Cervical cancer in pregnancy: diagnosis, staging and treatment TOG 2021

Question 1

Most common gynaecological cancer in pregnancy? How common /10,000

Answer 1

Cervical cancer
1-2/10,000

Question 2

How to managed abnormal bleeding in Cx in pregnancy

Answer 2

Speculum - if Cx appears abnormal → Colp

In invasive disease suspected, biopsy can be taken. Loop Dx CIN cannot exclude invasion.

Risk haemohorrage of diathermy is 25%

Question 3

What to do for
1) Routine smear recall in prengnay/ routine TOC?

2) TOC for cGIN, CIN2/3, with uncertain margins?

Answer 3

1) Routine smear recall in prengnay/routine TOC - delay 3 months PP

2) TOC for cGIN, CIN2/3, with uncertain margins? Cytology during pregnancy

Question 4

Does pregnancy itself effect cervical lesion or risk of becoming invasive?

Answer 4

No

Question 5

What is the first line imaging for staging in cervical cancer in pregnancy?

Answer 5

MRI, no contrast 1st line

CXR for lung mets

Question 6

After what gestation is node resection not advised?

Answer 6

Nodal resection not advised after 22/40

SLN biopsy not recommended in pregnancy.

Question 7

What is the management for stage 1a cancers (stromal invasion <3mm)

Answer 7

Cone Bx between 14-20 weeks.

Question 8

After cone Bx, can still aim for VD?

Answer 8

Yes

Question 9

What is the risk of pelvic lymph nodes with Stage 1a1 and 1a2 cervical caner?

Answer 9

Stage 1a1 (<3mm): <1%
Stage 1a2 3-5mm: 3-6%

Question 10

Management of 1A2 and 1B1 in prengnancy

Answer 10

1a2: 3-5mm stomal invasion
1b1: >5mm, <2cm in diameter

< 22 weeks offer PLND
If +ve - TOP, if continue neoadjuvant chemotherapy (NACT) after 1st trimester
If -ve Tracehelctomy or delay Tx until after delivery.

> 22 weeks - NACT/Delay

Question 11

Following AN trachelectomy risk of preterm delivery?

Answer 11

20-30%
Serial USS for cerival length 16-24 weeks

Question 12

Management of stage 1B2 in pregnancy

Answer 12

1B2: >3mm stomal invasion, diameter 2-4cm.

< 22 weeks:
Offer TOP with RAD + pelvic lymphdectomy
If continue: LLETZ/Tracehlectomy, NACT.

> 22weeks:
NACT until fetal maturation
C/S, radial hysterectomy + pelvic node dissection.

Question 13

How to manage stage 1B3 and above in pregnancy>

Answer 13

1B3 >3mm stromal, >4cm but confirmed to Cx

< 22 weeks: Offer TOP, if continue NACT

> 22 weeks: NACT, DTAD
Delivery LSCS + surgical or radial chemoradation (depending on stage & response to chemo)

Question 14

Risk of chemotherapy in 1st trimmest to major malformations

Answer 14

10-20%
Considered sage >14 weeks

Question 15

Which chemotherapies used cervical cancer in pregnancy

Answer 15

Carboplatin and paclitaxel based on actual weight
No recommnedned > 35 weeks
Stop 3 weeks before delivery

Question 16

Which women will require radiotherapy after delivery?

Answer 16

> 1B3
Will not support pregnancy again after radical pelvic radiotherapy

Question 17

If delaying treatment when should delivery be made?

Answer 17

34-36weeks
Earlier if best interests for mother

Question 18

Risk of vaginal delivery

Answer 18

Tumour can obstruct labour
Higher risk of tumour recurrence in episiotomy scars then CS scars.

Question 19

How long after chemo until can breast feed?

Answer 19

Minimum 14 days
Can cause neonatal leucopenia

Question 20

Which cancers metastasise to the placenta?

Answer 20

Melanoma
Haematopoietic
Lung cancers

Still advisable to send placenta