Cervical cancer and pregnancy Flashcards
Cervical Cancer During Pregnancy
The most appropriate imaging modality in pregnancy is magnetic resonance imaging, when indicated.
Treatment for Stage I Disease
Observation
Radical Trey colectomy
Cone biopsy
The best time to do this procedure is during the second trimester for viability
Treatment of 1A2 and 1B disease in pregnancy
Laparoscopic or open lymph node assessment should be taken and performed at approximately 20 weeks of pregnancy.
In patients with out lymphatic spread waiting for fetal viability to initiate treatment is an option
Treatment of cervical cancer stage 1A2 and 1B
Patients with positive lymph nodes should be counseled toward immediate treatment.
Treatment for Stages II, III, and IV Disease Treatment during pregnancy
For patients with stage II or greater disease, waiting for viability is generally not acceptable.[4] The standard of care is curative intent chemotherapy and radiation therapy. This treatment is toxic to the fetus and without ovarian transposition will render the ovaries nonfunctional after treatment. Evacuation of the fetus should be performed before the initiation of radiation. When this is not possible, the radiation will generally cause a spontaneous abortion 3 to 5 weeks after initiating treatment.
Neoadjuvant Chemotherapy In pregnancy
Neoadjuvant chemotherapy has been offered to patients with locally advanced disease as a way to initiate treatment while maintaining the pregnancy.[1] Most chemotherapy agents can be initiated safely in the second trimester of pregnancy and beyond; mild growth restriction of the fetus is the most common side effect. Restriction of growth has been reported in a relatively small number of patients, and data is lacking on long-term outcomes for these women; as a result, this strategy should be considered with caution. Most of the patients in the reports underwent standard treatment (either surgery or radiation) after completion of the pregnancy.
