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Kinderwunsch und Schwangerschaft bei Zervixkarzinom und Vorstufen

Cervical cancer and precancerous lesions in fertility patients and during pregnancy

  • Leitthema
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Der Gynäkologe Aims and scope

Zusammenfassung

Kinderwunschpatientinnen in der Dysplasiesprechstunde stellen den Behandelnden vor eine Herausforderung: Eine etwaige Dysplasie sollte vor einer geplanten Schwangerschaft möglichst saniert werden, andererseits kann eine Übertherapie Fertilitätseinschränkungen und Schwangerschaftsrisiken bedeuten. Zervixkarzinompatientinnen mit Kinderwunsch kann bis zum Stadium FIGO IB1 <2 cm ein Fertilitätserhalt mit Trachelektomie und pelviner Lymphonodektomie angeboten werden. Aktuelle Daten unterstützen den Fertilitätserhalt durch neoadjuvante Chemotherapie und konsekutive Trachelektomie auch in höheren Stadien. Während der Schwangerschaft muss die Differenzierung einer Dysplasie von der seltenen Diagnose eines Zervixkarzinoms in graviditate sorgfältig erfolgen, da klassische Zervixkarzinomsymptome in dieser Zeit fehlinterpretiert werden können. Tumorstadium und Schwangerschaftswoche sind für das Management entscheidend. Ein Staging mittels laparoskopischer pelviner Lymphonodektomie ist auch in der Schwangerschaft möglich. In fortgeschrittenen Stadien ermöglicht die neoadjuvante Chemotherapie eine Fortführung der Schwangerschaft.

Abstract

Therapeutic management of patients who wish to conceive and who present with intraepithelial lesions of the cervix uteri can be challenging: high-grade squamous intraepithelial lesions (HSIL) should be ruled out before pregnancy, while excessive conization should be avoided with regard to the risks of sterility and unfavorable impact on obstetric outcome. Cervical cancer patients who wish to conceive can opt for trachelectomy and pelvic lymphadenectomy in case of FIGO IB1 <2 cm. In larger carcinoma, cisplatin-based neoadjuvant chemotherapy for downstaging is favorable. In pregnancy, dysplastic lesions must be distinguished from invasive carcinoma. Therapeutic management depends on tumor stage and trimester. Pelvic lymphonodectomy can be performed during pregnancy. In distinct cases, neoadjuvant chemotherapy is an option.

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Authors and Affiliations

  1. Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum, Schleswig-Holstein Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland

    F. Hoellen &  C. Banz-Jansen

  2. Facharzt-Zentrum für Kinderwunsch, pränatale Medizin, Endokrinologie und Osteologie, amedes experts, Mönckebergstr. 20, 20095, Hamburg, Deutschland

    K. Diedrich

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  1. F. Hoellen
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  2. C. Banz-Jansen
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  3. K. Diedrich
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Correspondence to F. Hoellen.

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Interessenkonflikt

F. Hoellen, C. Banz-Jansen und K. Diedrich geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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D. Beyer, Kaiserslautern

N. Maass, Kiel

K. Diedrich, Hamburg

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Hoellen, F., Banz-Jansen, C. & Diedrich, K. Kinderwunsch und Schwangerschaft bei Zervixkarzinom und Vorstufen. Gynäkologe 49, 340–347 (2016). https://doi.org/10.1007/s00129-016-3839-8

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