Cervical cancer in pregnancy

Česká verzia

Authors: L. Nocarová ^1,2; D. Ondruš ¹
Authors place of work: I. onkologická klinika LF UK a OÚSA, Bratislava ¹; Interná klinika VŠZaSP sv. Alžbety a OÚSA, Bratislava ²
Published in the journal: Klin Onkol 2020; 33(4): 268-273
Category: Review
doi: https://doi.org/10.14735/amko2020268

Summary

Background: Cervical cancer is one of the most frequent cancers in pregnant women, despite this combination being a rare condition. More than 70% of cases are diagnosed in early stages and its treatment can be postponed after the delivery. Invasive cancer diagnosis in pregnancy is difficult for a patient, her family and doctors. A multidisciplinary team should take care of the patient and foetus and patient‘s wishes are respected regarding her treatment and pregnancy. Radiotherapy in pregnancy is contraindicated. Neoadjuvant or adjuvant chemotherapy is therefore a main treatment method in patients with high risk disease either during pregnancy, or after the delivery. Neoadjuvant chemotherapy choice, delivery timing and definitive treatment are keys to mother‘s and child‘s health. Palliative treatment during pregnancy is extremely rare and the prognosis is poor. Bevacizumab and pembrolizumab are promising in the palliative treatment of non-pregnant patients. Neither biological therapy by bevacizumab, nor immunotherapy by pembrolizumab can be administered to pregnant patient due to their mechanisms of action.

Purpose: This overview‘s aim is to analyse data of cervical cancer treatment for pregnant women, focusing on diagnostics, therapy and delivery timing and treatment modalities choice according to the stage of the disease and gestational age. Individual approach is always necessary; our aim is, however, to emphasise current evidence-based recommendations in pregnancy.

The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manuscript met the ICMJE recommendation for biomedical papers.

Keywords:

uterine cervical neoplasms – Pregnancy complications – gestational age – drug-related side effects and adverse reactions

Zdroje

1. Nguyen C, Montz Fj, Bristow RE. Management of stage I cervical cancer in pregnancy. Obstet Gynecol Surv 2000; 55 (10): 633–643. doi: 10.1097/00006254-200010000-00022.

2. Creasman WT. Cancer and pregnancy. Ann N Y Acad Sci 2001; 943: 281–286. doi: 10.1111/j.1749-6632.2001.tb03809.x.

3. Smith Lh, Dalrymple Jl, Leiserowitz GS et al. Obstetrical deliveries associated with maternal malignancy in California, 1992 through 1997. Am J Obstet Gynecol 2001; 184 (7): 1504–1512. doi: 10.1067/mob.2001.114867.

4. Smith Lh, Danielsen B, Allen ME et al. Cancer associated with obstetric delivery: results of link age with the California cancer registry. Am J Obstet Gynecol 2003; 189 (4): 1128–1135. doi: 10.1067/s0002-9378 (03) 00537-4.

5. 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 (3): 207–210. PMID: 12094956.

6. Duggan B, Muderspach Li, Roman Ld et al. Cervical cancer in pregnancy: reporting on planned delay in therapy. Obstet Gynecol 1993; 82 (4 Pt 1): 598–602. PMID: 8377988.

7. Van Calsteren K, Vergote I, Amant F. Cervical neoplasia during pregnancy: diagnosis, management and prognosis. Best Pract Res Clin Obstet Gynaecol 2005; 19 (4): 611–630. doi: 10.1016/j.bpobgyn.2005.03.002.

8. Figo Committee On Gynecologic Oncology. Revised FIGO staging for carcinoma of the vulva, cervix and endometrium. Int J Gynecol Obstet 2009; 106 (2): 103–104. doi: 10.1016/j.ijgo.2009.02.012.

9. Zemlickis D, Lishner M, Degendorfer P et al. Maternal and fetal outcome after invasive cervical cancer in pregnancy. J Clin Oncol 1991; 9 (11): 1956–1961. doi: 10.1200/JCO.1991.9.11.1956.

10. Hopkins MP, Morley GW. The prognosis and management of cervical cancer associated with pregnancy. Obstet Gynecol 1992; 80 (1): 9–13.

11. Lee RB, Neglia W, Park RC. Cervical carcinoma in pregnancy. Obstet Gynecol 1981; 58 (5): 584–589.

12. Baldauf JJ, Dreyfus M, Ritter J et al. Colposcopy and directed biopsy reliability during pregnancy: a cohort study. Eur J Obstet Gynecol Reprod Biol 1995; 62 (1): 31–36. doi: 10.1016/0301-2115 (95) 02178-a.

13. Robinson WR, Webb S, Tirpack J et al. Management of cervical intraepithelial neoplasia during pregnancy with LOOP excision. Gynecol Oncol 1997; 64 (1): 153–155. doi: 10.1006/gyno.1996.4546.

14. Douvier S, Filipuzzi L, Sagot P. Management of cervical intra-epithelial neoplasm during pregnancy. Gynecol Obstet Fertil 2003; 31 (10): 851–855. doi: 10.1016/j.gyobfe.2002.12.001.

15. Muller CY, Smith HO. Cervical neoplasia complicating pregnancy. Obstet Gynecol Clin North Am 2005; 32 (4): 533–546. doi: 10.1016/j.ogc.2005.08.007.

16. Goldberg GL, Altaras MM, Block B. Cone cerclage in pregnancy. Obstet Gynecol 1991; 77 (2): 315–317. doi: 10.1097/00006250-199102000-00033.

17. Palle C, Bangsbøll S, Andreasson B. Cervical intraepithelial neoplasia in pregnancy. Acta Obstet Gynecol Scand 2000; 79 (4): 306–310.

18. Reznek RH, Sahdev A. MR imaging in cervical cancer: seeing is believing. The 2004 Mackenzie Davidson Memorial Lecture. Br J Radiol 2005; 78 (2): S73–S85. doi: 10.1259/bjr/66333608.

19. Alouini S, Rida K, Mathevet P. Cervical cancer complicating pregnancy: implications of laparoscopic lymphadenectomy. Gynecol Oncol 2008; 108 (3): 472–77. doi: 10.1016/j.ygyno.2007.12.006.

20. Hertel H, Possover M, Kühne-Heid R et al. Laparoscopic lymph node staging of cervical cancer in the 19th week of pregnancy. A case report. Surg Endosc 2001; 15 (3): 324. doi: 10.1007/s004640042005.

21. Stan C, Megevand E, Irion O et al. Cervical cancer in pregnant women: laparoscopic evaluation before delaying treatment. Eur J Gynaecol Oncol 2005; 26 (6): 649–650.

22. 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. doi: 10.1097/IGC.0000000000000062.

23. Ackermann S, Gehrsitz C, Mehlhorn G et al. Management and course of histologically verified cervical carcinoma in situ during pregnancy. Acta Obstet Gynecol Scand 2006; 85 (9): 1134–1137. doi: 10.1080/000163 40600555926.

24. Yost NP, Santoso JT, Mcintire DD et al. Postpartum regression rates of antepartum cervical intraepithelial neoplasia II and III lesions. Obstet Gynecol 1999; 93 (3): 359–362. doi: 10.1016/s0029-7844 (98) 00483-9.

25. Paraskevaidis E, Koliopoulos G, Kalantaridou S et al. Management and evolution of cervical intraepithelial neoplasia during pregnancy and postpartum. Eur J Obstet Gynecol Reprod Biol 2002; 104 (1): 67–69. doi: 10.1016/S0301-2115 (02) 00058-1.

26. Ahdoot D, van Nostrand KM, Nguyen NJ et al. The effect of route of delivery on regression of abnormal cervical cytologic findings in the postpartum period. Am J Obstet Gynecol 1998; 178 (6): 1116–1120. doi: 10.1016/s0002-9378 (98) 70310-2.

27. Kaplan KJ, Dainty LA, Dolinsky B et al. Prognosis and recurrence risk for patients with cervical squamous intraepithelial lesions diagnosed during pregnancy. Cancer 2004; 102 (4): 228–232. doi: 10.1002/cncr.20428.

28. Takushi M, Moromizato H, Sakumoto K et al. Management of invasive carcinoma of the uterine cervix associated with pregnancy: outcome of intentional delay in treatment. Gynecol Oncol 2002; 87 (2): 185–189. doi: 10.1006/gyno.2002.6813.

29. Vercellino GF, Koehler C, Erdemoglu E et al. Laparoscopic pelvic lymphadenectomy in 32 pregnant patients with cervical cancer: rationale, description of the technique, and outcome. Int J Gynecol Cancer 2014; 24 (2): 364–371. doi: 10.1097/IGC.0000000000000064.

30. Hannigan EV, Whitehouse HH 3rd, Atkinson WD et al. Cone biopsy during pregnancy. Obstet Gynecol 1982; 60 (4): 450–455. PMID: 7121932.

31. Herod JJ, Decruze SB, Patel RD. A report of two cases of the management of cervical cancer in pregnancy by cone biopsy and laparoscopic pelvic node dissection. BJOG 2010; 117 (12): 1558–1561. doi: 10.1111/j.1471-0528.2010.02723.x.

32. Karam A, Feldman N, Holschneider CH. Neoadjuvant cisplatin and radical cesarean hysterectomy for cervical cancer in pregnancy. Nat Clin Pract Oncol 2007; 4 (6): 375–380. doi: 10.1038/ncponc0821.

33. van der Vange N, Weverling GJ, Ketting BW et al. The prognosis of cervical cancer associated with pregnancy: a matched cohort study. Obstet Gynecol 1995; 85 (6): 1022–1026. doi: 10.1016/0029-7844 (95) 00059-Z.

34. Method MW, Brost BC. Management of cervical cancer in pregnancy. Semin Surg Oncol 1999; 16 (3): 251–260. doi: 10.1002/ (sici) 1098-2388 (199904/05) 16: 3<251: aid-ssu11>3.0.co; 2-4.

35. Lee JM, Lee KB, Kim YT et al. Cervical cancer associated with pregnancy: results of a multicenter retrospective Korean study (KGOG-1006). Am J Obstet Gynecol 2008; 198 (1): 92. e1–6. doi: 10.1016/j.ajog.2007.06.077.

36. Germann N, Haie-Meder C, Morice P et al. Management and clinical outcomes of pregnant patients with invasive cervical cancer. Ann Oncol 2005; 16 (3): 397–402. doi: 10.1093/annonc/mdi084.

37. Pentheroudakis G, Orecchia R, Hoekstra HJ et al. Cancer, fertility and pregnancy: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol 2010; 21 (5): 266–273. doi: 10.1093/annonc/mdq198.

38. Rydzewska L, Tierney J, Vale CL et al. Neoadjuvant chemotherapy plus surgery versus surgery for cervical cancer. Cochrane Database Syst Rev 2012; 12: CD007406. doi: 10.1002/14651858.CD007406.pub3.

39. Dehaan J, Verheecke M, van Calsteren K et al. Oncological management and obstetric and neonatal outcomes for women diagnosed with cancer during pregnancy: a 20-year international cohort study of 1170 patients. Lancet Oncol 2018; 19 (3): 337–346. doi: 10.1016/S1470-2045 (18) 30059-7.

40. Cardonick E, Bhat A, Gilmandyar D et al. Maternal and fetal outcomes of taxane chemotherapy in breast and ovarian cancer during pregnancy: case series and review of the literature. Ann Oncol 2012; 23 (12): 3016–3023. doi: 10.1093/annonc/mds170.

41. Cardonick E. Chemotherapy in the treatment of pregnant women with cancer. In: Kehoe S, Jauniaux E, Maretin-Hirsch P et al. Cancer and reproductive health. London: RCOG Press 2008.

42. Bader AA, Petru E, Winter R. Long-term follow-up after neoadjuvant chemotherapy for high-risk cervical cancer during pregnancy. Gynecol Oncol 2007; 105 (1): 269–272. doi: 10.1016/j.ygyno.2007.01.009.

43. 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 Obstet Gynecol 2015; 213 (2): 206. doi: 10.1016/j.ajog.2015.02.022.

44. Zemlickis D, Klein J, Moselhy G et al. Cisplatin protein binding in pregnancy and the neonatal period. Med Pediatr Oncol 1994; 23 (6): 476–479. doi: 10.1002/mpo.2950230605.

45. Weisz B, Meirow D, Schiff E et al. Impact and treatment of cancer during pregnancy. Expert Rev Anticancer Ther 2004; 4 (5): 889–902. doi: 10.1586/14737140.4.5.889.

46. Beedie SL, Mahony C, Walker HM et al. Shared mechanism of teratogenicity of anti-angiogenic drugs identified in the chicken embryo model. Sci Rep 2016; 6: 30038. doi: 10.1038/srep30038.

47. Poulet FM, Wolf JJ, Herzyk DJ et al. An evaluation of the impact of PD-1 pathway blockade on reproductive safety of therapeutic PD-1 inhibitors. Birth Defects Res B 2016; 107 (2): 108–119. doi: 10.1002/bdrb.21176.

48. Cardonick E, Iacobucci A. Use of chemotherapy during human pregnancy. Lancet Oncol 2004; 5 (5): 283–291. doi: 10.1016/S1470-2045 (04) 01466-4.

49. Zagouri F, Sergentanis TN, Chrysikos D et al. Platinum derivatives during pregnancy in cervical cancer: a systematic review and meta-analysis. Obstet Gynecol 2013; 121 (2 Pt 1): 337–343. doi: 10.1097/aog.0b013e31827c5822.

50. Dildy GA 3rd, Moise KJ Jr, Carpenter RJ Jr et al. Maternal malignancy metastatic to the products of conception: a review. Obstet Gynecol Surv 1989; 44 (7): 535–540. doi: 10.1097/00006254-198907000-00008.

51. Baloglu A, Uysal D, Aslan N et al. Advanced stage of cervical carcinoma undiagnosed during antenatal period in term pregnancy and concomitant metastasis on episiotomy scar during delivery: a case report and review of the literature. Int J Gynecol Cancer 2007; 17 (5): 1155–1159. doi: 10.1111/j.1525-1438.2007.
00926.x.

52. Tewari K, Cappuccini F, Gambino A et al. Neoadjuvant chemotherapy in the treatment of locally advanced cervical carcinoma in pregnancy: a report of two cases
and review of issues specific to the management of cervical carcinoma in pregnancy including planned delay of therapy. Cancer 1998; 82 (8): 1529–1534. doi: 10.1002/
(sici) 1097-0142 (19980415) 82: 8<1529: aid-cncr15>3.0.
co; 2-6.