Cancer Cervical

ORIGINAL ARTICLE

Can We Diagnose Invasive Cervical Cancer During Pregnancy as Precise as in Nonpregnant Women?
Maternal and Perinatal Outcome in Pregnancies Complicated With Cervical Cancers
Kotaro Fukushima, MD, PhD, Shinji Ogawa, MD, PhD, Kiyomi Tsukimori, MD, PhD, Hiroaki Kobayashi, MD, PhD, and Norio Wake, MD, PhD

Abstract: Cervical cancer is the most common gynecologic malignancyassociated with pregnancy. However, there are no consensus guidelines that define the indications for or the optimal length of expectant management. The subjects were women who had a preexisting invasive cervical cancer or whose cancers were diagnosed during pregnancy or within 12 months after delivery. Thirty-nine consecutive women with cervical cancer, whose ages ranged from 20 to 40 years, werechosen as controls. We performed a retrospective chart review on the maternal profile and perinatal outcome and compared the clinical features between pregnancy- and nonYpregnancy-associated cervical cancer in patients. The percentage of asymptomatic cases in which cancer was detected in a routine Papanicolaou test was significantly higher in the pregnant patients. The percentage of induced pretermlabor or therapeutic abortions was 50%. Expectant management (mean length, 19.8 weeks) was chosen by 5 patients, and there were no cases of recurrence or death from disease. Seven subjects, including 5 patients whose diagnoses were changed from cervical intraepithelial neoplasm or condyloma to cancer, were managed as Bunexpected expectant[ because these subjects were not diagnosed as having stageIA/IB cancer during pregnancy. All of these subjects underwent vaginal delivery and included 2 patients with death from disease and lymph node recurrence. The percentage in which disease severity was underestimated was higher in pregnant patients. The option of therapeutic delay should be carefully discussed. Patient counseling should address the issue that risk may not be precisely estimated becauseof the possibility that disease severity may be underestimated during pregnancy. Key Words: Cancer-associated pregnancy, Cervical cancer, Expectant management, Diagnostic delay (Int J Gynecol Cancer 2009;19: 1439Y1445)

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ancer in the setting of pregnancy is a rare and nonspecific pregnancy complication. Several large population studies in western countries estimate the frequency of maternalcancers in
Department of Obstetrics and Gynecology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. Address correspondence and reprint requests to Kotaro Fukushima, MD, PhD, Department of Obstetrics and Gynecology, Graduate School of Medical Sciences, Kyushu University, Maidashi 3-1-1, Higashi-ku, Fukuoka 812-8582, Japan. E-mail: kfuku@gynob.med.kyushu-u.ac.jp. Copyright *2009 by IGCS and ESGO ISSN: 1048-891X DOI: 10.1111/IGC.0b013e3181a83ebf

pregnancy to be 0.068 to 1 per 1000 deliveries.1Y3 Cervical cancer is the most common gynecologic malignancy associated with pregnancy, with an incidence ranging from 1 per 1200 to 10,000 pregnancies.4 Although curing the patient is paramount, there exists a dilemma regarding whether the pregnancy should be continued untilthe fetus is viable. However, there are no consensus guidelines that define the indications for or the optimal length of expectant management.4Y6 In addition, the frequency of cervical intraepithelial neoplasm (CIN) and cervical cancers in young women is increasing.7 Thus, fertility-sparing treatments for cervical cancer are increasing in importance. In this study, we performed a retrospectivechart review of 24 cases of pregnancy-associated cervical cancer at our institution

International Journal of Gynecological Cancer

& Volume 19, Number 8, November 2009

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Copyright @ 2009 by IGCS and ESGO. Unauthorized reproduction of this article is prohibited.

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International Journal of Gynecological Cancer

& Volume 19, Number 8, November 2009

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