open access
Pregnancy-related cervical cancer in the material of the Regional Cancer Centre, Łódź, between 2011 and 2014
open access
Abstract
Introduction. Pregnancy-related cancer is defined as cancer diagnosed during pregnancy or in the first postpartum year. Cervical cancer affects approximately 1 in 1000 pregnant women and is the most common malignancy affecting pregnancy. We retrospectively analysed the clinical outcome and results of treatment in patients with pregnancy-related cervical cancer.
Material and methods. We retrospectively analysed the medical records of nine patients with invasive cervical cancer diagnosed during pregnancy and the postpartum period who had been treated in the Regional Oncological Centre, Łódź, between 2011–2014.
Results. Three patients with cervical cancer at stage I were diagnosed between the 14th and 17th week of pregnancy afterwards and underwent radical surgery. Two patients with cervical cancer at stage Ib who were diagnosed in the 19th and 24th week of gestation decided to continue pregnancy until the 30th and 32nd week; then a cesarean section combined with radical surgery was performed. In three patients with inoperative cervical cancer diagnosed between the 26th and 28th week of pregnancy, a cesarean section was performed at week 30–32. In one patient cervical cancer at stage IIb was diagnosed during the post-partum period. All patients were treated using intensity-modulated radiotherapy (IMRT) to a total dose of 44 Gy/2Gy, weekly cisplatin (40 mg/m2) concurrent with radiotherapy and brachytherapy. No toxicity was observed. During follow-up, two patients with inoperable cervical cancer were diagnosed with a recurrence 2 and 10 months after treatment, respectively.
Conclusions. The management of pregnancy-related cervical cancer is mainly determined by the week of the pregnancy and the stage of the disease at diagnosis, but also by the patient choice. The general condition and follow-up of newborns from pregnancies complicated by cervical cancer are similar to those of newborns arising from non-complicated pregnancies. Treatment toxicity is similar in cases with pregnancy-related cervical cancer and in non-pregnant women with cervical cancer. The major prognostic factor in pregnancy-related cervical cancer remains the stage of the disease at diagnosis.
Abstract
Introduction. Pregnancy-related cancer is defined as cancer diagnosed during pregnancy or in the first postpartum year. Cervical cancer affects approximately 1 in 1000 pregnant women and is the most common malignancy affecting pregnancy. We retrospectively analysed the clinical outcome and results of treatment in patients with pregnancy-related cervical cancer.
Material and methods. We retrospectively analysed the medical records of nine patients with invasive cervical cancer diagnosed during pregnancy and the postpartum period who had been treated in the Regional Oncological Centre, Łódź, between 2011–2014.
Results. Three patients with cervical cancer at stage I were diagnosed between the 14th and 17th week of pregnancy afterwards and underwent radical surgery. Two patients with cervical cancer at stage Ib who were diagnosed in the 19th and 24th week of gestation decided to continue pregnancy until the 30th and 32nd week; then a cesarean section combined with radical surgery was performed. In three patients with inoperative cervical cancer diagnosed between the 26th and 28th week of pregnancy, a cesarean section was performed at week 30–32. In one patient cervical cancer at stage IIb was diagnosed during the post-partum period. All patients were treated using intensity-modulated radiotherapy (IMRT) to a total dose of 44 Gy/2Gy, weekly cisplatin (40 mg/m2) concurrent with radiotherapy and brachytherapy. No toxicity was observed. During follow-up, two patients with inoperable cervical cancer were diagnosed with a recurrence 2 and 10 months after treatment, respectively.
Conclusions. The management of pregnancy-related cervical cancer is mainly determined by the week of the pregnancy and the stage of the disease at diagnosis, but also by the patient choice. The general condition and follow-up of newborns from pregnancies complicated by cervical cancer are similar to those of newborns arising from non-complicated pregnancies. Treatment toxicity is similar in cases with pregnancy-related cervical cancer and in non-pregnant women with cervical cancer. The major prognostic factor in pregnancy-related cervical cancer remains the stage of the disease at diagnosis.
Keywords
cervical cancer, pregnancy, radiotherapy, brachytherapy, radical hysterectomy
About this articleTitle
Pregnancy-related cervical cancer in the material of the Regional Cancer Centre, Łódź, between 2011 and 2014
Journal
Nowotwory. Journal of Oncology
Issue
Article type
Research paper (original)
Pages
359-366
Published online
2017-03-29
Page views
738
Article views/downloads
1066
DOI
Bibliographic record
Nowotwory. Journal of Oncology 2016;66(5):359-366.
Keywords
cervical cancer
pregnancy
radiotherapy
brachytherapy
radical hysterectomy
Authors
Justyna Danielska
Małgorzata Moszyńska-Zielińska
Leszek Gottwald
Miłosz Wilczyński
Jacek R. Wilczyński
Jacek Fijuth
References (30)- 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.
- Dahling MT, Xing G, Cress R, et al. Pregnancy-associated colon and rectal cancer: perinatal and cancer outcomes. J Matern Fetal Neonatal Med. 2009; 22(3): 204–211.
- Dalrymple JL, Gilbert WM, Leiserowitz GS, et al. Pregnancy-associated cervical cancer: obstetric outcomes. J Matern Fetal Neonatal Med. 2005; 17(4): 269–276.
- Świerczewski A, Pasiński J, Estemberg D, et al. Ciąża i poród u pacjentki z chłoniakiem nieziarniczym. Ginekol Pol. 2012; 83: 57–61.
- Creasman WT. Cancer and pregnancy. Ann NY Acad Sci. 2001; 943: 281–286.
- Loibl S, von Minckwitz G, Gwyn K, et al. Breast carcinoma during pregnancy. International recommendations from an expert meeting. Cancer. 2006; 106(2): 237–246.
- Krajowy Rejestr Nowotworów. http://onkologia.org.pl.
- Smith LH, Danielsen B, Allen ME, et al. Cancer associated with obstetric delivery: results of linkage with the California cancer registry. Am J Obstet Gynecol. 2003; 189(4): 1128–1135.
- Pavlidis NA. Coexistence of pregnancy and malignancy. Oncologist. 2002; 7: 279–287.
- Pentheroudakis G, Pavlidis N. Cancer and pregnancy: poena magna, not anymore. Eur J Cancer. 2006; 42(2): 126–140.
- Hoellen F, Reibke R, Hornemann K, et al. Cancer in pregnancy. Part I: basic diagnostic and therapeutic principles and treatment of gynecological malignancies. Arch Gynecol Obstet. 2012; 285(1): 195–205.
- Van Calsteren K, Heyns L, De Smet F, et al. Cancer during pregnancy: an analysis of 215 patients emphasizing the obstetrical and the neonatal outcomes. J Clin Oncol. 2010; 28(4): 683–689.
- Jones WB, Shingleton HM, Russell A, et al. Cervical carcinoma and pregnancy. A national patterns of care study of the American College of Surgeons. Cancer. 1996; 77(8): 1479–1488.
- Munkarah AR, Morris R. Malignant disease in pregnancy. . In: James DK, Steer PJ, Weiner CP. ed. High risk pregnancy: a management options. 2nd ed. W. B. Saunders, London 1994: 945–958.
- Nguyen C, Montz FJ, Bristow RE. Management of stage I cervical cancer in pregnancy. Obstet Gynecol Surv. 2000; 55(10): 633–643.
- Method MW, Brost BC. Management of cervical cancer in pregnancy. Semin Surg Oncol. 1999; 16(3): 251–260.
- 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.
- Sood AK, Sorosky JI, Krogman S, et al. Surgical management of cervical cancer complicating pregnancy: a case-control study. Gynecol Oncol. 1996; 63(3): 294–298.
- Mocarska A, Starosławska E, Kieszko D, et al. Rola rezonansu magnetycznego w ocenie stopnia zaawansowania raka szyjki macicy. Ginekol Pol. 2012; 83: 122–127.
- Balleyguier C, Fournet C, Ben Hassen W, et al. Management of cervical cancer detected during pregnancy: role of magnetic resonance imaging. Clin Imaging. 2013; 37(1): 70–76.
- 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.
- Bręborowicz G, Kędzia W. Nowotwory u kobiet w ciąży. In: Markowska J, Mądry R. ed. Zarys ginekologii onkologicznej. , Poznań 2012: 579–591.
- American Brachytherapy Society. https://www.americanbrachytherapy.org.
- Krebs L, Maillard S, Gaillot-Petit N, et al. Total radiation dose and overall treatment time are predictive for tumor sterilization in cervical carcinoma treated with chemoradiation and pulsed-dose-rate brachytherapy. Brachytherapy. 2015; 14(1): 16–22.
- Baltzer J, Regenbrecht ME, Kopcke W, et al. Carcinoma of the cervix and pregnancy. Int J Gynaecol Obstet. 1990; 31(4): 317–323.
- Creasman WT, Rutledge FN, Fletcher GH. Carcinoma of the cervix associated with pregnancy. Obstet Gynecol. 1970; 36(4): 495–501.
- Hopkins MP, Morley GW. The prognosis and management of cervical cancer associated with pregnancy. Obstet Gynecol. 1992; 80(1): 9–13.
- Russell AH, Shingleton HM, Jones WB, et al. Cervical carcinoma and pregnancy. A national patterns of care study of the American College of Surgeons. Cancer. 1996; 77(8): 1479–1488.
- Lee RB, Neglia W, Park RC. Cervical carcinoma in pregnancy. Obstet Gynecol. 1981; 58(5): 584–589.
- Manuel-Limson GA, Ladines-Llave CA, Sotto LS, et al. Cancer of the cervix in pregnancy: a 31-year experience at the Philippine General Hospital. J Obstet Gynaecol Res. 1997; 23(6): 503–509.