EP266 Cervical cancer in pregnancy – a clinical case. (1st November 2019)

• Record Type: Journal Article
• Authors: Branco, R; Diniz da Costa, T; Silva Pereira, J
• Is Part Of: International journal of gynecological cancer. Volume 29(2019)Supplement 4
• Page Start: A203
• Page End: A203
• Publication Date: 2019-11-01
• Subjects: Generative organs, Female -- Cancer -- Periodicals; 616.99465
• DOI: 10.1136/ijgc-2019-ESGO.327
• Languages: English
• ISSNs: 1048-891X

Abstract

Abstract : Introduction/Background: Cervical cancer is one of the most common malignancies in pregnancy and frequently diagnosed at an early stage. Vaginal bleeding is the most frequent symptom, but is dependent upon the clinical stage and lesion size. Methodology: Results: 29-year-old caucasian woman, 13 weeks pregnant (gravida 3 para 1), went to the emergency department due to vaginal bleeding. Pelvic examination revealed a polypoid cervical tumor, that was excised, sent to histologic review. The patient was referred to colposcopy unit. At 25 weeks, returned to the emergency department with the same symptoms. At this time, pelvic examination unveiled a cervical mass on the posterior lip of the cervix. A pelvic image confirmed a 3cm cervical lesion, without parametrial invasion. Colposcopic evaluation showed a suspicious high-grade disease, and excisional biopsy reported poorly differentiated invasive squamous cell carcinoma, identical to the first biopsy. Because the patient explicitly expressed the wish to preserve the pregnancy, an elective cesarean was performed at 34 weeks of gestation. A newborn was delivered with 2120g and Apgar index of 5/6/10. Five weeks after the delivery, a new colposcopic evaluation showed a suspicious high-grade disease, and the excisional biopsy revealed an high-grade squamous intraepithelial lesion. Laparoscopic radical hysterectomy with ovarian preservation and pelvic lymphadenectomy followed 1 moth later. Histological report disclosed a cervical squamous cell, with glandular differentiation and sarcomatoid carcinoma, margins free of disease, negative parametria and pelvic lymph nodes, compatible with FIGO stage IB1. The patient completed external radiation therapy, and now is under 6 months of follow-up. Conclusion: The illness trajectory and prognosis of cervical cancer are similar in pregnant and nonpregnant women. In early-stage cervical cancers, treatment delaying to minimize neonatal risks can be proposed under strict conditions: the patient wish to preserve the pregnancy and obstetrical and oncological favorable prognostic factors. Disclosure: Nothing to disclose.