a triplet pregnancy complicated by cervical clear cell carcinoma that was successfully treated with neoadjuvant chemotherapy and cesarean radical hysterectomy. Our experience and literature review suggest that neoadjuvant chemotherapy for cervical carcinoma diagnosed during pregnancy is associated with excellent oncologic and fetal outcome; therefore, it may be considered as a temporary fertility-sparing approach in selected patients with a strong desire for full-term pregnancy. Nonetheless, additional research and long-term follow-up are needed to reach a more definitive conclusion.
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Abstract
Cervical and ovarian cancers are the most common gynaecological cancers diagnosed during pregnancy. In early-stage cervical cancer during the first and at the beginning of the second trimester, the two main considerations for management of the patient are the tumour size (and stage) and nodal staging. MRI and laparoscopic lymphadenectomy are useful for clinicians planning a potentially conservative approach. The management of patients with locally advanced cervical disease is controversial and should be discussed on a case-by-case basis according to the tumour size, radiological findings, the term of pregnancy, and the patient's wishes. Different histological types of malignant ovarian diseases arise during pregnancy and their management depends on the diagnosis (histological subtypes, tumour differentiation, and nodal status), the tumour stage, and the trimester of the pregnancy. In patients with peritoneal spread or high-risk early-stage disease, neoadjuvant chemotherapy with pregnancy preservation could be appropriate.
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Affiliation(s)
- Philippe Morice
- Department of Gynecologic Surgery, Institut Gustave Roussy, Villejuif, France.
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Ilancheran A, Low J, Ng JS. Gynaecological cancer in pregnancy. Best Pract Res Clin Obstet Gynaecol 2012; 26:371-7. [PMID: 22301055 DOI: 10.1016/j.bpobgyn.2011.12.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2011] [Accepted: 12/16/2011] [Indexed: 10/14/2022]
Abstract
Cancer in pregnancy, fortunately, is uncommon. This is even more so for gynaecological cancer. Fertility preservation in gynaecological cancer is already a difficult issue, as the common gynaecological cancers affect organs intimately associated with conception and delivery. The presence of a viable pregnancy with gynaecological cancer presents tremendous challenges to the clinician, especially if the woman wants to conserve both her pregnancy and fertility. In this chapter, we address issues involved in such circumstances and suggest management decisions.
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Affiliation(s)
- Arunachalam Ilancheran
- Division of Gynaecologic Oncology, Department of Obstetrics and Gynaecology, National University Hospital, Singapore, Singapore.
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Rodriguez-Wallberg KA, Oktay K. Options on fertility preservation in female cancer patients. Cancer Treat Rev 2011; 38:354-61. [PMID: 22078869 DOI: 10.1016/j.ctrv.2011.10.002] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2011] [Revised: 10/10/2011] [Accepted: 10/11/2011] [Indexed: 12/17/2022]
Abstract
Infertility following treatment of cancer is a quality of survival's recognized issue and efforts should be made to help young cancer patients retaining their fertility potential. Options to preserve fertility in female patients include well established methods such as shielding to reduce radiation damage to reproductive organs, fertility-sparing surgery and emergency in vitro fertilization after controlled ovarian stimulation, aiming at freezing embryos. Transfer of frozen/thawed embryos today is a clinical routine in fertility clinics worldwide and it has been used for over 25 years. Mature oocytes after ovarian stimulation can also be frozen unfertilized, nevertheless overall pregnancy rates after fertilization of frozen-thawn oocytes are still relatively lower than those with embryo freezing. Remaining fertility preservation options are still in development and include the freezing of immature oocytes aiming at later in vitro maturing and fertilizing them and the cryopreservation of ovarian tissue for future retransplantation or for in vitro growth and maturation of follicles, both still experimental.
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Affiliation(s)
- Kenny A Rodriguez-Wallberg
- Karolinska Institute, Department of Clinical Science, Intervention and Technology, Division of Obstetrics and Gynecology, Stockholm, Sweden.
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