The document discusses the management of cervical cancer during pregnancy, highlighting imaging techniques and treatment options based on the gestational age and cancer stage. It addresses the safety of various diagnostic methods, the impact of pregnancy on disease progression, and the considerations for delivery methods. Key conclusions include the importance of antenatal checkups for early detection and tailored treatment strategies depending on the progression of the disease and the stage of pregnancy.

1. CA CERVIX PREGNANCY

9. Imaging
CECT Dose allowed to fetus is 10-15cGY Pavlidis NA. co existence of
pregnancy and malignancy.
Oncologist.2002;7(4) Dose of 1 ct scan is just 1 cGY, so it canbe done
USG/MRI To assess the tumour Size, adjacent organs(parametria/blad
der/rectum), LymphNode metastasis Method of choice for staging in
pregnant women

10. Treatment
• precursor lesions Monitor 3-6 mnthly during pregnancy using cytology and
colposcopy Re-evaluate 6-8wks after delivery using same methods. Biopsy if
suscpicion. Low grade lesions Regress 48-62% Unchanged 29-38% Progression to
severe lesions is infrequent during pregnancy (6%) Vlahos G, Rodolakis A.
conservative management of CIN 2-3 in pregnancy. Gynecol Obstet
Invest.2002;54(2)
• – invasive Ca cervix depends on Gestational age at time of diagnosis Stage of
disease and size of lesion Pts wish to maintain pregnancy and fertility
• Microinvasive Ca cervix (Ia1) Colposcopy every 2 months during pregnancy Re-
evaluate at 6wks after delivery with cytology & colposcopy Biopsy if suspicion
Simcock B, Shafi M. Invasive cancer of the cervix. Obs, Gynecol, reproductive
medicine. 2007;17(6).

11. Invasive ca cervix  No evidence that pregnancy accelerates disease
progression Survival doesn`t depend on trimester at diagnosis
 
Postponing treatment for fetal maturity doesn`t affect recurrence rate
(5%) Jacobs IA, Chang CK, Salti GI. Coexistence of pregnancy and cancer.
Am Surg.2004;70(11 Traen K, Svane D et al. stage Ib cervical cancer
during pregnancy. Eur J Gynaecol Oncol.2006;27(6)
Invasive carcinoma Ia2, Ib, Iia diagnosed at < 20wks gestational age
Immediate and definite treatment Radical Hysterectomy (fetus in situ)+
B/L Pelvic Lymphadenectomy EBRT which leads to spontaneous abortion
or MTP( if reqd) + brachytherapy Complications – vaginal fibrosis, cystitis,
enteritis

12. • 17. Classical Cesarian section + RH + B/L PLND In Locally advanced
cases – Neoadjuvant chemotherapy (cisplatin) followed by surgery
Chemotherapy should be avoided in 1st trimester due to fetal
malformations In other trimesters it may cause Low birth weight
(40%), Prematurity, IUGR, intrauterine death Chemo is avoided after
35 wks as delivery may occur in immunosupressed state If diagnosed
between 28- 34 wks – corticosteroids given for fetal lung maturity
before definitive t/t Invasive carcinoma Ia2, Ib, IIa > 20wks Cardonick
E, Iacobucci A. use of chemotherapy during pregnancy. Lancet Oncol.
2004;5(5).

13. • 18. Invasive carcinoma – IIb, III, IV Rare during pregnacy Immediate
t/t CT(cisplatin) +RT Adding chemo increases 5yr survival by 12% Van
Calsteren K, Vergote I, Amant F. Cervical neoplasia during pregnancy;
diagnosis, management and prognosis. Best Pract Res Clin Obstet
Gynecol. 2005;19(4)

14. • 19. Fertility preservation Oocyte cryopreservation – standard
treatment but delays t/t by 6 wks Ovary cryopreservation – upcoming
Ovary transposition to areas far from site of RT allows subsequent
retreival of oocyte for IVF Covens AL, van der Putten HW, Fyles AW.
Laparoscopic ovarian transposition. Eur J Gynecol Oncol.1996;17(3)
• 20.

15. • Route of delivery Choice is based on type and grade of lesion Vaginal
delivery is safe in precursor lesion as it may also lead to regression In
Advanced lesions cesarean is preferred
• 21. Vaginal delivery Preferred in - Ia1 -CIS -microinvasion <3mm ?
Promotes disease progression by lymphovascular dissemination ?
Implantation at episotomy site Ceasarian section Preferred in advanced
cases as bleeding/laceration/obstructio n of birth canal may occur in
vaginal delivery Increase hospital stay Increased risk of neonatal
prematurity Increase mortality Increase cost Route of delivery
• 22.

16. • Prognosis – maternal Diagnosed usually in early stages Better than
non pregnant ca cervix -prognosis is Not affected if postponed for
fetal lung maturity
• Prognosis - fetal Acc. To gestational age and type of t/t Increase
neonatal morbidity & mortality may occur due to LBW, IUGR
Chemotherapy may cause toxic effect on fetus

17. Conclusion
• Antenatal checkup provides opportunity for early detection Precursor
& microinvasive lesions can be monitored and managed postpartum
Invasive lesions
• <20wks – immediate and definitive t/t
• >20wks – may wait for fetal lung maturity followed by delivery and
definitive treatment