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Cervical cancer in the pregnant population

  • Special Section: Cancer in Pregnancy
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Abstract

Cervical cancer is the second most encountered cancer in pregnant patients. The 2018 International Federation of Gynecology and Obstetrics (FIGO) staging system for cervical cancer updated the staging of primary cervical carcinoma and disease process, with formal incorporation of imaging as a vital source of information in the management process to improve accuracy. Diagnosis and treatment of the pregnant population is a complex interplay of achieving adequate diagnostic information and optimal treatment while minimizing toxicity and risks to the mother and fetus. While novel imaging techniques and anticancer therapies are rapidly developed, much information on the safety and feasibility of different therapies is not yet available in the pregnant population. Therefore, managing pregnant patients with cervical cancer is complex and requires a multidisciplinary approach.

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References

  1. de Haan 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 (In eng). https://doi.org/10.1016/s1470-2045(18)30059-7.

    Article  PubMed  Google Scholar 

  2. Smith LH, Dalrymple JL, Leiserowitz GS, Danielsen B, Gilbert WM. Obstetrical deliveries associated with maternal malignancy in California, 1992 through 1997. Am J Obstet Gynecol 2001;184(7):1504–12; discussion 1512–3 (In eng). https://doi.org/10.1067/mob.2001.114867.

  3. Van Calsteren K, Vergote I, Amant F. Cervical neoplasia during pregnancy: diagnosis, management and prognosis. Best Pract Res Clin Obstet Gynaecol 2005;19(4):611-30 (In eng). https://doi.org/10.1016/j.bpobgyn.2005.03.002.

    Article  PubMed  Google Scholar 

  4. Duggan B, Muderspach LI, Roman LD, Curtin JP, d'Ablaing G, 3rd, Morrow CP. Cervical cancer in pregnancy: reporting on planned delay in therapy. Obstet Gynecol 1993;82(4 Pt 1):598-602. (In eng).

    CAS  PubMed  Google Scholar 

  5. Nguyen C, Montz FJ, Bristow RE. Management of stage I cervical cancer in pregnancy. Obstet Gynecol Surv 2000;55(10):633-43 (In eng). https://doi.org/10.1097/00006254-200010000-00022.

    Article  CAS  PubMed  Google Scholar 

  6. Zemlickis D, Lishner M, Degendorfer P, Panzarella T, Sutcliffe SB, Koren G. Maternal and fetal outcome after invasive cervical cancer in pregnancy. Journal of clinical oncology : official journal of the American Society of Clinical Oncology 1991;9(11):1956-61 (In eng). https://doi.org/10.1200/jco.1991.9.11.1956.

    Article  CAS  PubMed  Google Scholar 

  7. Lee RB, Neglia W, Park RC. Cervical carcinoma in pregnancy. Obstet Gynecol 1981;58(5):584-9. (In eng).

    CAS  PubMed  Google Scholar 

  8. Hannigan EV. Cervical Cancer in Pregnancy. Clinical Obstetrics and Gynecology 1990;33(4) (https://journals.lww.com/clinicalobgyn/Fulltext/1990/12000/Cervical_Cancer_in_Pregnancy.19.aspx).

  9. Carusi D. The gynecologic history and pelvic examination. Uptodate Available from: https://www.uptodate.com/contents/the-gynecologic-history-and-pelvic-examination2022.

  10. Lockwood C. Prenatal care: Initial assessment. Uptodate. Available from: https://www.uptodate.com/contents/prenatal-care-initial-assessment?topicRef=3253&source=see_link2022.

  11. Baldauf JJ, Dreyfus M, Ritter J, Philippe E. Colposcopy and directed biopsy reliability during pregnancy: a cohort study. Eur J Obstet Gynecol Reprod Biol 1995;62(1):31-6 (In eng). https://doi.org/10.1016/0301-2115(95)02178-a.

    Article  CAS  PubMed  Google Scholar 

  12. Bhatla N, Aoki D, Sharma DN, Sankaranarayanan R. Cancer of the cervix uteri. Int J Gynaecol Obstet 2018;143 Suppl 2:22-36 (In eng). https://doi.org/10.1002/ijgo.12611.

    Article  PubMed  Google Scholar 

  13. Union for International Cancer Control (UICC) (2017) TNM classification of malignant tumours, 8th edn. Wiley, Oxford and Hoboken.

    Google Scholar 

  14. Speiser D, Köhler C, Schneider A, Mangler M. Radical vaginal trachelectomy: a fertility-preserving procedure in early cervical cancer in young women. Dtsch Arztebl Int 2013;110(17):289-295 (In eng). https://doi.org/10.3238/arztebl.2013.0289.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Liyanage SH, Roberts CA, Rockall AG. MRI and PET scans for primary staging and detection of cervical cancer recurrence. Womens Health (Lond) 2010;6(2):251–67; quiz 268–9 (In eng). https://doi.org/10.2217/whe.10.7.

  16. Grigsby PW. PET/CT imaging to guide cervical cancer therapy. Future Oncol 2009;5(7):953-8 (In eng). https://doi.org/10.2217/fon.09.70.

    Article  PubMed  Google Scholar 

  17. Paño B, Sebastià C, Ripoll E, et al. Pathways of lymphatic spread in gynecologic malignancies. Radiographics 2015;35(3):916-45 (In eng). https://doi.org/10.1148/rg.2015140086.

    Article  PubMed  Google Scholar 

  18. Aoki Y, Sasaki M, Watanabe M, et al. High-risk group in node-positive patients with stage IB, IIA, and IIB cervical carcinoma after radical hysterectomy and postoperative pelvic irradiation. Gynecol Oncol 2000;77(2):305-9 (In eng). https://doi.org/10.1006/gyno.2000.5788.

    Article  CAS  PubMed  Google Scholar 

  19. Odunsi KO, Lele S, Ghamande S, Seago P, Driscoll DL. The impact of pre-therapy extraperitoneal surgical staging on the evaluation and treatment of patients with locally advanced cervical cancer. Eur J Gynaecol Oncol 2001;22(5):325-30. (In eng).

    CAS  PubMed  Google Scholar 

  20. Yang WT, Lam WW, Yu MY, Cheung TH, Metreweli C. Comparison of dynamic helical CT and dynamic MR imaging in the evaluation of pelvic lymph nodes in cervical carcinoma. AJR Am J Roentgenol 2000;175(3):759-66 (In eng). https://doi.org/10.2214/ajr.175.3.1750759.

    Article  CAS  PubMed  Google Scholar 

  21. Gui B, Cambi F, Micco M, et al. MRI in pregnant patients with suspected abdominal and pelvic cancer: a practical guide for radiologists. Diagn Interv Radiol 2020;26(3):183-192 (In eng). https://doi.org/10.5152/dir.2019.19343.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Amant F, Berveiller P, Boere IA, et al. Gynecologic cancers in pregnancy: guidelines based on a third international consensus meeting. Ann Oncol 2019;30(10):1601-1612 (In eng). https://doi.org/10.1093/annonc/mdz228.

    Article  CAS  PubMed  Google Scholar 

  23. Park JJ, Kim CK, Park SY, Park BK. Parametrial invasion in cervical cancer: fused T2-weighted imaging and high-b-value diffusion-weighted imaging with background body signal suppression at 3 T. Radiology 2015;274(3):734-41 (In eng). https://doi.org/10.1148/radiol.14140920.

    Article  PubMed  Google Scholar 

  24. Liu B, Gao S, Li S. A Comprehensive Comparison of CT, MRI, Positron Emission Tomography or Positron Emission Tomography/CT, and Diffusion Weighted Imaging-MRI for Detecting the Lymph Nodes Metastases in Patients with Cervical Cancer: A Meta-Analysis Based on 67 Studies. Gynecol Obstet Invest 2017;82(3):209-222 (In eng). https://doi.org/10.1159/000456006.

    Article  CAS  PubMed  Google Scholar 

  25. Yu KK, Hricak H, Subak LL, Zaloudek CJ, Powell CB. Preoperative staging of cervical carcinoma: phased array coil fast spin-echo versus body coil spin-echo T2-weighted MR imaging. AJR Am J Roentgenol 1998;171(3):707-11 (In eng). https://doi.org/10.2214/ajr.171.3.9725301.

    Article  CAS  PubMed  Google Scholar 

  26. Engelaere C, Poncelet E, Durot C, Dohan A, Rousset P, Hoeffel C. Pelvic MRI: Is Endovaginal or Rectal Filling Needed? Korean J Radiol 2018;19(3):397-409 (In eng). https://doi.org/10.3348/kjr.2018.19.3.397.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Brown MA, Mattrey RF, Stamato S, Sirlin CB. MRI of the female pelvis using vaginal gel. AJR Am J Roentgenol 2005;185(5):1221-7 (In eng). https://doi.org/10.2214/ajr.04.1660.

    Article  PubMed  Google Scholar 

  28. Kataoka M, Kido A, Koyama T, et al. MRI of the female pelvis at 3T compared to 1.5T: evaluation on high-resolution T2-weighted and HASTE images. J Magn Reson Imaging 2007;25(3):527–34 (In eng). https://doi.org/10.1002/jmri.20842.

  29. Jeong SY, Park BK, Choi CH, et al. Utility of 3T MRI in Women with IB1 Cervical Cancer in Determining the Necessity of Less Invasive Surgery. Cancers (Basel) 2022;14(1) (In eng). https://doi.org/10.3390/cancers14010224.

  30. Murbach M, Cabot E, Neufeld E, et al. Local SAR enhancements in anatomically correct children and adult models as a function of position within 1.5 T MR body coil. Prog Biophys Mol Biol 2011;107(3):428-33 (In eng). https://doi.org/10.1016/j.pbiomolbio.2011.09.017.

    Article  PubMed  Google Scholar 

  31. Pediaditis M, Leitgeb N, Cech R. RF-EMF exposure of fetus and mother during magnetic resonance imaging. Phys Med Biol 2008;53(24):7187-95 (In eng). https://doi.org/10.1088/0031-9155/53/24/012.

    Article  CAS  PubMed  Google Scholar 

  32. Balleyguier C, Fournet C, Ben Hassen W, et al. Management of cervical cancer detected during pregnancy: role of magnetic resonance imaging. Clinical imaging 2013;37(1):70-6 (In eng). https://doi.org/10.1016/j.clinimag.2012.04.004.

    Article  PubMed  Google Scholar 

  33. Rasmussen PE, Nielsen FR. Hydronephrosis during pregnancy: a literature survey. Eur J Obstet Gynecol Reprod Biol 1988;27(3):249-59 (In eng). https://doi.org/10.1016/0028-2243(88)90130-x.

    Article  CAS  PubMed  Google Scholar 

  34. Mansoori B, Khatri G, Rivera-Colón G, Albuquerque K, Lea J, Pinho DF. Multimodality Imaging of Uterine Cervical Malignancies. AJR Am J Roentgenol 2020;215(2):292-304 (In eng). https://doi.org/10.2214/ajr.19.21941.

    Article  PubMed  Google Scholar 

  35. Dappa E, Elger T, Hasenburg A, Düber C, Battista MJ, Hötker AM. The value of advanced MRI techniques in the assessment of cervical cancer: a review. Insights into imaging 2017;8(5):471-481 (In eng). https://doi.org/10.1007/s13244-017-0567-0.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Prola-Netto J, Woods M, Roberts VHJ, et al. Gadolinium Chelate Safety in Pregnancy: Barely Detectable Gadolinium Levels in the Juvenile Nonhuman Primate after in Utero Exposure. Radiology 2018;286(1):122-128 (In eng). https://doi.org/10.1148/radiol.2017162534.

    Article  PubMed  Google Scholar 

  37. Spencer JA, Tomlinson AJ, Weston MJ, Lloyd SN. Early report: comparison of breath-hold MR excretory urography, Doppler ultrasound and isotope renography in evaluation of symptomatic hydronephrosis in pregnancy. Clinical radiology 2000;55(6):446-53 (In eng). https://doi.org/10.1053/crad.2000.0443.

    Article  CAS  PubMed  Google Scholar 

  38. De Santis M, Straface G, Cavaliere AF, Carducci B, Caruso A. Gadolinium periconceptional exposure: pregnancy and neonatal outcome. Acta Obstet Gynecol Scand 2007;86(1):99-101 (In eng). https://doi.org/10.1080/00016340600804639.

    Article  PubMed  Google Scholar 

  39. Kinkel K, Ariche M, Tardivon AA, et al. Differentiation between recurrent tumor and benign conditions after treatment of gynecologic pelvic carcinoma: value of dynamic contrast-enhanced subtraction MR imaging. Radiology 1997;204(1):55-63 (In eng). https://doi.org/10.1148/radiology.204.1.9205223.

    Article  CAS  PubMed  Google Scholar 

  40. Hricak H, Swift PS, Campos Z, Quivey JM, Gildengorin V, Göranson H. Irradiation of the cervix uteri: value of unenhanced and contrast-enhanced MR imaging. Radiology 1993;189(2):381-8 (In eng). https://doi.org/10.1148/radiology.189.2.8210364.

    Article  CAS  PubMed  Google Scholar 

  41. Alcázar JL, Arribas S, Mínguez JA, Jurado M. The role of ultrasound in the assessment of uterine cervical cancer. J Obstet Gynaecol India 2014;64(5):311-316 (In eng). https://doi.org/10.1007/s13224-014-0622-4.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Woitek R, Prayer D, Hojreh A, Helbich T. Radiological staging in pregnant patients with cancer. ESMO Open 2016;1(1):e000017 (In eng). https://doi.org/10.1136/esmoopen-2015-000017.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Vandecaveye V, Amant F, Lecouvet F, Van Calsteren K, Dresen RC. Imaging modalities in pregnant cancer patients. Int J Gynecol Cancer 2021;31(3):423-431 (In eng). https://doi.org/10.1136/ijgc-2020-001779.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Leyendecker JR, Gorengaut V, Brown JJ. MR imaging of maternal diseases of the abdomen and pelvis during pregnancy and the immediate postpartum period. Radiographics 2004;24(5):1301-16 (In eng). https://doi.org/10.1148/rg.245045036.

    Article  PubMed  Google Scholar 

  45. Rohwer AC, Khondowe O, Young T. Antispasmodics for labour. Cochrane Database Syst Rev 2013;2013(6):Cd009243 (In eng). https://doi.org/10.1002/14651858.CD009243.pub3.

  46. Ackermann S, Gehrsitz C, Mehlhorn G, Beckmann MW. Management and course of histologically verified cervical carcinoma in situ during pregnancy. Acta Obstet Gynecol Scand 2006;85(9):1134-7 (In eng). https://doi.org/10.1080/00016340600555926.

    Article  CAS  PubMed  Google Scholar 

  47. 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):67-9 (In eng). https://doi.org/10.1016/s0301-2115(02)00058-1.

    Article  PubMed  Google Scholar 

  48. Karam A. Cervical cancer in pregnancy. Uptodate Oct 18, 2021 (https://www.uptodate.com/contents/cervical-cancer-in-pregnancy).

  49. Hammond C. Second-trimester pregnancy termination: Induction (medication) termination. Uptodate. Available from: https://www.uptodate.com/contents/second-trimester-pregnancy-termination-induction-medication-termination?topicRef=4805&source=see_link2022.

  50. 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.e1-5 (In eng). https://doi.org/10.1016/j.ajog.2015.02.022.

    Article  CAS  PubMed  Google Scholar 

  51. Zagouri F, Sergentanis TN, Chrysikos D, Bartsch R. Platinum derivatives during pregnancy in cervical cancer: a systematic review and meta-analysis. Obstet Gynecol 2013;121(2 Pt 1):337-343 (In eng). https://doi.org/10.1097/AOG.0b013e31827c5822.

    Article  CAS  PubMed  Google Scholar 

  52. Van den Broek NR, Lopes AD, Ansink A, Monaghan JM. "Microinvasive" adenocarcinoma of the cervix implanting in an episiotomy scar. Gynecol Oncol 1995;59(2):297-9 (In eng). https://doi.org/10.1006/gyno.1995.0025.

    Article  PubMed  Google Scholar 

  53. Tewari K, Cappuccini F, Gambino A, Kohler MF, Pecorelli S, DiSaia PJ. 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):1529–34 (In eng). https://doi.org/10.1002/(sici)1097-0142(19980415)82:8<1529::aid-cncr15>3.0.co;2-6.

  54. Schneider A, Erdemoglu E, Chiantera V, et al. Clinical recommendation radical trachelectomy for fertility preservation in patients with early-stage cervical cancer. Int J Gynecol Cancer 2012;22(4):659-66 (In eng). https://doi.org/10.1097/IGC.0b013e3182466a0e.

    Article  PubMed  Google Scholar 

  55. Li J, Wu X, Li X, Ju X. Abdominal radical trachelectomy: Is it safe for IB1 cervical cancer with tumors ≥ 2 cm? Gynecol Oncol 2013;131(1):87-92 (In eng). https://doi.org/10.1016/j.ygyno.2013.07.079.

    Article  PubMed  Google Scholar 

  56. Lintner B, Saso S, Tarnai L, et al. Use of abdominal radical trachelectomy to treat cervical cancer greater than 2 cm in diameter. Int J Gynecol Cancer 2013;23(6):1065-70 (In eng). https://doi.org/10.1097/IGC.0b013e318295fb41.

    Article  PubMed  Google Scholar 

  57. Halaska M, Robova H, Pluta M, Rob L. The role of trachelectomy in cervical cancer. Ecancermedicalscience 2015;9:506 (In eng). https://doi.org/10.3332/ecancer.2015.506.

    Article  PubMed  PubMed Central  Google Scholar 

  58. Koliopoulos G, Sotiriadis A, Kyrgiou M, Martin-Hirsch P, Makrydimas G, Paraskevaidis E. Conservative surgical methods for FIGO stage IA2 squamous cervical carcinoma and their role in preserving women's fertility. Gynecol Oncol 2004;93(2):469-73 (In eng). https://doi.org/10.1016/j.ygyno.2004.02.002.

    Article  PubMed  Google Scholar 

  59. Lakhman Y, Akin O, Park KJ, et al. Stage IB1 cervical cancer: role of preoperative MR imaging in selection of patients for fertility-sparing radical trachelectomy. Radiology 2013;269(1):149-58 (In eng). https://doi.org/10.1148/radiol.13121746.

    Article  PubMed  Google Scholar 

  60. Elit L, Fyles AW, Oliver TK, Devries-Aboud MC, Fung-Kee-Fung M. Follow-up for women after treatment for cervical cancer. Curr Oncol 2010;17(3):65-9 (In eng). https://doi.org/10.3747/co.v17i3.514.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  61. Pedra Nobre S, Mazina V, Iasonos A, et al. Surveillance patterns of cervical cancer patients treated with conization alone. Int J Gynecol Cancer 2020;30(8):1129-1135 (In eng). https://doi.org/10.1136/ijgc-2020-001338.

    Article  PubMed  Google Scholar 

  62. Ries LAG HD, Krapcho M, et al. SEER Cancer Statistics Review, 1975 to 2003. National Cancer Institute, Bethesda, MD 2006.

  63. 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 (In eng). https://doi.org/10.1093/annonc/mdi084.

    Article  CAS  PubMed  Google Scholar 

  64. Sood AK, Sorosky JI, Mayr N, Anderson B, Buller RE, Niebyl J. Cervical cancer diagnosed shortly after pregnancy: prognostic variables and delivery routes. Obstet Gynecol 2000;95(6 Pt 1):832-8 (In eng). https://doi.org/10.1016/s0029-7844(00)00789-4.

    Article  CAS  PubMed  Google Scholar 

  65. Cliby WA, Dodson MK, Podratz KC. Cervical cancer complicated by pregnancy: episiotomy site recurrences following vaginal delivery. Obstet Gynecol 1994;84(2):179-82. (In eng).

    CAS  PubMed  Google Scholar 

  66. Copeland LJ, Saul PB, Sneige N. Cervical adenocarcinoma: tumor implantation in the episiotomy sites of two patients. Gynecol Oncol 1987;28(2):230-5 (In eng). https://doi.org/10.1016/0090-8258(87)90219-8.

    Article  CAS  PubMed  Google Scholar 

  67. Khalil AM, Khatib RA, Mufarrij AA, Tawil AN, Issa PY. Squamous cell carcinoma of the cervix implanting in the episiotomy site. Gynecol Oncol 1993;51(3):408-10 (In eng). https://doi.org/10.1006/gyno.1993.1313.

    Article  CAS  PubMed  Google Scholar 

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

    CAS  PubMed  Google Scholar 

  69. Johansson ALV, Fredriksson I, Mellemkjaer L, et al. Cancer survival in women diagnosed with pregnancy-associated cancer: An overview using nationwide registry data in Sweden 1970-2018. Eur J Cancer 2021;155:106-115 (In eng). https://doi.org/10.1016/j.ejca.2021.07.008.

    Article  PubMed  Google Scholar 

  70. Pettersson BF, Andersson S, Hellman K, Hellström AC. Invasive carcinoma of the uterine cervix associated with pregnancy: 90 years of experience. Cancer 2010;116(10):2343-9 (In eng). https://doi.org/10.1002/cncr.24971.

    Article  PubMed  Google Scholar 

  71. Dalrymple JL, Gilbert WM, Leiserowitz GS, et al. Pregnancy-associated cervical cancer: obstetric outcomes. J Matern Fetal Neonatal Med 2005;17(4):269-76 (In eng). https://doi.org/10.1080/14767050500123962.

    Article  PubMed  Google Scholar 

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Nguyen, T., Nougaret, S., Castillo, P. et al. Cervical cancer in the pregnant population. Abdom Radiol 48, 1679–1693 (2023). https://doi.org/10.1007/s00261-023-03836-x

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