Cervical cancer in pregnancy

Question 1

Biopsy of a pregnant woman’s cervix abnormality confirms SCC. Outline your management:

Answer 1

Staging:

• Physical exam: tumour, uterus, vagina, parametria, groin, RUQ and subclavicular nodes.
• EUA if awake exam suboptimal.
• CXR: pulmonary mets.
• Renal tract ultrasound or pelvic MRI.
• MRI abdo/pelvis.
• Laparoscopic lymphadenectomy
• Bloods: FBC, U&Es, LFTs

General management:

• Refer to gynaecology oncology.
• MDT: high risk obstetrics, gynae onc, anaesthetists, neonatologists, SW
• Offer option of TOP and manage as non-pregnant.

Gestation specific (3rd trimester) management:

• Stage IA1-1B1: delay until PP
• Stage IB1 or higher: neoadjuvant chemotx

Gestation specific (<3rd trimester) management

• Stage IA1: definitive tx with cone +/- prophylactic cerclage.
• Stage IA2-IB1: lap PLND and if node negative for cone or simple trachelectomy.

Obstetric mgmt:

• Serial growth scans
• MoD: Caesarean section (may need to be classical to avoid tumour)